CARE HOMES FOR OLDER PEOPLE
Weir Nursing Home The Swainshill Hereford Herefordshire HR4 7QF Lead Inspector
Sandra J Bromige Unannounced Inspection 31st October 2005 10:05 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 Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 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. Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Weir Nursing Home The Address Swainshill Hereford Herefordshire HR4 7QF 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) 01981 590229 01981 590445 Mrs Christine Juul Allen Mr David Anthony Kingham Care Home 35 Category(ies) of Dementia (35), Dementia - over 65 years of age registration, with number (35), Old age, not falling within any other of places category (35), Physical disability (35), Physical disability over 65 years of age (35) Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. This Home provides care for residents aged 60 years and over. This Home provides specialist care for Parkinsons Disease sufferers. The Registered Provider shall carry out the requirements of the local authority, planning department, building control and environmental health (together called `the associated bodies`) in respect of the extension and until the associated bodies have indicated their satisfaction of due and satisfactory completion to the registered provider, it shall admit no more than 31 service users. The home may continue to admit service users with the categories DE and DE(E) provided that dementia is not of such severity as to render such service users either, as a danger to themselves or others. 18th July 2005 4. Date of last inspection Brief Description of the Service: The Weir care home is situated in the village of Swainshill 4 miles from Hereford. The Georgian property is leased from the National Trust and managed by The Weir Nursing Home Ltd. It is set in attractive gardens adjacent to the Weir National Trust gardens with extensive views over the River Wye and surrounding countryside. It is a care home with nursing currently registered for a maximum of 35 service users of both sexes over the age of 60 years. Categories of care offered are physical disability; terminal illness, dementia and specialist care for Parkinson’s Disease sufferers. The Home was registered in 1995 and consists of a two and three-storey building. The Home has 15 single bedrooms, 5 have en-suite facilities. 4 double bedrooms, all without an en-suite facility. The Home has a further two multiple occupancy rooms. The multiple occupancy bedrooms are currently being phased out as part of the building work that is taking place with the extension to the rear of the property. One multiple occupancy is to be converted into a further sitting room at the from of the building. There is a passenger lift to all floors of the Home. Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over 8.25 hours on the 31st October 2005 by two Inspectors. Information has been obtained through a tour of part of the premises, observation, looking at care, staff and other records in the Home and discussion with residents’ and staff including the manager (designate), Clinical Manager and the Training Facilitator/Personnel Manager. A complaint has been received and investigated by the Commission since the last inspection. The complaint was about the Home’s management of medication for an identified resident. This complaint was upheld. The Home’s current certificate of registration was not on display at the time of the inspection and their employer’s liability insurance certificate had expired. The Provider reported that the new insurance certificate had not arrived and was due any day. A number of requirements from the previous reports have not been met. These relate to assessment of residents’ needs prior to admission, consultation with residents’ about their care needs, the provision of recreational care and exercise, staff supervision and aspects of health & safety training. Failure to meet these requirements may result in enforcement action being taken by the Commission. What the service does well:
People are able to live in a Home that is set in beautiful countryside with views across the River Wye. The gardens are very large and are well looked after. The Home is kept clean and there are no bad smells. Staff follow good practice by using aprons & gloves when appropriate to prevent cross infection. Hand washing facilities are provided throughout the Home and were seen being used by staff. Residents are well groomed and their clothes are nicely laundered. Fresh fruit is available in the sitting rooms for residents’ to help themselves and all residents seen had a drink within reach. Staff are smartly dressed, friendly, speak appropriately to residents and visitors to the Home and have a good knowledge of the residents’ individual care needs. Some good training has taken place about identified care procedures and the handouts given to staff are well put together and are very informative.
Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 6 The laundry is well organised and the cleaning chemical store is secure with safety data information sheets available in case of emergency. A clear and comprehensive system of recording complaints is in place. What has improved since the last inspection? What they could do better:
All of the information listed on the Home’s pre-admission assessment form needs to be obtained and recorded after visiting the person before a decision is made for a resident to be admitted to the Home. The information obtained needs to be accurately recorded and the resident’s medicines must be checked on admission to ensure that they are all as prescribed. Medication Administration Records must be accurately written to correspond with the label on the medicine. Risk assessments must be written and included in the care plan where residents have been identified as being at risk of wandering out of the premises. Bedrail risk assessments must be reviewed each month to see if they are still needed and that they are appropriate for the resident. Written consent must be obtained prior to use from the resident or their representative. Care plans need to be discussed with the resident and/or their next of kin to ensure that they agree with the care needs identified. Care plans need to be further developed to include information how the social care needs of the residents are being met. Written information must be provided in the care plan when a problem has been identified to show all of the action taken by the Home and the outcome of this problem. The medicine fridge temperature must be checked each day to ensure that the medicines are being stored within the correct temperature range. Monthly stock checks must be made of all controlled drugs being held by the Home. All medicines must be given to the residents in the presence of the trained nurse who is conducting the medicine round to ensure that they are given to the right person and that they have been swallowed by the resident. Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 7 Opportunity for residents to exercise, engage in any interests and activities and to go out into the community need to be provided by the Home on a regular basis. Appropriate door locks need to be provided on all bedroom doors in the Home. The Home must ensure that staff references received prior to employment are written by the person nominated on the application form and they include information about why that employee left their previous employment. The owners must develop a system, which allows them to assess the standard of the service given by the Home. All care staff must have regular supervision and this information needs to be recorded. Staff must be sent for training to make sure that a first aider is in the Home at all times. All staff must receive fire training at regular intervals to make sure that they know what to do in the event of a fire in the Home. All staff must be given training in moving & handling residents upon employment and updated each year. Chemicals used for hand washing must be kept in their original containers. The laundry door must be kept shut at all times in case of fire and not wedged open. 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. Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 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 Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 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): 3 Thorough and accurate assessments are not being done by the Home prior to admission of the resident to ensure that their care needs can be met and to form the basis of the care plan. EVIDENCE: The records of a recently admitted resident contained an assessment completed by the manager (designate) the day before admission. All parts of the assessment form were not completed. The assessment form stated that the resident’s sight was ‘good’, but the resident is registered blind and has difficulty seeing particularly at night. The medicines listed by the hospital upon discharge to the Home were not the same as the medicines listed on the Medication Administration Records in the Home. Identified eye drops had not been received by the Home and had not been followed up by the registered nurses upon admission. Pain relieving tablets were prescribed by the Doctor to be given four times each day, but had been written up on the Medication Administration Records by the registered nurse to be given “when necessary”. Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Care plans are not being consistently completed to provide clear and accurate information for staff to ensure that they know what to do for each resident. Procedures for the management and administration of medicines are not being followed and have the potential to place residents at risk. Staff are not always seeking permission prior to entering a residents’ room and respecting their privacy. EVIDENCE: Four care records were inspected. The standard of recording is improving, although there are still shortfalls as follows: • The residents and/or their next of kin are not being consulted regarding the content of the care plan and their agreement to the content is not being sought. • Dental/oral hygiene care is not being recorded in all care plans. • A risk assessment where a resident had been identified as being ‘at risk’ due to wandering had not been completed. Another care record did not contain any information for the staff on how to manage a resident who has a tendency to wander. • An identified risk assessment for the use of bedrails had not been reviewed since November 2003.
Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 11 • • • Consent to the use of bedrails had not been sought for an identified resident. An entry regarding a sore area on an identified resident’s leg had no written information to show that it had been treated. The registered nurse on duty confirmed that this sore area had now healed. An identified resident’s care plan did not contain any social or recreational information. The medicines prescribed upon discharge from hospital for an identified resident had not been accurately written on the Medication Administration Records upon admission. (Please refer to the previous section for evidence). Medicine fridge temperatures are not being checked and recorded each day. The medicine trolley was not secured to the wall. The trolley was secured immediately by the Home when this was drawn to the attention of staff. Two identified controlled drugs had not been checked since February and June 2005 to ensure that the stock levels were accurate. Two registered nurses were observed giving out medicines. The second nurse was observed taking medication to a resident in another room and giving the medication without this being witnessed by the other registered nurse Two trained staff were observed entering a resident’s room without knocking or being invited to enter by the two residents who were talking to one of the Inspectors. Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Social activities are still not being provided by the Home with sufficient regularity to provide exercise, stimulation and interest for the people living in the Home. EVIDENCE: The Home employs a part time activity organised that works 6.5 hours a day on 2 days a week. This person has had no specific training to enable her to perform her role as activity co-ordinator and does not have any access to the residents’ care plans. Individual activity programmes are not in place and there is no evidence that residents are being consulted about their individual hobbies and interests. Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 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 The Home has a satisfactory complaints system with some evidence that relatives and residents’ views are listened to and acted upon. EVIDENCE: The complaints and compliments file contains many letters of thanks to the Home from relatives of people who received care at the Home. There are two complaints recorded, this includes a complaint that was received by the Commission regarding the management of an identified resident’s medicine. Upon investigation the Home had not ensured that sufficient medicine was held in stock and the medication ran out prior to further stock being obtained. This complaint was upheld. Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 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 & 21 Recent investment has significantly improved some of the bedroom facilities provided by the Home and removed the use of the 5-bedded unit creating a more comfortable environment for the people using these rooms. An identified bathroom needs refurbishment in order to create a more pleasing and pleasant environment for the people using it. EVIDENCE: The Home is generally clean, tidy and well maintained. The building work is still in progress and the 5-bedded bedroom has been converted into two double bedrooms with en-suite bathrooms. At the time of the inspection the new flooring was being laid in these rooms. One bathroom was noted as needing refurbishment as there was no lampshade and the blind was broken. It also contained a commode, which had a torn seat covers, the frame was rusty and the commode pot and underside of the seat were not very clean. Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 15 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 deployment and numbers of staff are sufficient to ensure that the residents’ physical care needs are met. There are not sufficient staff to ensure that the recreational care needs of residents are met. A programme of staff training is provided to ensure that new and existing staff have the skills to provide the care needed by the people living in the Home. Recruitment practice continues to improve but is still insufficiently thorough to ensure that staff appointed are suitable to work with vulnerable people. EVIDENCE: On the morning of the inspection there was a registered nurse on duty, 6 care staff and the Activity Coordinator. There was also a newly recruited registered nurse on duty who was receiving her induction to the Home. Ancillary staff included a cook, 2 domestic staff and a laundry assistant. In addition to these there was the Manager (designate), Clinical Manager, and the Training Facilitator/Personnel Manager providing further clinical and administrative support. Training records provided by the Home show that one member of the care team has achieved NVQ 2 & 4. None of the other care staff have NVQ 2, although 8 of the care staff hold overseas qualifications such as a trained nurse, midwife or a physiotherapist. Four ancillary staff have achieved NVQ 1 in cleaning & support services. Records show that newly appointed staff are being inducted to the Home to ‘Skills for Care’ standards. Records show that internal training has taken place on topics such as continence care, oral hygiene, pressure ulcer prevention, dementia care, respect & nutrition & hydration. Some of these training sessions included a written paper about the
Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 16 course during which the staff member had her teeth cleaned by another staff member. Experiential learning of this sort is a useful way for staff to increase their understanding of the needs of older people. The records for recently appointed staff showed that staff are not starting work until a PoVAfirst check has been received. Evidence was seen of Criminal Records Bureau checks for all staff employed at the Home. Five staff files were seen which contained all the relevant checks prior to employment. However testimonial style references had been accepted for two of these staff. There was no information to show that the authenticity of these ‘To whom it may concern’ testimonials had been checked and there was no information to show the Home had verified the reason why they had left their previous employment. Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 17 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, 36 & 38 Staff are not all being appropriately supervised to ensure that the Homes policies, procedures are being put into practice for the care and safety of the residents’. Systems for the management of health & safety in the Home need to be improved to promote and safeguard the health, safety & welfare of the people living in the Home. EVIDENCE: The manager (designates) application for registration with the Commission is currently being processed. Records show that very few care staff have received supervision and the Clinical Manager confirmed that supervision for trained staff had not been commenced, but it is something they will be doing. Records provided show that not all staff have received moving & handling and fire training since they have started work at the Home. A first aid training course has been organised for the beginning of November.
Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 18 The laundry door was found wedged open despite there being a sign on the door stating ‘Fire door please keep door closed at all times’. The laundry was unattended. Hand washing liquid was seen in an identified bathroom in a container with a handwritten label. Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 19 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X 2 X X X X X STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 1 X 2 Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 20 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 OP3 Regulation 14 Requirement Timescale for action 31/12/05 2 OP7 15 3 OP7 13 4 OP7 15 5 OP7 12, A detailed pre-admission assessment for all residents must be carried out to show consideration of all elements of Standard 3.3. Timescale of Immediate & Ongoing not met. Risk assessments must be included in the care plan where a resident is confused and is at risk of wandering out of the premises. All bedrail risk assessments must be reviewed monthly. Written consent must be obtained prior to use. An immediate requirement was made. Care plans must be developed and reviewed in discussion with the resident and/or their next of kin, to ensure that they agree to the content. Timescale of 30/09/05 not met 15, 16 Care plans need further development to show consultation with residents about how the social care needs of individual residents are being met.
DS0000027692.V262847.R01.S.doc 31/12/05 03/11/05 31/12/05 31/01/06 Weir Nursing Home The Version 5.0 Page 21 6 OP7 15 7 OP9 13, 17 8 9 OP9 OP9 13, 17 13 10 OP9 13, 17 11 OP12 16 12 OP24 12, 13 13 OP29 19 14 OP33 18 Written information must be provided in the care plan when a problem is identified to clearly show all of the action taken by the Home and the outcome. The medicine fridge temperature must be checked and recorded on a daily basis to ensure that temperatures are maintained in the range 2-8°C. Stock checks of controlled drugs held by the Home must be carried out each month. All medicines must be given to the identified resident in the presence of the trained nurse who is conducting the medication round. Medication Administration Records must be accurately written to ensure that they contain the same instructions for administration as shown on the label of the medication which has been prescribed by the Doctor. The registered person, having regard to the needs of residents and in consultation, must provide recreation and exercise. Timescale of 30/09/05 not met. Bedroom door locks must be provided for all doors. Timescale of 31/03/05 not met. The registered person must make sure that references received are authentic and that they have obtained written verification as to the reason why the applicant ceased to work in that position. The Provider must develop a system to monitor and audit the quality of service delivered by the Home. Brought forward, not assessed.
DS0000027692.V262847.R01.S.doc 31/12/05 30/11/05 30/11/05 30/11/05 30/11/05 31/01/06 31/12/05 31/12/05 31/03/05 Weir Nursing Home The Version 5.0 Page 22 15 OP36 18 16 OP38 13 17 OP38 23 18 OP38 13 19 20 21 OP38 OP38 OP31 13 13 CSA 2000 The registered person must ensure that care staff receive formal supervision. Timescale of 28/02/05 not met. The registered person must ensure provision of a qualified first aider at all times. Timescale of 31/01/05 not met All staff must receive suitable training in fire prevention. Timescale of 31/12/04 not met All staff must receive moving & handling training upon commencing employment at the Home and at annual intervals thereafter. Chemicals must not be decanted into containers with handwritten labels. The laundry door must not be wedged open. The Home’s current certificate of registration must be displayed at all times. 31/01/06 31/12/05 31/12/05 31/12/05 30/11/05 30/11/05 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN 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 Weir Nursing Home The DS0000027692.V262847.R01.S.doc Version 5.0 Page 24 - 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!
