Care Home: Ferndale Nursing Home

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What the care home does well Staff support people in the home to maintain their dignity and independence.Staff are assisting people to maintain their interests and hobbies. All registered nurses and carers attend training or awareness sessions on the Mental Capacity Act, and in consultation with people and their next of kin Mental Capacity Act assessments are being carried out. Eleven care staff have achieved the national vocational qualification (NVQ) in care at least at level 2, and around 90% of care staff will be NVQ Level 2 qualified by the end of 2009. What has improved since the last inspection? Care plans which are designed to support people with dementia have been introduced, and the needs of people being cared for are being more fully reassessed. The home has purchased more mobility equipment and equipment to assist with pressure relief, and there have been significant improvements in the management of pressure relief and continence care in the home. Risk assessments are now better recorded, which assists in keeping people in the home safe. Seventeen beds with pressure relieving air mattresses have been purchased to assist in the care of people at risk of pressure areas. A number of slings have been purchased to ensure that each person who needs a sling to assist them in mobilising has their own sling. The call system in the home has been replaced, and care plans include an assessment of the person`s ability to make use of the call system. What the care home could do better: Some of the decoration and furnishing in the home have not been maintained to an acceptable standard. CARE HOMES FOR OLDER PEOPLE Ferndale Nursing Home 124 Malthouse Road Crawley West Sussex RH10 6BH Lead Inspector Ed McLeod Unannounced Inspection 7th May 2008 09:45 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 Ferndale Nursing Home DS0000024142.V363386.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. Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ferndale Nursing Home Address 124 Malthouse Road Crawley West Sussex RH10 6BH 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) 01293 520368 01293 528898 ferndalehealth@btconnect.com Ferndale Health Care Limited Mr Ishwurduth Mannick Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (28) of places Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons in the home should not exceed 28. Date of last inspection 23rd July 2007 Brief Description of the Service: Ferndale is a care home providing nursing care and accommodation for twentyeight older people with dementia. The home is owned by Ferndale Health Care Limited. The responsible individual on behalf of the organisation and registered manager of the service is Mr Ishwurduth Mannick. The home is in Crawley and close to the amenities offered by the town centre. The home was first registered in 1994 and consists of accommodation on three floors, all of which are accessed by a passenger lift. The home provides accommodation in eighteen single and five double rooms, one and three of which respectively provide en suite facilities. The home has a garden, which can be accessed by ramped pathways. The fees for this care home currently range from £539 to £650 per week Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection visit was carried out by one inspector and was arranged to follow up requirements made at the previous visit, and to assist us in assessing the home’s compliance with the key standards of the national minimum standards for care homes for older people. Planning for the visit took into account information received on the service since our previous visit, including the annual CSCI self-audit completed by the home manager. On the day of the visit we were on the premises for four hours and forty minutes, and spoke with three people living in the home, the manager, four members of staff, and a visiting professional. We sampled the individual plans of care for three people living in the home. Other records sampled included recruitment and training records for three members of staff, survey forms and records relating to health and safety issues in the home. We visited the main areas of the care home and six bedrooms. We observed a number of interactions between people living in the home and staff, and observed the arrangements for lunch. At this inspection we also looked at how people are safeguarded. This was part of a thematic element being carried out in all care homes and agencies being inspected between the 5th and 15th May 2008. What the service does well: Staff support people in the home to maintain their dignity and independence. Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 6 Staff are assisting people to maintain their interests and hobbies. All registered nurses and carers attend training or awareness sessions on the Mental Capacity Act, and in consultation with people and their next of kin Mental Capacity Act assessments are being carried out. Eleven care staff have achieved the national vocational qualification (NVQ) in care at least at level 2, and around 90 of care staff will be NVQ Level 2 qualified by the end of 2009. What has improved since the last inspection? What they could do better: Some of the decoration and furnishing in the home have not been maintained to an acceptable standard. Ferndale Nursing Home DS0000024142.V363386.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 summary of this inspection report can be made available in other formats on request. Ferndale Nursing Home DS0000024142.V363386.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 Ferndale Nursing Home DS0000024142.V363386.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. EVIDENCE: The AQAA tells us that there is an opportunity for visits to the home before Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 10 admission is arranged. The manager tells us in the AQAA that all people who are privately funded have a written contract, and people funded by a local authority or heath trust have a copy of the agreement and terms and conditions. There have been no admissions to the home since the previous inspection, so we did not look at pre-admission assessments during this visit. Ferndale Nursing Home DS0000024142.V363386.