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Inspection on 10/07/06 for Valley View Residential Nursing Home

Also see our care home review for Valley View Residential Nursing Home for more information

This inspection was carried out on 10th July 2006.

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

The inspector 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

The staff have a good understanding of the support needs of the residents. This is evident from the positive relationships, which was seen to have been formed between staff and residents and the atmosphere in the home was very friendly and relaxed with staff seen chatting and joking with residents. The home has detailed care plans on all residents. The meals in this home are excellent offering both choice and variety and cater for special dietary needs. Residents were complimentary about the food, the inspector had the same lunch as the residents and this was very tasty. The home was clean and tidy on the day and all the residents` rooms felt homely and personalised with their own bits and pieces. The home has a comprehensive and robust policy and procedure on recruitment that they follow meticulously. The information retained by the home on staff files is kept well maintained. The levels of activities and outings provided for the residents by an enthusiastic and committed member of staff exceeds the minimum standards.

What has improved since the last inspection?

The home has made significant progress and has addressed the staffing issues that were causing concern and raised an adult protection meeting at the beginning of the year. There was feedback from the service users and relatives following the last inspection of the home that recognised at times staffing was poor and residents have to wait a long time for staff to see to them. This now appears to have been resolved with the home setting up ways of monitoring on a daily basis by the trained staff, meetings with relatives and matron doing 1 day a week on the floor with the staff. A revision of the homes routine can now ensure staffing levels are kept at a good level and staff can meet all the needs of the service users. It was also suggested that a questionnaire go to all relatives to gauge the level of satisfaction with the home and a meeting could be set up to address any concerns and explain why they may be happening this also has happened and the results were positive with some ideas implemented. The levels of supervision in the home were low and clinical supervision needed to be happening for all trained staff, this has now also been addressed and is happening on a regular basis.

What the care home could do better:

The home needs to expand on their moving and handling risk assessments to ensure all areas are covered. The homes daily records need to provide more information on what care is being provided during the day. All records of staff supervision need to be kept on the premises. All staff personnel files and supervision records need to be kept in a secure place.

