Inspection on 02/08/06 for The Winsor Nursing Home

This inspection was carried out on 2nd August 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 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 Winsor Nursing Home 24/07/07

The Winsor Nursing Home 06/03/07

The Winsor Nursing Home 13/12/05

The Winsor Nursing Home 10/05/05

The Winsor Nursing Home 28/10/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Winsor Nursing Home 54 The Avenue Minehead Somerset TA24 5AW Lead Inspector Shelagh Laver Unannounced Inspection 2nd August 2006 10:30 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 Winsor Nursing Home DS0000061582.V306600.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 Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Winsor Nursing Home Address 54 The Avenue Minehead Somerset TA24 5AW 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) 01643 707870 Sanctuary Care Limited Mrs Amanda Susan Dorothy Ricketts Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One named person aged 45 - 64 years for General Nursing Care Three places for Respite Care for people aged 45 - 64 years, for a period of up to 28 days 13th December 2005 Date of last inspection Brief Description of the Service: The Winsor Nursing Home provides nursing care for 43 persons over the age of 60 years. The home is situated in Minehead, a short walk from the seafront. The accommodation is arranged over three floors serviced by a passenger lift. The accommodation is provided in 38 bedrooms that include 33 single en-suite rooms. The home is well adapted for the service user group. There are assisted bathrooms and disabled toilet facilities. There is a spacious communal dining room and three lounge areas. A Registered General Nurse is on duty at all times and links are made with a network of health services to meet service users’ needs. The home has been owned by Sanctuary Care Ltd. since 27th July 2004. The home has a block contract for 14 beds with Somerset Social Services. The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection took place over one day and was carried out by one inspector and a regulation manager. There had been a random inspection on 18th May 2006 and a visit to the home as part of a complaints investigation on 28th June 2006. Following the receipt of the Pre-inspection questionnaire on 19th May comment cards were sent to all service users in the home and their relatives. Comment cards were also sent to health and social care professionals. Ten service users and twelve relatives returned cards. The inspectors spoke with the manager and staff throughout the day of inspection. Service users were visited in their rooms during a tour of the premises. In addition to observations and evidence gathered during the visit to the home the inspectors reviewed and used information gained from the random inspection, complaint investigation, homes quality audit and Regulation 26 reports supplied by the area manager to assist them to make judgements about the service. What the service does well: Ten service users returned comment cards. Six felt they always received the care they needed. Three felt they usually did. Seven felt staff were either always or usually available when needed. Twelve relatives returned comment cards. Ten were satisfied with the care provided to their relative. There were positive comments from service users and relatives including “my mother is well looked after”, “I should like to praise the staff for their care” and “All staff are always helpful’’. Staff were described as “busy and helpful”. All but one person felt they were kept informed about their relatives’ health. The home is well maintained according to requirements and records are up-todate and accurate. The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 6 Recruitment records are managed according to company guidance in a way that protects service users. There is continuous substantial investment in the fabric of the home. The manager and deputy manager are experienced nurses committed to the well-being of service users. What has improved since the last inspection? What they could do better: It is not possible to be sure that very dependent service users receive regular fluids diet and adequate changes of position due to poor record keeping. This is a fundamental requirement of nursing care that has been requested in reports since 13th December 2005. New staff without previous experience must have supervision and training in sufficient quantities to enable them to deliver skilled care. Trained nurses must have access to appropriate levels of training and updating to enable them to continue to develop further skills and knowledge in nursing older people with high dependency levels. The manager must review communication pathways so she is able to ensure her directions are complied with and that the team are undertaking their care duties effectively. Recent arrangements for NVQ training have not resulted in successful qualification of candidates. The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. The outcome for this area is good. The home produces information for service users and their representatives prior to admission. Service users are assessed by qualified staff prior to admission to the home. EVIDENCE: The home produces information material and a statement of purpose to inform prospective service users. Of the ten service users who returned comment cards eight felt they had received enough information about the home. The other two stated that the home had been chosen for them by relatives or was the home available to them in the area they chose. The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 10 Eight service users confirmed they had received contracts. Assessments are undertaken only by the manager or the deputy manager both of whom are experienced trained nurses. During the inspection a person called at the home requesting an information brochure. The deputy manager made time to welcome the enquirer and to discuss the nature of their request. The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. While service users are treated with respect the outcome for this area is poor. There are Individual care plans in place however, a lack of consistency in detail means that some residents’ needs and preferences may not always be met. There are concerns about the provision of some areas of personal care. The management of medication is generally good but the management of application of prescribed creams is poor. There is evidence that skills in palliative care must be further developed. EVIDENCE: Four care plans were examined during the inspection. A care plan had also been examined during a recent complaint. The inspectors receive detailed regulation 26 reports from the regional manager. All sources indicate some short falls in care documentation. An area of major concern is that of fluid The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 12 balance and nutritional monitoring. Fluid balance charts were observed in rooms to be incomplete. It was