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, people manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. EVIDENCE: Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 12 The AQAA tells us that all care plans are normally reviewed by trained nurses every month and as necessary, and that all care plans are agreed with the next of kin. At this visit we looked at three sets of care plans. More in-depth care plans which are designed to support people with dementia have been introduced, and the needs of people being cared for are being fully reassessed. The new care assessments can assist staff in better assessing the complex needs of the people living in the home. A member of staff we spoke to said the new care plans “are a great improvement, feel we can better meet people’s needs. A second member of staff told us “we are moving from general care to personal care”. In December 2007 we were advised that the local care trust had concerns around the management of nutritional needs, weight loss, pressure care management, care planning and risk assessment in the home. Since December 2007 the home has put in measures and systems to improve recording and care planning and increase staff training. The home has also purchased more mobility equipment and equipment to assist with pressure relief. We talked to a nurse from the care trust who was visiting the home on the day of our inspection. We were advised by her that there have been significant improvements in the management of pressure relief, continence care. An example given was that pressure area risks were previously being underestimated, but staff are now better evidencing the need for pressure relief. Staff we spoke to gave us examples of how people’s dignity and independence are being encouraged in the home. One member of staff told us “some mornings people wake up happy, chatty, sometimes not. If person says “go away” we return in an hour or so, ask if they want a cup of tea”. A member of staff told how they had been encouraging one person to mobilise, as a result of which they were now more mobile and steadier on their feet. We looked at food and fluid records for two people who were being nursed in bed, and these indicated that they were being assisted to receive regular food and fluids. We looked at the arrangements for the administration of medicines, Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 13 and found that topical medicines are now being administered from individually labelled containers. Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks at a time and place to suit them. EVIDENCE: The AQAA tells us that the activity organiser arranges all activities according Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 15 to service user’s interests and ability to participate. At the visit we found that activities were being provided five days per week, and that staff involved in providing activities are receiving training in this. We spoke with one of the activities workers in the home. She told us that one to one activity with people includes reading magazines with them, doing a memory book and going through their photo albums with them. We asked about how the home is assisting people to maintain their interests and hobbies. The activities worker gave us several examples of this, including reading the bible with one person who is a regular churchgoer, and giving one person the opportunity to sing along with musicals such as The Sound of Music which she likes to do. The previous requirement made concerning activities was found to have been met. We observed many friendly and positive interactions between staff and people living in the home. A nurse we spoke told us the home is seeking to provide better individual care for people and responding to their individual needs. Examples given of this were staff supporting if a person wants to have a nap, and that people are supported with walking around more if they wish to. The AQAA tells us that a new menus are in place and were discussed with people living in the home and their next of kin. The manager also tells us in the AQAA that specialist diets, for example diabetic, muslim, or jewish meals can be provided. A dietician referral is made for those who need special attention to their nutrition. For the day of our visit, the lunch main meal choices were chicken, vegetables and potatoes or egg sandwiches. The choice of desserts was banana mousse or fruit salad. The menu advised that supper would include soup, sandwiches or omelette, and cake or ice cream. We spoke with the cook who has a record to the people who will be receiving soft or pureed food or a diabetic diet. He gave examples of people’s likes and dislikes, and keeps a record of people who are unable to have certain foods due to their religious persuasion. Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 16 We found that a regular stock of fresh produce is being used in the preparation of meals. We found that food in the fridge was labelled and dated, and records are kept for fridge and freezer temperatures, and kitchen cleaning schedules. The Safer Food system for kitchen hygiene is being used. We observed a lunch sitting, and found that people who needed assistance with eating were receiving this. The meal was relaxed and unhurried. Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people have concerns about their care, they or other people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. EVIDENCE: The AQAA tells us that the complaints procedure is displayed in the entrance and forms part of the statement of purpose and service user guide. At the visit we found that no complaints had been received since the previous visit, and survey forms given out by the home in November 2007 which we looked at indicated people were happy with the service being provided. The manager tells us in the AQAA that all registered nurses and carers are attending for training/awareness of the Mental Capacity Act, and that after consultation with people and their next of kin Mental Capacity Act assessments Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 18 have been carried out. In October 07 we were advised of a safeguarding investigation being undertaken by the local health trust and social services team. The home cooperated with this investigation and have put in place measures to address the shortfalls identified, including a new care planning system. This has led to improvement to the systems for protecting people in the home, and a visiting professional told us that the home are now better evidencing the need for restraint, and risks assessments are now better recorded (for example the use of cot sides on beds). Staff we spoke to told us they now have a better understanding of mental capacity and responding to challenging behaviour following training in these topics. Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People stay in a well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their rooms feels like their own, it is comfortable and they feel safe when they use it. EVIDENCE: Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 20 The manager tells us in the AQAA that new equipment in the home has included the purchase of 17 beds with pressure relieving air mattresses. A number of slings have also been purchased to ensure that each person who needs a sling to assist them in mobilising has their own sling. Improvements have also included replacing some of the chairs in the lounge and the provision of gel cushions for pressure relief. People now have their names on their doors where this can help orientate them. The manager tells us in the AQAA that all equipment on the premises is regularly checked by contracted engineers. A handyman is employed to assist with the upkeep of the building. The call system in the home has been replaced, and care plans include an assessment of the person’s ability to make use of the call system. The previous requirement made concerning this was found to have been met. In May 2008 an environmental health officer visiting the home required that the standard of kitchen fittings be improved, and the manager told us that the refurbishment of the kitchen was due to start on the 27th May 2008. We visited a number of bedrooms, bathrooms and the communal areas of the home, and found some of the decoration, furniture, fittings and carpets to be in poor condition. We did not find any evidence of a plan with timescales to attend to these matters. The manager tells us that hot water is delivered via thermostatically controlled valves at around 43 degrees centigrade, and water outlets we hand tested indicated safe hot water is being provided. We found suitable arrangements in place for soiled laundry. The AQAA tells us that eleven staff have received training in infection control and more training in this is arranged for July 2008. All parts of the home we visited were clean and fresh. Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 21 Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. EVIDENCE: On the day of our visit we found staff numbers were sufficient to ensure the needs of people living in the home were met. For example, there were sufficient numbers of staff to ensure that people who needed assistance with meals and drinks were receiving this. The manager tells us in the AQAA that staff are not recruited before receipt of satisfactory criminal record bureau/POVA check, and a minimum of two years’ satisfactory references. Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 23 We looked at three sets of staff recruitment records and found that the required checks and references were being obtained for staff working in the home. In the AQAA the manager tells us that eleven care staff have achieved the national vocational qualification (NVQ) in care at least at level 2, and that around 90 of care staff will be NVQ Level 2 qualified by the end of 2009. There is a training schedule in place to help staff improve the quality of care provided, and planned training in the near future was seen to include manual handling, challenging behaviour, fire safety, infection control and health and safety. Staff we spoke to gave examples of how they had found particular trainings helpful. Staff also told us that staff meetings were helping theme improve the care provided. We are told in the AQAA that all catering staff have received training in the safe handling of food, and 30 of care staff have undertaken this training. Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. EVIDENCE: Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 25 The manager, Mr Mannick, advised us he is presently undertaking the registered manager’s award, and continues to update his training. The manager tells us in the AQAA that comments and input are welcomed, and that following wide ranging consultation with families regarding menus new menus have been introduced. During our visit we looked at surveys that had been filled out by relatives and people using a service. Mr Mannick told us they would consider any suggestions for inclusion in the home’s improvement programme, and that there is a suggestions box in the home. The manager told us in the AQAA that people’s valuables (with written approval from next of kin) and personal money can be held by the home. A record is kept and receipts issued, and we looked at the system in place for this during our visit. We found that a record is kept of money issued and received, and cash is held in an individual wallet for the person. Invoices are sent out to relatives and receipts are issued. The AQAA tells us all staff receive regular supervision, and three sets of supervision records we looked at indicated this was true. We looked at a number of records relating to health and safety in the home, and found these to be in good order. Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 26 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 x x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 3 x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23 (2) (b) (d) Requirement The provider must ensure the premises are kept in a good state of repair an decoration. This to an include an assessment of what needs replacing or repair, and a plan with timescales to address this. Timescale for action 30/10/08 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 Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Ferndale Nursing Home DS0000024142.V363386.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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