Care Home: Henry Nihill House

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What the care home does well Henry Nihill House has a relaxed and friendly atmosphere and is well designed to meet the needs of the residents living there. The home is well managed by a dedicated and committed manager. The staff team are caring and supportive and treat the residents with respect and dignity. Residents` health and personal care needs are understood and met by staff and residents are encouraged to be as independent as possible. The home provides a range of interesting activities both inside and outside the home. Residents are able to choose from a variety of well prepared and wholesome meals. What has improved since the last inspection? Two requirements and three good practice recommendations were issued at the last inspection. The registered manager has complied with all of these. Staff have undertaken training in adult protection so that they are aware of the issues that vulnerable people face in a residential setting. People who use the service have a say in how the home is run and can see how their suggestions have been put into practice. The amount of falls occurring at the home is now analysed so possible patterns can be highlighted and more accurate risk assessments developed. A training audit of all staff has taken place so that the manager knows which staff need the appropriate training. Night staff now undertake fire drills every three months so they are aware of what to do in the event of a fire occurring at the home at night. What the care home could do better: No new requirements have been made as a result of this inspection. Two good practice recommendations have been made relating to the recording of medication being carried over from one month to the other and that allreferences should be returned from the referees with a company stamp or letter headed paper to further evidence its authenticity. The CSCI is confident that these recommendations will be complied with by the registered manager. CARE HOMES FOR OLDER PEOPLE Henry Nihill House 94 Priory Field Drive Hale Lane Edgware Middlesex HA8 9PU Lead Inspector Mr David Hastings Key Unannounced Inspection 09:30 20th December 2007 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 Henry Nihill House DS0000010452.V343737.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. Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Henry Nihill House Address 94 Priory Field Drive Hale Lane Edgware Middlesex HA8 9PU 020 8905 4200 020 8958 4713 henrynihill@yahoo.co.uk 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) The Community of St Mary at the Cross Mrs Susan Margaret Teresa Sinfield Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home shall not accommodate more than 9 physically disabled persons, some of whom may be elderly, at any one time. 31st October 2006 Date of last inspection Brief Description of the Service: Henry Nihill House is a modern, purpose built care home registered to provide personal care and nursing care for a maximum of thirty older people. The home is owned by a religious order called The Community of St. Mary at the Cross. The stated aim of the home is to provide a secure, relaxed and homely environment in which service users well being and comfort are of prime importance. The home is a large detached two storey building situated in the extensive grounds of the convent of St Marys at the Cross. It has thirty single bedrooms of which are spacious and have en-suite facilities. There is a kitchenette on each floor. The communal areas are a spacious lounge/sitting area that can be divided into two rooms, an open plan dining room is on the ground floor, two day/quiet rooms, a small attractive front garden and an open landscape garden at the back. The home has recently built a conservatory area, which opens out on to a paved patio area for service users to walk at their leisure. The home has its own driveway and provides parking facilities for visitors and staff. The home is about half a mile from the A1 and close to Edgware shopping area, restaurants and pubs. Public transport facilities are also near and the nearest underground transport link is Edgware. The current scale of charges range from £600 to £745 per week. A copy of this report is available on the CSCI website or/and from the home. Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 20th December 2007 and lasted seven hours. The registered manager, who was very open and helpful, assisted throughout the inspection. We spoke with eight staff, two visitors and fourteen residents of the home. We inspected the building and examined various care records as well as a number of policies and procedures. The home has also sent us their Annual Quality Assurance Assessment (AQAA), which has provided us with important information about the service. All of the residents we spoke with said they were very happy with the care and support they received. One resident told us, “They are marvellous”. What the service does well: What has improved since the last inspection? What they could do better: No new requirements have been made as a result of this inspection. Two good practice recommendations have been made relating to the recording of medication being carried over from one month to the other and that all Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 6 references should be returned from the referees with a company stamp or letter headed paper to further evidence its authenticity. The CSCI is confident that these recommendations will be complied with by the registered manager. 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. Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 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 Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home carries out a comprehensive assessment of individual’s needs so that they know that the home is suitable for them before they decide to move in on a trial basis. EVIDENCE: We looked at the “Service User Guide”. This gives people information about the home and services and facilities available. The guide was detailed and included a clear statement that people from different backgrounds and cultures were welcome and that any discrimination would not be tolerated at the home. This ensures that Henry Nihill House has an inclusive approach to the care of everyone at the home. We examined assessments of people who have recently moved into the home. These assessments were detailed and covered all the requirements of Standard 3.3 of the National Minimum Standards for Older People. Residents we spoke with said that the staff knew them well and understood their needs. It was Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 9 clear from discussion that the manager understood the importance of making sure the home could properly support the person before a decision to move in was made. There was evidence that people moving into the home have a review of their placement after four to six weeks to see if they are happy at the home and whether they decide to move in on a permanent basis. Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans clearly set out residents’ health, personal and social care needs so that staff know how best to support everyone at the home. Residents have good access to health care professionals and they are treated with respect. Residents get the medication they require, at the right times and by appropriately trained staff. EVIDENCE: Six care plans were examined. These plans were holistic in approach and set out the plan of care for each individual for staff to follow. The plans set out the health, personal and social needs of residents. Staff we interviewed had a good understanding of the needs of the people in their care. Plans were being reviewed and updated regularly and residents were being involved in the review of their plans. Risk assessments were seen in all care plans, which highlighted a potential risk for the individual. Risk assessments covered moving and handling, the use of bed rails and pressure care. Following a good practice recommendation, made Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 11 at the last inspection the manager regularly carries out a falls analysis in order to highlight any possible patterns of falls at the home. Those residents who are highlighted as at risk from falling are referred to the falls clinic. From records and discussions with the manager it was evident that people have been supported to access health care. Residents told us that their health care needs were being met by the home. One resident told us, “I have my own doctor”. Records indicated that doctors, dentists, chiropodist, opticians, speech therapists and district nurses regularly saw residents. We were able to speak to the doctor who was visiting the home on the day of the inspection and he told us that there was excellent communication and there are good relations with the pharmacy. Satisfactory records were examined in relation to the receipt, administration and disposal of medication. We did find in some instances that medication that being carried over from the last month was not always being recorded on medication charts. A good practice recommendation has been issued relating to this in the relevant section of this report. Medication was being stored appropriately and the temperature of the medication room was being monitored and recorded. Only nursing staff are permitted to administer medication. The manager carries out regular medication audits to ensure that residents get the right medication at the right times and that staff are maintaining accurate records. Throughout the inspection we saw examples of staff treating people with respect and upholding residents’ privacy. For example staff were seen to be knocking on people’s doors before going in. People we spoke with confirmed that they were treated with dignity and staff upheld their need for privacy. People who use the service told us that staff are, “Respectful” and, “Friendly”. Staff we interviewed were able to give practical examples of when they have upheld peoples’ privacy. Examples that staff gave did not just include the need for privacy whilst carrying out personal care but also in relation to sharing information and ensuring that residents can see their visitors in private. Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can choose from a range of activities at the home and are kept suitably occupied and engaged. Visitors to the home are made to feel welcome and can visit at any reasonable time. Residents are helped to exercise choice and control over their lives. The food provided is of good quality and mealtimes are relaxed and enjoyable. EVIDENCE: People who use the service told us about activities available to them at the home including dancing, flower arranging and arts and crafts. Some people have completed training courses at colleges and other residents enjoy regular swimming trips. Residents and their visitors can attend chapel every day if they so wish and there is a well-tendered garden with raised flowerbeds. We also saw staff sitting and talking with less mobile residents. The manager and staff at the home have recently taken seveteen residents including fifteen people who use wheelchairs to the London Eye. Residents told us they really enjoyed this outing and staff were very aware of the need to take people out of the home on a regular basis. The home has two mini buses to take people out shopping and other places of interest. Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 13 People told us that visitors to the home are welcomed. The record of visitors also confirmed that relatives and friends could visit at any reasonable time. Visitors we spoke with confirmed this and one person commented, “I’ve always thought that this was a great place”. One relative attends Mass on a Sunday, at the home, with her Husband. Another visitor told us, “They always offer me a cup of tea”. Residents confirmed that they were able to have choice and control over their lives at the home. One resident told us, “You can do what you like here”. Staff we interviewed were able to give examples of how they ensure people are able to exercise choice and control within their daily routines. We did not see any institutional practices taking place during the inspection. The kitchen was inspected. The cook on the day of the inspection was aware of individual’s likes and dislikes as well as any special diets people may require. The kitchen was clean and there was a good selection of fresh food. Fridge and freezer temperatures were being monitored and recorded. The home has recently been awarded 4 stars from the local environmental health department for food hygiene standards at the home. People we spoke with were positive about the food provided by the home and confirmed that a choice of menu was always available. The cook was helping to serve the meals and was getting feedback from residents about how they enjoyed their lunch. There appeared sufficient quantities of food for everyone. Lunchtime was relaxed and staff were providing discreet assistance when required. Residents comments about the food included, “It’s very nice”, “The food is lovely” and “It’s very good”. Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 14 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): 16 and 18 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and responded to in a professional manner. Residents are protected from abuse by clear policies and procedures and by an appropriately trained staff team. EVIDENCE: The home has satisfactory policies and procedures in relation to complaints and the protection of residents from abuse. The record of complaints showed that there have been eleven complaints since the last inspection. Although most of these complaints were relatively minor, records indicated that they had all been dealt with in accordance with the homes procedures and in a professional and open manner. Records showed the outcomes of all complaints including the complainant’s responses. All the residents we spoke with said they had no complaints about the service but were clear that they would say something if they had a concern. As a result of a requirement issued at the last inspection staff at the home have attended adult protection training. Staff were able to describe to us how vulnerable people could be at risk of abuse in a residential care setting. All staff were clear of their responsibility to report any suspicions of abuse to the appropriate authorities. Residents that we spoke to said they felt safe and well supported at the home. Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 15 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): 19 and 26 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is safe and cleaned and maintained to a very good standard. EVIDENCE: Henry Nihill is a modern, purpose built nursing home registered for a maximum of thirty older people. All the bedrooms are spacious with en-suite shower facilities to accommodate wheelchair users. The communal areas consist of a large lounge/sitting area, which can be divided into two rooms for activities, open plan dining area, conservatory, and small meeting/quiet areas on the ground floor. The corridors are very wide to accommodate at least two wheelchair users passing. We toured the building with the manager and visited a number of residents’ rooms. The building is well maintained and decorated to a very good standard. Peoples’ rooms have an individual feel and contained their pictures, ornaments Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 16 and small pieces of furniture. There are two maintenance workers at the home who work very hard to ensure that building is safe and well maintained. The grounds are beautiful and well kept. There are car park facilities for visitors and staff. During the tour of the building it was evident that that the home was very clean and well maintained. The home employs a housekeeper who is responsible for a group of domestic staff. The domestic staff are to be commended for their hard work in ensuring the home is clean and free from offensive odours. The laundry area is accessed through the Convent. Washing machines wash at the correct temperatures to minimise the risk of cross infection. Residents and visitors we spoke with said the home was always clean. Training records indicated that staff have undertaken training in infection control. Staff awareness of this issue minimises the risk of cross infection and better protects people who use the service. Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 17 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): 27, 28, 29 and 30 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. All the staff at the home work very hard to meet the needs of residents and are provided with good training opportunities to further enhance their knowledge and skills. Recruitment practices are sufficiently detailed in order to protect residents at the home. EVIDENCE: Present on the day of the inspection were the manager, two nurses, seven carers, two handypersons, three domestics, one cook and a kitchen assistant. The staffing rotas examined reflected this. The manager stated that there is always at least one trained nurse on duty. The manager has recently employed a nurse tutor to offer advice and carry out in house training for all staff. People who use the service told us that they felt there were enough staff on duty to meet their needs. One resident told us the staff were, “Very nice”. Records indicated that well over 50 of care staff have undertaken NVQ level 2 training or equivalent. Three staff files were examined. These files, of the most recently employed staff, contained all the information required by standard 29 of the National Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 18 Minimum Standards. This included CRB disclosures, proof of identity and two written references. A good practice recommendation has been issued that all written references received from referees should contain a company stamp or letter headed paper to further confirm its authenticity. Staff were positive regarding the opportunities for training at the home. Records of staff training indicated that the majority of staff have completed the required training. As a result of a good practice recommendation made at the last inspection the manager has developed a training over view plan to assist in the provision of future training at the home. The manager has also developed a training plan for the coming year and all staff have an individual training plan. The home has an excellent induction system for all new staff. Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 19 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): 31, 33, 35 and 38 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager of the home is professional and knows the residents very well and understands their needs. Residents have opportunities to have a say in how the home is run. Residents’ financial interests are being safeguarded. The health and safety of residents and staff are being promoted and protected. EVIDENCE: Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 20 The registered manager is a qualified nurse, and also has a certificate in NVQ level 5 in management and BSc in professional nursing practice. Both people who use the service and staff that we spoke with were very positive about the manager’s role within the home and her ability to create an open and inclusive atmosphere. One resident commented that the manager is, “A very nice person”. Staff said the manager is, “Very helpful”. The registered provider carries out monthly visits to the home and provides written reports to the CSCI. Following a requirement made at the last inspection, the results of any quality monitoring questionnaires are now published and made available to all interested parties. These quality monitoring systems provided evidence that the home makes changes to the service provision and acts on suggestions made by people who use the service. Feedback received from residents and their representatives was overwhelmingly positive regarding the quality of care provided by staff at the home. All residents have a lockable safe in their room. Small amounts of money are held in these safes and most people manage their own financial affairs. We checked a random sample of accounts that the manager assists residents with. All these accounts were accurate and clear audit trails were in place including appropriate receipts. Satisfactory Records in relation to fire safety were examined. Following a good practice recommendation, made at the last inspection, night staff are now undertaking fire drills every three months so they are confident they know what to do in the event of a fire occurring in the home at night. Records indicated that fire equipment is being checked and serviced regularly. The home has a range of health & safety policies, including manual handling, fire safety, first aid, food hygiene and infection control. Maintenance checks had been made on the home and follow up work completed. Up to date test certificates for gas, electrical installation, electrical appliances and Legionella were inspected. Water temperatures are being monitored weekly and all radiators seen were appropriately covered. Portable appliance checks are carried out by the maintenance staff who have been trained to do so. Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 21 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 X X 4 Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The registered person should ensure that all medication that is carried over from the last months supply is accurately recorded. 2 OP29 The registered person should ensure that references for all new staff include a company stamp or letter headed paper to further evidence their authenticity. Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection London Regional Office 3rd Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Henry Nihill House DS0000010452.V343737.R01.S.doc Version 5.2 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. 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