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Inspection on 26/07/06 for The Green Nursing Home (Hasland)

Also see our care home review for The Green Nursing Home (Hasland) for more information

This inspection was carried out on 26th July 2006.

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

There was a range of positive comments made by service users and relatives regarding the manager staff at the home. It was evident that service users felt able to approach the staff if they wished.

What has improved since the last inspection?

Since the last inspection there has been new washers and dryers purchased. The one requirement from previous related to the redecoration of a bedroom, the Manager reported that this had been completed.

What the care home could do better:

Care plans in the home require more individualisation and personalisation to ensure that staff have clear instructions on how to deliver care. Many records such as the monthly Providers visits and supervision records were scant in the detail recorded and had significant scope for improvement. Some health and safety issues were found at this visit such as unsecured cleaning products and no information regarding the assessment of risk from legionella.

CARE HOMES FOR OLDER PEOPLE Green, The Nursing Home (Hasland) 45 The Green Hasland Chesterfield Derbyshire S41 0LW Lead Inspector Bridgette Hill Key Unannounced Inspection 26th July 2006 09:00 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 Green, The Nursing Home (Hasland) DS0000002084.V303676.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. Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Green, The Nursing Home (Hasland) Address 45 The Green Hasland Chesterfield Derbyshire S41 0LW 01246 556321 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) The Green Nursing Homes Limited Christine Eluned Innes Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23rd November 2005 Brief Description of the Service: The Green Care Home is situated within the village of Hasland, close to the centre of Hasland, which has numerous shops, park and a church. The home provides nursing and residential care for 40 service users. The home is purpose built and is fully accessible. There are two lounges, the smaller of which is designated as a quiet lounge. There is also a separate dining room. Outside there is a well maintained garden with a seating area for service users. The fees charged at the home range from £298.20 - £513.00. There are additional costs for hairdressing, chiropody, and personal newspapers. Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced one, which took place over 7 hours. The focus of this inspection was to assess all key standards. A range of records was examined at this visit including a sample of service users care plans and a partial tour of the building conducted. Service users were spoken to individually and as group. Two relatives were spoken with and one staff member. The person in charge during this visit was the Manager Christine Eluned Innes (known as Eluned). What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 6 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 Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 7 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): 3,6 Service users needs were assessed by staff from the home prior to admissions being agreed. Documents relating to assessments require improved information re place/time of assessment and validation. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The care file of a recently admitted service user was examined. This confirmed that an assessment had been completed but the poor record keeping made it impossible to know whom, where and when the assessment was completed. The Manager said that herself or the Deputy Manager assessed all prospective service users and the assessment examined had taken place in the service users home prior to admission. It was noted that some service users used the home for respite care prior to being admitted on a full time basis. Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 8 The home does not offer intermediate care as defined by National Minimum Standards 6. Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Care plans in place lacked personalisation and details of care delivery instructions. One area of assessed need was not documented potentially adversely affecting the care delivery for the service user. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: A sample of three service users care files were examined to assess how standards were being met. Some were assessed in part to explore different aspects. The care plans in place were found to be variable in the content. Some risk assessments were included in the care files including tissue viability and moving and handling. Reviews were untaken of needs but using a separate format that did not necessarily detail the actual plan of care. Many general terms such as ‘give care as required’ were used and it was not possible to know what care was assessed as being needed. The daily log notes Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 10 also recorded on occasions ‘care given as plan’ but as the plan did not detail specifically what care was required it is not known what care was given. Essentially the care plans lacked detail and personalisation on service users abilities, needs and preferences. Some assessed needs were not documented or care planned for example one service user had a high risk relating to tissue viability but there was not a plan of care for this. The home accessed the services of 8 GP practices. There was evidence in care files of visits by GP’s being recorded. Service users had also seen the private chiropodist who visited the home 8 weekly and an optician who provided a regular service to the home. District nurses provided care to service users who were assessed as requiring personal care only. The storage and administration of medicines was examined at his visit. A monitored dosage system was used at the home. Photographs of service users were on medication administration records to aid identification. Policies and procedures require updating to reflect the changes in disposal of medications. Records of medicines disposed of were kept. An up to date drug reference book was available. Eye drops had been dated on opening. Discussions with the Manager were held re communal use of some medications after this was found to be included in the homes procedure documents. This is not acceptable practice as each prescribed item belongs to the person for whom it is dispensed and communal usage is not acceptable. Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 11 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): 12,13,14,15 Whilst some activities do occur these appear to be unstructured, irregular and are not documented or offered in response to assessed needs. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: All staff were said to have responsibility for the organisation of activities. It was frequently said throughout the day that staff had little time, were very busy and had little opportunity to organise activities. Hence there was no structure to activities in house and the main social events were external entertainers. The range of activities offered included bingo, sing-alongs, progressive exercise, 6 monthly visits by the choral society, and a visit from the local Church approximately 2 monthly for a church service. Few of the activities offered had any active participation element to them and were passive in nature. Two out of three care plans did not detail a plan of care on how social needs were to be met. The daily log entries did not record that any service user had participated in any social activity. Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 12 Some social histories were documented but variable in the content recorded. These did not appear to be considered when planning care and social needs. A library of large print books was available and one service user accessed talking books. Whilst the home is close to local shops and services on discussion it was said that there were rarely times when service users had the opportunity to go out. Staffing levels were attributed to being a barrier to this. Some service users did go out with their families. There were a number of visitors to the home on the day of the visit and they said they were always made welcome by staff. A choice of meal was routinely offered and the day’s menu was displayed in the dining room in large letters. One service user said if they didn’t like any of the choices they would ask for an alternative. Despite some service users spending the majority of the time in their room most service users said they went to the dining room for meals. General comments received were the quality of the food served was good. Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Service users appeared to be empowered to voice any concerns and documents demonstrated appropriate responses. A procedure for handling allegations of abuse must be developed and the planned Protection of vulnerable adults training must be completed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The complaints procedure was on display in the entrance. This gave the details of the Commission for Social Care Inspection address. No complaints have been received about the home at the Commission for Social Care Inspection. The pre inspection questionnaire indicated that one complaint had been received at the home. Records for this were examined. The complaint was regarding missing property and records indicated that this has been investigated and written responses given to the complainant well within the timescale of 28 days. Service users said that if they had any problems they felt they could voice them and expressed a confidence that they would be sorted out. The Protection of vulnerable adults procedure in the home was the locally agreed Derbyshire policy. There was not an in house policy or procedure which described any other actions to be taken such as the need to protect the service Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 14 user from any possible repetition of abuse once an allegation had been made and considering if any immediate help/input was required such as medical assistance or Police involvement. A policy and procedure must be drawn up to ensure staff are consistently aware of what action to take. Not all staff had received Protection of vulnerable adults training this was planned for September. Staff spoken to said they would feel confident about reporting any concerns they had. Staff had some knowledge of the principles of the whistle blowing policy but this was not extensive. Green, The Nursing Home (Hasland) DS0000002084.V303676.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): 19,26 Service users were cared in a home which was well maintained and clean. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: A partial tour of the environment was undertaken at this visit. The communal areas, some bedrooms, some bathrooms, some toilets and the laundry was visited. There is a large entrance hall in the home leading to a small lounge with patio doors to the garden area. There was also a larger lounge and adjacent large dining area. Some service users said they did not use the communal areas very much and preferred to spend time in their own room. A garden area was available which was well maintained and had seating. Some service users were observed sat out enjoying the sun. Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 16 All areas of the home were found to be clean. All visitors spoken to said there were not any odours at the home. The laundry area was viewed. Two new washers and dryers were in place. The washers included a ‘medical’ sluicing programme. The laundry area was not lockable and there were chemical cleansers openly being stored. A method of ensuring these are securely stored must be found. One relative said that there were occasions when they had found stains had not been removed from clothing during the laundering process. Green, The Nursing Home (Hasland) DS0000002084.V303676.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): 27,28,29,30 Service users were care for a staff group who were knowledgeable regarding there assessed needs. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The occupancy of the home on the day of the visit was 39 service users. 15 service users required nursing care, 24 service users required personal care only. The typical staffing levels at the home were 1 nurse on duty for all shifts with 6 care staff for morning shifts, 5 care staff in the afternoons. At nights there was one qualified nurse and 3 care staff. Staff spoken to at the home appeared to have a good knowledge of the service users including their ‘peculiarities’ and preferences. There was reports that the staff team was a friendly one and it was observed that all visitors were warmly greeted on arrival. It was considered that there was a significant number of visitors to the home during the visit. From the pre inspection questionnaire there were 27 care staff employed at the home of which 15 held NVQ (National Vocational Qualification) level 2 in care qualifications. Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 18 A sample of staff personnel files were examined. These indicated that there were occasions where staff had been commenced in post without a Criminal Records Bureau check being undertaken by the home. Previous Criminal Records Bureau checks had been accepted which had been completed in alternative employment – this is not acceptable. In these circumstances a Protection of vulnerable adults First check had also not been completed. Some staff files also did not contain proof of identity or photographs. A requirement is listed regarding recruitment checks. Training records were examined. It was noted on the staff rota that training for Dementia and continence was planned for the coming weeks. Protection of vulnerable adults training was being planned for September 2006. There was a staff member who was a moving and handling trainer and all updates had been completed. Other training completed included fire safety, infection control, and health and safety. Green, The Nursing Home (Hasland) DS0000002084.V303676.