not clear when very dependent service users were receiving fluids. Several charts were in rooms all with one or two recordings. There was no evidence that nursing staff had monitored these charts or made reference to fluid intake in care plans. This issue has been recorded since December 2005. It was advised that monitoring systems are put in place without delay. The monitoring of food intake when completed was done in a perfunctory manner. The manner of recording indicated that staff were not aware of how vitally important the nutrition of elderly frail people is to their general well being. If a meal is refused it should be clear what action was taken by staff. For example have alternatives been offered or has any attempt been made to discover the few things that the service user might have enjoyed. On one output chart the only entry was “quarter of a bag”. This is not acceptable in a nursing home and indicates a need for closer supervision and training of care staff by nurses. There was evidence that service users developed sacral pressure damage that was dressed and healed by staff. However there was no indication in care plans or service users rooms that pro-active preventative actions were taken. A daily care record stated “tongue very dirty”. There was no indication to provide “daily oral hygiene”. The complaint investigated by CSCI indicated a lack of knowledge by some nursing staff of the main principles of palliative care. An action plan has been produced by the manager including the identification of a nurse to gain clinical expertise in this area of care. During the inspection the care plan of a service user who had recently died was examined. The manager must monitor closely the care provision of terminally ill service users to ensure that their changing needs are met. The feed back from the service users’ family was positive and staff were thanked for their kindness. Staff interactions with service users were seen to be appropriate and kindly. Service users were complimentary about staff and the kindness shown by them to service users. Medication records were accurate. Creams in service users bedrooms were not dated on opening. There had been in the past a system for recording the application of prescribed creams but this has fallen into disuse. The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. The outcome for this are is adequate. Service users are encouraged and supported to maintain contact with their families. Service users receive a wholesome diet but efforts must continue to ensure it meets individual needs. There is a need to improve the opportunities for social and recreational interests in the home. EVIDENCE: Service users were observed to be able to spend their day in a variety of ways. Some remain in their rooms or come downstairs for meals. Others spend time in the smaller day rooms while the large sitting room is unavailable. The home has recently appointed an activities co-ordinator after a period of time with a vacancy. Comment cards contain the question “Are there activities arranged by the home that you can take part in?” The following responses The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 14 were received: One said “yes”, one “usually”, two “sometimes” three “never” and four stated “unable”. The home quality questionnaire asks questions about the provision of activities. The responses indicate a need for improvement. Individual needs assessments must result in adequate guidance of service users social care needs particularly when service users are frail or spending the majority of time in their room. The newly appointed activities co-ordinator should receive a programme of training to enable him to fulfil his role effectively. Service users commented that staff have limited or no time to talk to them. Currently there is no access to outside space. The home has some interesting and pleasant views from bedroom windows so it was disappointing to see service users sitting facing into their rooms unable to glance at hills or trees if they wished to. Some service users were taken out by families. All comment cards received from relatives confirmed they were welcome in the home and could see their relatives in private. Service users can chose to eat in the pleasant dining room or have meals served in their rooms. A four week menu is produced. Service users were seen to be eating a choice of meals. Comment cards indicated that service users were largely satisfied with the food provided. Comments from service users during the inspection were less complementary. The menu board in the dining room should be replaced following redecoration. The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18. The outcome for this area is good. The home has a complaints policy and investigates complaints. Service users are protected from abuse by the homes policies and current recruitment practice. EVIDENCE: The majority of service users and relatives confirmed they knew how to make a complaint and knew who to talk to if they were not happy. Three complaints from service had been acted on. One complaint referred to CSCI indicated that initial and appropriate action had been taken by the home. Protection of vulnerable adults of training for staff has begun and further sessions are planned. It was surprising that staff who had been on this training did not understand the meaning of “Whistle Blowing”. Recruitment checks undertaken are efficiently managed and sufficient to protect service users. The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. The outcome for these standards at the moment is poor due to the impact of substantial building in the home. It is anticipated that upon completion the environment will be graded as good. The home is well safe and well maintained. Service users rooms are pleasant and newly decorated. EVIDENCE: At the random inspection on 18th May 2006 the home was seen to be clean bright and cheerful and had benefited from considerable investment in redecoration, curtains and carpeting. At this inspection the home was in the grip of major structural work that inevitably had an impact on the environment. The home is covered in The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 17 scaffolding. The main sitting room is unavailable while the work is taking place. Service users windows are being replaced and alternative rooms are offered while this is occurring. On the day of the inspection some areas of the home were uncomfortably hot. There is no access to any garden area and parking has been reduced substantially. Inevitably there is building noise. Work is due to be completed by October when service users will benefit from a great reduction in drafts and noise during the winter months. A new shower room is to be installed this month. The home should consider ways in which the disruption to service users during this time is limited. For example additional staff at times could enable service users to go out along the sea front or to the nearby municipal gardens. Some service user rooms and en-suites were