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Inspection on 26/10/05 for Birchwood Nursing Home

Also see our care home review for Birchwood Nursing Home for more information

This inspection was carried out on 26th October 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All residents spoken to said staff were helpful and supportive. One said, "It is the best place I have been and I wanted to stay right away." Another resident said they had been in the home a month for a trail visit and that "this a great place and staff are really good." Residents said they liked their single ensuite/shower accommodation and used it regular when they preferred their own space. They felt involved in the decision-making processes in the home and had a copy of their care plan and service user guide within their rooms. They also said that food was good and choices were available to them. Especially enjoyed was the kitchenette area of the main lounge which providing tea making facilities for residents throughout the day.

What has improved since the last inspection?

Staff reported they felt improvements had been made in communication, staff support and team work providing a more cohesive team. This was evidenced through the recording of regular meetings held within the home. The home had also extended their quality assurance questionnaires to reflect other stakeholders in the service.

What the care home could do better:

Errors were found in the recording, administration and storage of medication. Medication policies and procedures need to be reviewed to reflect practices in the home.Evidence was on staff file in an e-mail format from Turning Point human resources to verify that criminal record bureau checks had been obtained for staff, however, the record number had not been forwarded to the manager for verification this should be recorded for future reference. Residents had personalised their rooms providing a homely appearance. Communal areas do have institional appearances especially corridors, there is also a need of redecoration in some areas. All bank staff should receive regular training reflective of the needs of residents.

