Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 16/08/05 for The Manor House Nursing Home

Also see our care home review for The Manor House Nursing Home for more information

This inspection was carried out on 16th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

The service offers a high standard of 24hr nursing care to service users requiring a range of specialist services. The team of staff are well trained, professional and very caring. Service users spoke of the staffs` kindness, patience and compassion shown towards them. They complemented the cook on her lovely meals and some spoke of the pleasure that the newly employed activity organiser had brought them.

What has improved since the last inspection?

The requirements made at the last visit were all completed to a high standard. The environment upgrades had been completed, and were much improved. The large lounge area to the rear of the home had been redesigned to include laminate flooring, various seating areas and a nurse`s station. The conservatory, which was also now being used, had a lovely dining area situated within it and also a seating area. The views from this area all look on to the spacious gardens and flowerbeds. A new patio area had been built with a walled edge on to the lawn.

What the care home could do better:

The bathrooms are still to be refurbished and the fixtures and fittings have been ordered. Completion should be in the near future.

CARE HOMES FOR OLDER PEOPLE The Manor House Nursing Home Hyde Lea Stafford Staffordshire ST18 9AT Lead Inspector Joanna Wooller Announced 16 August 2005 09.15am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Manor House Nursing Home Address Hyde Lea Stafford Staffordshire ST18 9AT 01785 241351 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hyde Lea Nursing Home Ltd Mrs Kathleen Ann Cleaver CRH 43 Category(ies) of PD - 43 registration, with number PD(E) - 43 of places TI - 4 The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1) Thirty one PD minimum 60 years on admission 2) 12 PD to be accommodated in designated unit of which six PD- may be intermediate care Date of last inspection 12 January 2005 Brief Description of the Service: Manor House is a 43-bed care home, which offers 24 hour nursing care.The house is in a rural area on the outskirts of Stafford town. It has a bus route close by. Set in its own grounds, the service users enjoy a very attractive view from all sides of the home. The home is owned by Hyde Lea Nursing Home Limited, and Managed by Mrs Kathleen Cleaver, a Registered Nurse with a wealth of knowledge and experience. A registered nurse is on duty 24 hours a day and the home is also staffed with well-trained carers and experienced ancillary staff. Four of the beds are registered for palliative care service users, 6 beds are designated to intermediate care services and 4 other beds are registered for service users between the age of 18 and 60yrs who have physical disabilities. The home is split on two levels with bedrooms upstairs and down. First floor access is available via two passenger lifts and stairs. There are several lounges within the home, at the rear of the building is a large airy lounge which has a smaller cosy lounge situated to the side of the area. The dining room is situated within the beautiful conservatory. There are 31 single and 2 double bedrooms. All bedrooms (except one) have en-suite facilities, which include WC and sink. The environment improvements have been completed to a high standard. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine announced visit was made on the 16th August 2005 @ 09.15hrs. The inspection was undertaken using the National Minimum Standards for Older People as a reference. The total time spent for the inspection, including pre and fieldwork, amounted to 9hrs. The registered care manager Kathy Cleaver was in the home accompanied by the provider Mr Chris Mullin. There were two-trained nurse on duty with five care assistants. The ancillary staff on duty included cook and one catering assistant, the laundress and two domestics. One maintenance person was in the home and three administrators. These staffing levels were adequate to meet the needs of current 34 service users in the home. The inspection included the following elements; A tour of the building, Observation and inspection of records relating to provision of care, Discussions with several service users, Discussions with the staff members on duty, Observation and sampling of other services provided such as catering and laundry, An inspection of the managerial aspects such as staffing issues, quality assurance and health & safety. Since the last inspection on 12th January 2005; there had been no changes to the management of the home, one complaint had been received by the CSCI and this had been concluded. No additional visits had been necessitated. It was clearly evident to the inspector that all aspects of care for individual service users had been well addressed. Service users were able to choose the home following a pre admission assessment and an invitation to visit the home. Service user plans had been well written, some being based on the community care plans completed by social workers. Health, personal and social care needs had been met and well documented. Privacy, dignity and choice aspects for service users were evidenced as being upheld. No incidents or reports of abuse of any kind had been received since the last inspection, and policies and procedures seen covered these issues. The home was evidenced as fit for purpose and was found to provide a safe environment for the service users and staff. A very homely atmosphere had been created, and the premises were exceptionally clean and tidy. Pleasant areas for service users were provided including; plenty of communal space, dining/activity space, bathing/toilet facilities, and bedrooms. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 6 Services and facilities, including catering and laundry, were more than adequately provided. Health and safety aspects had been given a high priority and no shortfalls were noted. Recruitment and retention of staff was good with little staff turnover. Staff training had been given a high priority, with induction training being followed by NVQ training or TOPPS foundation training, and care staff had received regular clinical supervision. The home was managed well by Mrs Cleaver, a qualified and competent care manager. General management aspects were good. Quality assurance was carried out at regular intervals, including internal care audits and service users satisfaction surveys. Records had been correctly filed and stored. Assurances were given regarding the positive financial viability of the home, and that suitable accounting/business procedures are adopted. The home is in the final stage of the refurbishment, which will include the planned installation of a shaft lift, alterations to existing bathrooms and installation of a reception area. There were no requirements or recommendations made, the team of dedicated staff have worked considerably well to achieve the standard of care and services that the home can now offer. What the service does well: What has improved since the last inspection? The requirements made at the last visit were all completed to a high standard. The environment upgrades had been completed, and were much improved. The large lounge area to the rear of the home had been redesigned to include laminate flooring, various seating areas and a nurse’s station. The conservatory, which was also now being used, had a lovely dining area situated within it and also a seating area. The views from this area all look on to the spacious gardens and flowerbeds. A new patio area had been built with a walled edge on to the lawn. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 7 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. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 Service users are only admitted following completion of a robust preadmission procedure. Intermediate care services are well established within the home. EVIDENCE: The documentation seen, and following a discussion with the service users and their representatives, the inspector evidenced that individuals had been assessed prior to admission and they had been enabled to make a choice about the home. All those involved had the opportunity to visit the home prior to choosing to stay. Several service users spoken to had visited the home, and had a meal prior to deciding to stay, and this was seen documented within the care plans. The community care plans provided by the social worker, as part of the individual needs assessment process, were seen within some service user plans. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 10 Service users confirmed that they had been fully involved and were in agreement with the assessments. The records seen and a discussion with the staff evidenced that care staff, individually and collectively, had the necessary experience and skills to meet the assessed needs of the current service users. Intermediate care service users had individual care files, stored in their own bedrooms. Services were in place to support the individuals in their rehabilitation to return home. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 to 11 The assessed health and personal care needs of service users had been well documented and were being met, with good standards of care being delivered. There was a safe system for the receipt, storage, administration and disposal of medicines. Individuals are treated with respect, privacy and dignity, during the caring process. EVIDENCE: The service user plans and associated documentation was well written, meaningful and reflected the current condition of residents. The documentation seen evidenced that health and personal care needs were being well met. Staff that were spoken to were aware of the aims and ethos of the home and felt they were trained to achieve the levels expected of them. NHS facilities and professionals including community nurses, medical consultants and clinical nurse specialists had all been accessed when required, and these events were seen recorded. A local GP practice and a local pharmacist support the home, and there is an excellent working relationship with them. Records of their visits and outcomes were seen documented. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 12 The medication administration procedure follows a robust procedure and no issues were noted. It was observed that a safe system was in place, and that the comprehensive medicines policy documentation seen was being complied with. During the inspection the inspector spoke to many service users who felt content with their life in the home and the care they received. It was observed by the inspector that the privacy and dignity of service users were being respected and there was very good interaction with all the staff. Care staff were seen knocking on doors before entering. Several service users told the inspector that they were very much at home and appreciated being treated with respect, and that the staff were very good. Many cards and letters were displayed that had been received from appreciate families for the care that had been given to their loved ones whilst at the home. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 to 15 Service users were satisfied with their lifestyle in the home, and they had been able to exercise choice and influence decisions affecting them. Contact had been maintained with relatives and friends of service users. Community contact was made available. Catering aspects were very good with balanced nutritious meals being served. Individual service users were given choice and preferences were documented. EVIDENCE: Several service users told the inspector that their views had been listened to, and that they had been able to influence some aspects of the running of the home e.g. mealtimes, menus. These comments had been documented along with the feed back from the service users and relatives’ questionnaires, and they had been acted upon. Contacts had been maintained, where possible, with relatives and friends and this was seen documented. Service users spoke of their visitors and their involvement with the home. A few visitors attended the home during this inspection and they were seen to interact with the staff well. Linda the newly employed activity organiser showed the inspector the activities folder, which evidenced the activities both inside and outside the home along with the individual records for each service user. Service users spoke of the The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 14 entertainment offered within the home and how much they had enjoyed the recent summer fete. When asked several service users spoke of their satisfaction with the lovely meals and the choices offered. The 4 weekly menus and the relevant catering records were examined and found to be in order. A recent environmental health inspection had been undertaken and minor issues identified had been rectified. The inspector evidenced that individual dietary requirements of the service users were being met. The records evidenced special diets were being catered for. The cook when asked said that fresh, good quality food from local suppliers was delivered on a weekly basis, the records seen confirmed this. The cook had been baking and preparing pastry, fresh vegetables and a variety of fruits were also seen. The mid day meal, which was a choice of chicken chasseur or cottage pie, was seen well presented and met all nutritional requirements. The kitchen assistant spoke to each service user on a daily basis to establish his or her choice of food for the next day, and this was also seen documented. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18 There was evidence that complaints are listened to and resolved. The home policies, procedures and staff training, protected residents from aspects of abuse. Legal rights are protected for each individual service user. EVIDENCE: On examination of the complaints procedure it was identified to be robust and in line with the relevant policy documentation. On discussion with staff and service users, the inspector evidenced that complaints or concerns were listened to and dealt with in the correct manner. Since the last inspection one complaint had been recorded and brought to the attention of this commission. This was now completed. Many ‘thank you’ and complimentary cards were seen from appreciative relatives. No incidents of neglect or abuse of any kind has been reported. The policy documentation seen, and a discussion with staff confirmed that service users are protected from all forms of abuse. The manager was arranging for a refresher course with regard to the vulnerable adults procedure. Documentation seen evidenced that the above issues relating to this standard had been discussed at length during staff induction, training and on-going supervision. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 to 26 The home provides a safe and well-maintained environment for individuals. The home was exceptionally clean and tidy, and had a very comfortable and friendly atmosphere. There is a need to finish the few remaining items that will complete the major upgrading work to the home. EVIDENCE: A tour of the building, and a check on the maintenance documentation, verified that the premises were fit for purpose, exceptionally clean and tidy. Suitable equipment is provided to accommodate and support the individuals’ mobility needs. Profile beds were now in place in all bedrooms to assist service users and staff with transfers. Hoists and bath hoists were sited throughout the home to assist manual handling procedures. The duty rosters evidenced that adequate ancillary staff were employed. Staff, when asked told the inspector of their knowledge on infection control, and was aware of the relevant COSHH documentation and adequate hand washing facilities was available throughout the home. The laundry facilities were seen to be fully compliant, and the installation of a new sluice (with disinfector) is planned. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 17 The records evidence that maintenance of the premises was now being given high priority. Painting and re-decorating had been tastefully completed to a high standard. Hot water temperature checks, and emergency lighting/fire alarm tests were seen up to date and correct. There are no outstanding issues known from the Fire Prevention or Environmental health departments. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 to 30 The assessed needs of service users had been met by an adequate number of suitably trained staff. Recruitment procedures had been correctly addressed which had contributed to the protection of service users. Staff training had been given a high priority. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 19 EVIDENCE: The duty rosters seen, and a discussion with the manager and the staff, evidenced that adequate numbers of staff had been on duty to meet the needs of the existing service users. Staffing levels were being maintained as set at the last increase in registered beds. Staffing rosters were checked and were in order. On each morning shift there are two trained nurses and five care assistants, on each afternoon shift there are two trained nurses and five care assistants and on the night shift there is one trained nurse and three carers. These levels are flexible to allow for increased levels should the individual dependencies increase, then staffing would also be increased. Adequate ancillary staff had been provided each week. Several service users stated that staff were available when they wanted them, and that the staff were capable. The records seen evidenced that 60 of care staff were trained to NVQ level 2 or above. The homes recruitment policy, procedures and documentation were examined and recruitment issues had been handled correctly. Staff had been subject to POVA/CRB comprehensive checks, and these were seen recorded. Staff asked stated that they had job descriptions and contracts of employment. Training had been given a high priority and the training records of individuals were seen. The records evidenced that care assistants had benefited from ‘in house’ and external training which had covered the needs of the registered client group. Staff told the inspector that they were encouraged to study. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 to 38 The home appeared to be well managed and quality assurance was in place. Financial aspects were correctly addressed and recorded with safeguards to residents. Health and safety issues had been given a high priority and managed well. EVIDENCE: Kathy Cleaver is a registered manager with the Commission for Social Care Inspection. She has achieved NVQ level 4 in management and she is also the NVQ assessor and Manual Handling trainer. She is also now registered on an Open University course for palliative care. The environment and ambiance promotes the ethos of the home, with the warmth and friendliness of all the staff. A check on the records and a discussion with both service users and representatives evidenced that all service users had the opportunity to handle their own finances and all service users and families had chosen to do so. Inventories of valuables and belongings brought into the home were seen recorded. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 21 From observations made, discussion with service users, and discussions with the manager and staff, it was evident that the home was being run in the interests of service users. Quality assurance, including feedback from service users and their representatives, was seen documented. Documentation seen evidenced that the views of visiting professionals had also been established, and included in the review process. No health and safety issues were noted during this inspection, including a tour of the home. The documentation seen for checks and examination of plant and equipment was all correct and up to date. The manager and staff spoken to confirmed that health and safety issues are given high priority. The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 4 x x 4 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 4 4 3 4 4 4 4 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 4 3 4 3 4 3 3 3 4 4 The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement There were no requirements made at this visit. 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. 1. Refer to Standard Good Practice Recommendations The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Manor House Nursing Home E51-E09 S22349 Manor House V239968 160805 Stage 4.doc Version 1.40 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!