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): 31,33,35,37,38 Whilst managerial processes were in place there appeared to be a minimalist approach to recording. Some documents lacked any depth or quality to the information therefore it is not possible to assess them as anything more than adequate and there was significant scope to improve these. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: The Registered Manager had been in post for 7 years at the home and had completed a relevant managerial qualification. Discussions with all staff, service users and relatives positive comments were made about the Manager. Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 20 There was some documented monthly visit records from the Registered Provider however these were found to be inadequate in assessing the quality of the service. The total comments for one recent month were ‘No comments, No problems, Nil to report’. These comments give no indication of the assessment of the quality of care (positive or negative) or detailed how these comments were arrived at. It is recommended that more detail is included to demonstrate how the quality of care is being monitored. The Manager completed an annual audit tool annually. This considered a wide range of aspects but was brief in the recording of the findings generally giving a score out of 10.. An annual quality assurance survey was completed this was last done in November 2005. Questionnaires were sent out to all service users and where they were unable to complete these they were passed to families. Surveys were also sent out to GP’s to gain professional feedback. A summary of the responses had been completed. The general feedback on forms was found to be good. The style of the form however was in a small typeface and there was scope to improve the size of typeface or add pictures to improve its accessibility with sight difficulties or impaired ability to understand sentences. One relative said that the home had a good reputation locally. Some monies are stored on service users behalf in the home for safekeeping. Records for these were examined. Transactions were recorded typically with one signature from the Manager it is recommended that for protection of the service users and the Manager two signatures are used to evidence the balance. Where monies had been given in relatives were asked to sign the sheet. For some service users their personal allowance was paid directly into the Providers account. It was evident from the dates of the money transfers that this was done infrequently and service users did not have access to all their monies. The pre inspection questionnaire recorded that the Provider/Manager does not act as an appointee for any service user. The last staff meeting had been held one year ago. There had not been any service users meetings for a number of years. Staff supervision records were examined. These confirmed that staff were receiving documented supervision. The records were however brief and often limited to describing what training had been completed. Service users records were being held openly on shelving in an unlocked office. This was near the reception area, which was accessible by any person from outside the home. Records must be held securely to prevent unauthorised access. Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 21 Information taken from the pre inspection questionnaire confirmed that most service checks had been completed. There was no information given for legionella on the questionnaire. The Manager could not locate a legionella risk assessment. A document was found from the Health and Safety Executive requesting this. It is a requirement that a risk assessment is in place. There was some checking of water temperatures in the home and some of these were found to be low – as little as 36ºc but no action had seemingly been taken to address this. There was also no information on the storage temperature of hot and cold water; this is required to ensure there is minimum risk of legionella. Accidents and incidents were recorded and service users log records indicated that where an accident was included a corresponding accident report form was available. Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 2 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 2 3 2 2 Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care plans must be sufficiently detailed to ensure all staff have clear instructions on how to deliver care to the service user All medications must be used on a personal basis and only for the person for whom they were prescribed There must be a policy and procedure in place to ensure that any allegations of abuse are handled consistently in the home prior to accessing Social services Protection of vulnerable adults procedures All staff must receive training in the Protection of vulnerable adults Timescale for action 30/09/06 2 OP9 13 30/08/06 3 OP18 13 30/08/06 4 OP18 18 30/10/06 5 OP26 13 6 OP29 19 7 OP37 17 All chemical cleansers (including denture cleaning products) must 30/08/06 be securely locked away to prevent accidental ingestion Staff must not be confirmed in 30/08/06 post until all required checks and documents have been obtained as described by Schedule 2 All personal records must be held 30/08/06 securely in the home to prevent DS0000002084.V303676.R01.S.doc Version 5.2 Page 24 Green, The Nursing Home (Hasland) 8 OP35 13,20 9 OP38 23 unauthorised access in accordance with data protection principles A system must be implemented to ensure service users monies are transferred regularly and swiftly to service users from the Providers account A legionella risk assessment must be available and identified actions to reduce risks taken in accordance with the guidance given to the home by the Health and Safety Executive 30/08/06 30/09/06 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 2 3 Refer to Standard OP9 OP12 OP33 Good Practice Recommendations The drug disposal policy should be updated to reflect actual practice in the home Service users individual interests/assessed social needs must be recorded with a plan of care on how these are to be met Regulation 26 visits documented by the Provider should be expanded to fully indicate how the quality of care is assessed and detail positive or negative aspects found and detail how these are to addressed if this is required All financial transactions for service users monies should be checked and verified by a second person. This protects staff and the service user Staff supervision records should be expanded to improve documented discussions on the role of staff and philosophies of care 4 5 OP35 OP36 Green, The Nursing Home (Hasland) DS0000002084.V303676.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Green, The Nursing Home (Hasland) DS0000002084.V303676.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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