CARE HOMES FOR OLDER PEOPLE Valley View Residential Nursing Home Maidstone Road Rochester Kent ME1 3LT Lead Inspector Lucy Ansell Key Unannounced Inspection 10:00 10th July 2006 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 Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 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. Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Valley View Residential Nursing Home Address Maidstone Road Rochester Kent ME1 3LT 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) 01634 409797 Dr Prathap Padmanabhan Jana Mrs Jyothi P Jana Mrs Hazel Beattie-Burrows Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (5), Terminally ill (4) of places Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2006 Brief Description of the Service: The home is purpose built. Service user accommodation is located on the ground and the first floor. There are 27 single bedrooms and three double rooms and all have en suite toilet facilities. The communal lounge and dining area is on the ground floor and there is also a pleasant conservatory. On the first floor there is a small lounge and on the lower ground floor there is a visitors room. There is a passenger lift. The home is accessible for wheelchairs and there are aids and adaptations to support those with mobility problems. The accommodation is built in a square around an enclosed courtyard garden. There are further gardens around the property at the front and rear and ample parking space is provided. The home is managed by a registered nurse and employs a further 5 trained nurses. In addition the home employs care, domestic, catering, maintenance staff and an activity organiser. Valley View is privately owned and the registered providers have two other homes in the area. The home is located in a residential area of Rochester close to local amenities and a bus route. The fees for this home range from £510-£590 per week. Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Key inspection by two inspectors Lucy Ansell and Sally Hall. This took into account a thorough look at how well the service is performing, detailed information provided by the services owner/ manager, and any information or concerns the CSCI has received since the last inspection. Time was spent case tracking and reviewing records kept within the home. The Inspector also asked the views of the people who use this service, and looked at the environment with a tour of the premises, these all combined will inform how well the service is meeting the standards set by the government and decide how the service is rated. What the service does well: What has improved since the last inspection? The home has made significant progress and has addressed the staffing issues that were causing concern and raised an adult protection meeting at the beginning of the year. There was feedback from the service users and relatives following the last inspection of the home that recognised at times staffing was poor and residents have to wait a long time for staff to see to them. This now appears to have been resolved with the home setting up ways of monitoring on a daily basis by the trained staff, meetings with relatives and matron doing 1 day a week on the floor with the staff. A revision of the homes routine can now ensure staffing levels are kept at a good level and staff can meet all the needs of the service users. It was also suggested that a questionnaire go to all relatives to gauge the level of satisfaction with the home and a meeting could Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 6 be set up to address any concerns and explain why they may be happening this also has happened and the results were positive with some ideas implemented. The levels of supervision in the home were low and clinical supervision needed to be happening for all trained staff, this has now also been addressed and is happening on a regular basis. 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. Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6-N/A Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The resident’s benefit from having their needs assessed prior to moving into the home. EVIDENCE: Evidence was gathered that the trained staff are completing all new preassessments and this is completed alongside their care manager or family representative if possible. Evidence was seen of the pre-assessment forms; these have been reviewed and are now a comprehensive tool. The manager, once she has completed a needs assessment, also completes a social history to ensure a holistic approach, and to assure the home can meet all the service users’ care needs. Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ benefit from an excellent standard of care planning and are treated with respect and dignity. All residents’ benefit from being consulted, and their health care needs are fully met. EVIDENCE: Four care plans were sampled and checked and this also included the last service user to come into the home. The admission assessment creates a baseline from observations and previous care plans this covers a wide range of areas including mobility, personal care, nursing needs and continence. Evidence was seen that the care plans were reviewed regularly and were updated monthly. These were also reassessed and rewritten six monthly by the service users’ key worker. The care plans were of a high standard with good evidence of outcomes recorded. The health needs of residents are well met with evidence of good multidisciplinary working taking place on a regular basis. The home promotes and maintains residents’ health through supporting and facilitating medical Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 10 appointments as required. There were records seen of external visits from G.Ps, district nurses, tissue viability nurses and continence advisors. The home is able to evidence that a high standard of health care is being offered. Whilst we were there, the optician was seeing a service user whom has been recently admitted to the home. One service user was at risk of falls and good risk assessments were in place and reviewed regularly. The moving and handling assessments were seen to be on file and a recommendation was made to expand these to cover all areas of the home to protect staff and service users. Evidence was seen that specialist equipment is in place for all service users and this is regularly reviewed and serviced. The staff are recording enough detail in the daily report for the morning and evening shift. However it was also noted that when events and care delivery occurs throughout the day a detailed and comprehensive record needs to be kept with good use of times also. One member of the home’s trained staff was observed carrying out the morning medication routine. The manager stated that this usually took about an hour. Service users have a choice as to where they can take their medication and if they prefer to stay in their rooms they are able to. MAR sheets were inspected and they were completed accurately in relation to entries for administering medication. The Home has a book that records medication in and out of the Home and the chemist picks up returns on a monthly basis. There is a policy and procedure in place for giving treatment and medication. The treatment room was clean and tidy and evidence was seen that temperatures are being recorded for the room as well as the medication fridge. The home was advised to get the pharmacy to visit to check accuracy on some medication sheets. The importance of promoting privacy and dignity is covered in the induction, with evidence seen of staff providing this in their day-to-day interactions. The staff on duty were observed indirectly throughout the inspection, they were seen to interact in a positive and respectful manner with residents. Many residents and family or friends gave positive feedback in the comment cards about the approach of the staff team; one said, “They show great care and kindness”. In the residents shared rooms it was noted that privacy curtains were in place that ensured privacy and dignity for the occupier. The manager also evidenced that consent forms for all residents sharing were on their files. Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The residents’ benefit from an excellent range of recreational interests and outings, and also from contact with family and their local community. Residents now benefit from having more choice and control over their lives. Dietary needs of residents are well catered for with an excellent balanced and varied selection of food. EVIDENCE: The home has an experienced Activities Co-ordinator, who works between two homes. There are a variety of activities in place for service users including games of varying skill levels, arts and crafts, group and individual sessions, games and activities which include using different senses and areas of skill. She aims wherever possible to ensure that the many activities can be used to prompt reminiscence and promote their well being. Other activities also include knitting, sewing, bingo and monthly film shows etc. The Activities Coordinator accesses specialist organisations that cater for special recreational activities. An entertainer or singer also visits the home, and the service users go out on trips. It was evidenced that outings occur on a regular basis during this inspection. The home keeps good records that show all service users are Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 12 being motivated on a regular basis. This standard has been exceeded due to the family tree and life story work done by the Activity Co-ordinator. The home actively promotes ‘open’ visiting hours and encourages family and friends to participate wherever possible. The routines of the home are starting to evidence more flexibility to suit the residents’ preferences and capacities. They can get up and wander around the home, and can choose from many places to sit. The residents are now being encouraged to exercise choice in relation to meals and mealtimes, and with participation of leisure and social activities, and also what time to get up or to retire for the evening. Evidence was seen that staff are recording choices made and keep records of activities for each person. A number of residents spoken to in the home, commented on the food and said how good it is and that they welcomed all the choices offered. Evidence was seen of a four weekly rota, and a daily menu was displayed where service users could see it. Residents were observed during meal- time and choice and variety was offered. One resident stated “ the food was excellent and they always have something on the menu which I like”. The cook regularly makes homemade cakes with tea and cake or snacks being offered mid-morning and mid-afternoon. Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 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): 16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents have access to a clear complaints procedure, which is acted upon by the home when necessary. The resident’s benefit from all staff knowing how to report appropriately any possible abuse, and what immediate action to be taken to protect residents. EVIDENCE: The homes complaint procedure was recently rewritten and now contains all the required information. Copies of the policy had been sent to all residents and family members and are clearly displayed in the home. The home had an ongoing adult protection this has now been closed, and no further complaints have been raised to my knowledge. Evidence was seen of the Home’s Policy for the Protection of Service Users and staff “Whistle blowing” procedure. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. These procedures are supplemented by the local authorities adult protection policy, which the home is signed up to. The owner provides training in adult protection during induction. More courses are then planned to ensure all staff receive the training required to protect service users from abuse. Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ benefit from living in a safe, well maintained, clean and homely environment in which there are high standards of décor, furnishings and fittings. EVIDENCE: The home location and layout is suitable for its stated purpose; and has had all up to date visits by the fire officer and environmental health and they meet all their requirements. In addition there was an enclosed courtyard where there were plant boxes and seating for the summer months. The grounds are kept tidy, safe, and accessible to service users. The home can provide evidence of monthly routine checks and maintenance and renewal programmes. Bedrooms seen had all been personalised by the service users and have sufficient space to accommodate the required furniture. There are high standards of décor, furnishings and fittings in the home and the rooms are redecorated and refurbished regularly. Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 15 The home has good standards of cleanliness and the cleaning staff know which rooms to deep clean and no odours were detected when walking around the home. The home has a separate laundry room, which met infection control requirements. The kitchen was viewed and this was well maintained. Hand washing facilities are prominently sited and the provision of protective clothing was clearly seen. Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ needs are met by sufficient staff and the residents benefit from a staff team who are a competent and skilled workforce, and ensure all residents are provided with good care. EVIDENCE: The staffing rota was discussed and normally seven care staff and two nurses are on duty for the AM shift. Six care staff and one nurse for the PM shift, and one nurse and two carers for the night. The home at present is not full with seven service user vacancies so staff sickness is not always being covered allowing the number of carers to drop by one, this is not an issue until the home becomes full again. There has, since the beginning of the year, been a high turn over of staff and although the staffing levels are satisfactory this may have contributed to residents feeling unsettled and having to wait a long time for staff. The management has spoken to the carers about staff issues and how the service users were feeling rushed and staff were missing small but important details. This is now monitored on a daily basis by the trained staff and overall has improved significantly with good staff morale and staffing levels. The home gives good support in all aspects of training and evidence was seen of a clear training matrix. The home has a very robust and inclusive induction programme carried out in-house, then a foundation course to the NTO standards. Overall there is a good standard of training with all mandatory Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 17 courses completed last year, the home actively encourages training and is working with all available resources as has large numbers of staff to train. The home has excellent staff files, which contain all the required information, however these need tidying so information is clearly accessed and organised in sections. The new staff folders would also benefit from having a checklist /index. The home needs to evidence that the staff files are kept securely in a locked place with less access from general staff. Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 18 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): 33,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents’ benefit from the manager continuing to staff the home sufficiently. The home’s policies, procedures and management mostly guard the best interests of the residents. The residents can be confident that staff are in receipt of regular supervision, but staff would be further safeguarded by records being stored more securely. The residents now benefit from regular monitoring and quality assurance testing. EVIDENCE: The home is run in the best interests of the service users and the manager is aware of the potential to slip back into old habits. As part of the fieldwork evidence the staffing issues were thoroughly scrutinised and the manager is overall starting to put the systems and structures into place that will ensure Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 19 that staffing issues are managed appropriately. She is now more visible on the floor spending one day a week working with the care girls, and one day in the office with the paperwork. The home was able to evidence good monitoring and quality assurance. The resident and family surveys are going out on a regular basis and meetings are held twice yearly with service users and their families to ascertain the level of service and how happy people are with this level. Supervision is occurring for care staff on a regular basis, and does appear to be an in-depth process that reflects practice, the home’s philosophy and also identifies any training or further support needs. The owner has found clinical supervision for her managers and this is booked to be starting shortly. The manager does not have anywhere secure to store staff supervision notes and so these are not kept at the home, a requirement is made for this to happen. Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 20 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 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x X 3 X X 3 2 2 Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? N0 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 OP38 Regulation 14(d) Requirement The home needs to expand on their moving and handling risk assessments to ensure all areas are covered All staff personnel files and supervision need to be kept in a secure place. Timescale for action 30/08/06 2. OP36 17(b) 30/08/06 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. Refer to Standard OP36 OP7 Good Practice Recommendations All records of staff supervision need to be kept on the premises The homes daily records need to provide more information on what care is being provided during the day. Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Valley View Residential Nursing Home DS0000026211.V292482.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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