untidy. The checklist designed to be completed by key carers had not been completed regularly. The general maintenance of the home is undertaken efficiently and detailed records are made. The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 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 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. The outcome for this area is adequate. There was sufficient number of staff on duty at this inspection. The recruitment practice was of a good standard. There are concerns about the training and management of newly recruited staff. Trained nurses must receive up-dates and further training commensurate with their role. EVIDENCE: The home has recently lost several experienced staff members. New staff have been recruited however many are inexperienced never having undertaken care work before. Care and domestic staff spoken to during the inspection were positive and pleased with their decision to try a new type of work. On the day of the inspection the staff on one floor consisted of three carers all with less than six months experience. Whilst staff confirmed that they had had an induction period including an adequate number of supernumerary shifts The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 19 feedback would suggest there needs to be a more robust and comprehensive approach to induction. Staff receive mandatory training in manual handling, food hygiene and health and safety. There are a number of service users who have high dependency levels and complex care needs who need skilled nursing and care. There are requirements from this inspection to ensure that new inexperienced staff are supervised and trained in an effective way that ensures they develop the necessary skills and knowledge to provide holistic and person centred care to service users. All trained staff in the home share the responsibility of ensuring that these new staff are supported and managed effectively. The deputy manager is implementing 1:1 supervision with the nurses who have day to day responsibility for the shifts. Trained nurses in the home have received updates designed for care staff. There must be a development programme for trained staff that increases their awareness and knowledge of nursing elderly people. NVQ attainment by staff in the home has been beset with problems. At the next inspection this area will be reviewed when it is anticipated that progress will have been made. The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 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 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, 32, 33, 36 & 38. The outcome for this area is adequate. A formal quality assurance system has been implemented. Good systems are in place to promote the safety and health of residents and staff. The manager and deputy manager clearly demonstrated a strong commitment to improving standards within the home. EVIDENCE: The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 21 Formal 1:1 supervision has begun in the home. The responsibilities are shared by the manager and trained nurses. Records of appraisals and supervisions were seen. The manager takes action in response to issues that effect the well-being of service users. This means that issues must be delegated to other staff. It is important that a system of “reporting back” is devised so that she is confident that her instructions have been followed and that concerns have been fully addressed. Sanctuary Care has a range of quality assurance measures which are being implemented. A copy of an annual quality questionnaire were supplied to inspectors. An action plan had been completed. The response rate was 45 . The home health and safety systems are efficient. A permanent maintenance person has responsibility for monthly health and safety inspections. All regular records were seen including fire safety and service & maintenance certificates. All were satisfactory being accurate, up to date and accessible. All records were stored securely and appropriately. The Winsor Nursing Home DS0000061582.V306600.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 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 3 x 2 3 3 The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 23 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 OP8 OP15 Regulation 16(i) 12(1) Requirement Following nutritional screening service users are offered regular fluids and diet appropriate to their needs. Records kept are sufficiently accurate to enable decisions on future care to be undertaken. Qualified nurses must be able to access training and up-dating commensurate with their role to enable them to maintain clinical competence. Care staff without previous experience must be trained and managed in such a way to enable them to deliver skilled care to service users. Nursing staff must receive sufficient training in palliative care to enable the needs of service users to be met. 3. OP32 12 (a)(b) 5(a)(b) The lines of accountability within the home must be monitored by the manager to ensure actions required by her in the interests of service users are complied DS0000061582.V306600.R01.S.doc Timescale for action 01/09/06 2. OP30 18 (1) 01/10/06 01/09/06 The Winsor Nursing Home Version 5.2 Page 24 with. 3. OP14 12(2 & 3) 15(1 & 2c) You must - as far as practicable - 01/11/06 enable residents to make decisions with respect to the care they receive, ascertaining their wishes & feelings, by consulting them prior to writing & reviewing their care plan. [Reg 12 (2)& (3); Reg 15 (1) & (2) (c)] This requirement from December 05 will be reassessed at the next inspection. 4. OP12 16 Service users must be must be consulted about social activities. Both group and individual opportunities must be available. A programme of activities must be arranged to include activities in relation to recreation, fitness and training. Training for the activities coordinator must be provided. 5. OP32 24(1) The manager shall establish and maintain a system for reviewing and improving the quality of care provided in the care home, including the quality of nursing. 01/09/06 01/10/06 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. Refer to Standard OP15 Good Practice Recommendations It is recommended that further action be taken to try to DS0000061582.V306600.R01.S.doc Version 5.2 Page 25 The Winsor Nursing Home provide an appealing diet in respect of individual preferences. 2. 3. 3. OP4 OP9 OP28 One nurse should be identified as the clinical lead for palliative care. The administration of creams should comply with recognised good practice. It is recommended that a strategy be developed to ensure that staff are supported and encouraged to obtain NVQ 2 or above and that timescales for meeting the standard are agreed. Standard not yet met. The manager and company are planning further NVQ training in the near future. The Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Winsor Nursing Home DS0000061582.V306600.R01.S.doc Version 5.2 Page 27 - 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!