CARE HOME ADULTS 18-65 Birchwood Nursing Home Lees New Road Oldham Lancashire OL4 5PL Lead Inspector Sandra Bennett Unannounced Inspection 09.00a 26 October 2005 th Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 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 Birchwood Nursing Home DS0000025456.V249264.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 Adults 18-65. 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. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Birchwood Nursing Home Address Lees New Road Oldham Lancashire OL4 5PL 0161 621 2750 0161 621 2779 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) Turning Point Mrs Sheila Margaret Matthews Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 16 (MD) No service user under the age of 18 years to be admitted to the establishment. 20th December 2004 Date of last inspection Brief Description of the Service: Birchwood is a large, detached building situated approximately four miles from Oldham town centre. The home is registered to provide nursing care for up to 16 service users with past and present mental health problems, aged 18 years and over. The property is owned and managed by the charity Turning Point, in conjunction with the local NHS Trust. Their aim is to provide care and accommodation to service users who no longer require care within a hospital setting but still require support and observation. The service offers a step down approach and enables service users to learn or re-learn life skills, enabling them to achieve independence within the community. Accommodation is in 16 single rooms, all of which have en-suite and shower facility. Two of the rooms have been adapted to form bed-sits, with a cooker and a fridge to promote independent living. Each room has a telephone, which receives incoming calls. There is a large lounge/dining room and a small library/sitting room. A kitchenette is provided for service users to make refreshments situated in the occupational therapy/computer room. The home provides a designated smoking area for service users. In addition to the en-suite facilities, there is one bathroom suitable for service users who may have a disability, and a domestic type bathroom; three communal toilets are situated in other areas of the building. The home has appropriate aids and adaptations to promote the independence of their service users. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unscheduled inspection took place on 26/10/05. During the inspection two residents were interviewed in private, as were three members of staff. Discussions also took place with a group of residents, the manager and deputy manager. Ten residents and relative questionnaires were left for completion, none had been returned at the time of writing this report. The inspector also undertook a tour of the building selecting rooms at random for inspection and scrutinised a selection of residents and staff records, as well as other documentation, including duty rotas, medication records. What the service does well: What has improved since the last inspection? What they could do better: Errors were found in the recording, administration and storage of medication. Medication policies and procedures need to be reviewed to reflect practices in the home. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 6 Evidence was on staff file in an e-mail format from Turning Point human resources to verify that criminal record bureau checks had been obtained for staff, however, the record number had not been forwarded to the manager for verification this should be recorded for future reference. Residents had personalised their rooms providing a homely appearance. Communal areas do have institional appearances especially corridors, there is also a need of redecoration in some areas. All bank staff should receive regular training reflective of the needs of residents. 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. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 4. Information is available to residents to enable an informed choice to be made. A detailed assessment ensures the home meets the needs of residents. Residents are encouraged to visit the home prior to admission. EVIDENCE: Residents are given detailed information on the home’s facilities and services, a copy of which is retained in their rooms. Interviews with residents confirmed they had been invited to visit prior to their admission. One resident said, “It is the best place I have been and wanted to stay right away” another said, “ I would not like to live anywhere else no matter how much money I had”. On the day of inspection a perspective resident was visiting for the second time and had a weekend overnight stay was planned in order for the staff to assess if they could meet the resident needs and to allow time to be spent with other residents. Another resident had been admitted for a trial period and said, “ I am only here for a months trial but this is a great place and staff are really good”. Detailed assessments of the residents needs are obtained prior to admission with an additional assessment being undertaken by the home. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Residents are involved in care planning, their independence being supported within a risk assessment framework. EVIDENCE: Residents spoke about their involvement in the care planning process. Risk assessments were detailed and reflected their assessed needs. Each resident has a copy of their care plan and risk assessment in their bedrooms. One resident showed the inspector their care plan and risk assessments to demonstrate the various activities they were involved with. Residents may have tea-making facilities in their rooms if a risk assessment indicates it is safe to do so. Any limitations placed on residents are within a risk assessment framework. Some residents spoke about going out alone into town for shopping, whilst others commented they needed staff support. Residents in the rehabilitation flats receive minimum support from staff and are encouraged to budget, shop and cook for themselves. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and17. Residents are provided with opportunities for personal development, education and leisure, which are community based in order to and promote their independence. Residents maintain contact with family and friends. Appropriate well-prepared food is provided by the home. EVIDENCE: Individual support plans are completed with the residents and identify their goals. One residents discussed their work in a photography group in further education, another their involvement in a maths and English course within the local community. Some of the residents attend a local day centre for social and therapeutic intervention. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 11 One resident said they went home to their family at weekends. Staff encouraged residents to maintain contact with their family and friends. Visiting times to the home are flexible. A number of residents commented on the quality of food served and the choices available to them. Food is served in a canteen style from a serving hatch with those residents able to do so going for their own meals and choosing what they want on their plate, staff also dine with residents. Comments made by residents included “Food is excellent here”, “It is just like home” and “Food is very good and we can get a drink when we want”. A separate small kitchen area is provided off the main lounge so that residents can help themselves to a drink whenever they wish. One resident said they would like to go on holiday. In discussions with the manager they reported that Turning Point have a holiday home and a mini bus especially for people in their care. At the time of this inspection a short holiday was being planned for those residents who wished to participate. Staff also provide in house activities, one resident said they liked the quiz and a recent trip to Blackpool. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Residents care files were maintained in good order. Residents were satisfied that their physical and emotional needs were being met. Medication procedures were not sufficient to protect the interests of service users. EVIDENCE: Four service users files were examined and contained detail care plans. The education, welfare and medical needs of service users had been recorded. Service users confirmed they are involved in the care planning process and their preferences taken into consideration. Evidence was on file of access to health professionals e.g. psychiatrist and psychologist. Residents are supported to clinical appointments by staff when required. Residents said “we have a review with our key worker and named nurse together to look at how we are doing.” Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 13 Medication policies and procedures required updating to reflect current practices in the home. There were errors in the recording, receipt, administration and disposable of medication, including some charts which were not dated. There was evidence of overstocking of medication. Resident’s consent to medication was retained on file. Risk assessments had been completed for those who self medicate. Items bought over the counter by the resident had not been identified on their risk assessment. Some drugs were also retained in a fridge, which did not require this and may affect the composition of the drug. Although no controlled drugs were being used at the time of this inspection examination of the controlled drug cupboard found that this was not secured as detailed in the Misuse of Drugs (Safe Custody regulations 1973). The home did not have a controlled drugs register. Medication is dispensed by qualified nurse with the aid of a care assistant however there is no competency assessment for those who assist with administering medication. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users were confident they could raise concerns with staff and they would be listened to. Service users are protected from abuse and exploitation. EVIDENCE: Residents did say they felt listened to if they had any concerns or complaints. How to make a complaint is reflected in the service user guide retained within the resident’s bedroom. Examination of information and leaflets given to residents from Turning Point on how to make a complaint found that these did not advise them on how to contact the CSCI should they be dissatisfied with outcome or investigation of the complaint, however there is a space on the leaflet for additional addresses to be listed, the Commission address should be added to this leaflet before giving out to perspective residents. Staff training in the protection of vulnerable adults is mandatory in the organisation. Staff demonstrated a good knowledge the forms abuse may take and was aware of the action to take should they witness such action. Staff at interview confirmed they received training in POVA as part of their initial induction at the home. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The home is clean, tidy and odour free. Residents are provided with a good standard of personal accommodation. Some areas are in need of redecoration. EVIDENCE: Residents are provided with single ensuite accommodation, which includes a shower. There are also communal bathrooms and toilets situated close to bedrooms and communal areas. Two residents were interviewed within their rooms, which they had personalised with favourite possessions. Several residents chose to spend time within their rooms preferring privacy to watch their personal choice on TV rather than with the larger community. One resident said, “I just prefer my own privacy”. Community facilities include a large lounge/dining room on the lower ground floor, a smoking room and a small kitchen, which is in addition to the homes main kitchen. On the first floor there is a small quite lounge library area available to residents. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 16 The home was clean and odour free. Only a selection of rooms were inspected some were found to have water seepage or be in need of redecoration. The corridors in the home especially have an institutional appearance with walls being painted and little other decoration. The manager reported that the decoration of the home was presently under discussion with the company responsible for maintenance of the building. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36. Staff training and induction is appropriate to residents needs. The lack of training available to bank staff may pose a risk to staff and service users. The number of staff who holds NVQ needs to be increased. Staffing levels needs to be kept under review to ensure the changing needs of residents can be met. EVIDENCE: Staff training and induction is in line with TOPSS. Each staff member has a training file, examples of training being, mental health and mental disorder, protection of vulnerable adults, health and safety and food hygiene. Five qualified nurses are in post alongside thirteen care staff of which only one has achieved NVQ2 all other staff have enrolled on NVQ3 promoting independence. The number of staff who have achieved NVQ needs to be increased. Each resident has a named nurse and support worker to ensure continuity of care. Evidence was on file of regular staff supervision sessions. This was validated through staff interviews. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 18 The home also accesses the Local Authority training partnership scheme. During staff shortages the home have a limited number of bank staff some of which are used on a regular basis. Unfortunately bank staff do not have access to training this needs to be reviewed along with staffing levels if bank staff are used on a regular basis. It was identified through interviews with staff and discussions with the manager that referrals received recently lean towards a younger age group who require more intense rehabilitation work. Although staffing levels were appropriate at the time of this inspection this needs to be kept under review in order to ensure the changing needs of residents are met. Examination of staff records found they contained all necessary checks. Criminal Record Bureau checks are undertaken by Turning Point with the home being informed when these are received. A record of the CRB number must be retained on file together with the date on which the CRB was obtained. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39 and 41. The management structure in the home provides a good support system for residents and staff through effective communication systems and consultations. EVIDENCE: The manager is a Registered Mental Nurse and holds NVQ in management and has many years experience in care of people with mental health problems. Residents and staff meetings are held two weekly to identify and resolve any problems. Staff reported that they felt having a forum to discuss issues had promoted a more cohesive staff team. A clinical nurse manager provides staff supervision and support in the absence of the manager. Resident’s and other stakeholder’s views are sought through anonymous questionnaires. Residents confirmed that staff consult with them on a regular basis many of the residents said, “staff are really great here”. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 20 In the main record keeping was well maintained however particular attention needs to be given to medication records policies and procedures. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 2 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Birchwood Nursing Home Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 3 X 2 X X DS0000025456.V249264.R01.S.doc Version 5.0 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. 1 Standard YA41YA20 Regulation 13 Requirement The registered person must ensure that an accurate dated record is maintained of all medication received or disposed of by the home. The registered person must ensure that medication administration records are signed contemporaneously. The registered person must ensure that if the dosage of medication is amended by the prescriber, the current record is discontinued and a new record is commenced. The registered person must ensure that duplicate labels are not requested from the supplying pharmacy for the purpose of affixing to the medication administration record chart. The registered person must ensure that medication is only administered to residents from containers, which have been dispensed by a pharmacist or dispensing doctor. Timescale for action 02/12/05 2 YA41YA20 13 04/11/05 3 YA20 13 02/12/05 4 YA20 13 02/12/05 5 YA20 13 08/11/05 Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 23 8 YA20 13 The registered person must ensure that all items of medication which have exceeded their expiry dates, do not belong to current residents or are not labelled with prescribed directions are separated for disposal by the appropriate agency. 04/11/05 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 YA20 Good Practice Recommendations 1 2 3 YA20 YA20 4 YA20 5 YA20 6 7 YA20 YA20 The registered person should ensure that the competency of nursing staff and carers with responsibility for medication administration is assessed regularly on a formal basis. The registered person should obtain a hardbound controlled drugs register for the purpose of recording the receipt, administration and disposal of controlled drugs. The registered person should ensure that the controlled drugs cabinet is affixed securely to an internal solid wall, using rag bolts, as detailed in the Misuse of Drugs (Safe Custody) Regulations 1973. The registered person should ensure that stocks of medication are rotated regularly and that stock is checked each month prior to medication ordering to prevent the build up of excess medication. The registered person should ensure that the temperature of the medicines refrigerator is monitored daily using a maximum/minimum thermometer and that it is only used to store items of medication which specify cold storage. The registered person should ensure that selfadministration risk assessments are expanded to include the use of any purchased remedies. The registered should ensure that the medicines policy is developed and expanded to reflect current guidance issued by the Royal Pharmaceutical Society and comply with the National Minimum Standards. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 24 8 YA22 9 10 11 YA32 YA33 YA34 The registered person should ensure that the complaints leaflet includes the address and telephone number of the Commission for Social Care Inspection, and details the right of residents to contact the Commission at any time during the investigation. The registered person should ensure the number of staff who hold NVQ is increased to 50 by 2008. The registered person should ensure that bank staff used on a regular basis are offered opportunities for training. The registered person should ensure that CRB certificate numbers are retained on staff files. Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Birchwood Nursing Home DS0000025456.V249264.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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