Inspection on 22/02/06 for Bracken Lodge

This inspection was carried out on 22nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bracken Lodge 08/05/07

Bracken Lodge 06/06/06

Bracken Lodge 27/07/05

Bracken Lodge 15/12/04

Bracken Lodge 29/06/04

Bracken Lodge 05/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bracken Lodge 5 Bracken Road Southbourne Bournemouth Dorset BH6 3TB Lead Inspector Marjorie Richards Unannounced Inspection 22nd February 2006 03:15 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 Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bracken Lodge Address 5 Bracken Road Southbourne Bournemouth Dorset BH6 3TB 01202 428777 NO FAX 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) Mr W O`Flaherty Miss V Flemming Miss V Flemming Care Home 18 Category(ies) of Dementia - over 65 years of age (18) registration, with number of places Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th July 2005 Brief Description of the Service: Bracken Lodge is a large detached property, situated in a quiet residential area of Southbourne, Bournemouth. The home is positioned within 400 metres level walk from the centre of Southbourne, which offers a wide range of amenities, such as shops, post office, churches, GP surgeries and library. The home is also close to the cliff top and sea. Parking for visitors is available on surrounding roads and there is a good local bus service nearby. Bracken Lodge is registered with the Commission for Social Care Inspection to accommodate up to 18 older people with dementia, who are in need of 24-hour nursing and personal care. The property has been converted for use as a care home and is arranged over three floors. A passenger lift is available to assist access between floors. The home has fourteen bedrooms, ten of which are for single occupancy. None of the bedrooms has en-suite facilities, but there are sufficient numbers of communal bathrooms and W.C.s available. The home has a lounge on the ground floor, which also provides a small dining area. This is the only communal space so recreational facilities are somewhat limited. There are issues over accessibility to some rooms but staff make good use of the space available. A secure garden is not available, but there is a paved patio area, with a water feature and pots of seasonal colourful flowers, where service users can sit out under staff supervision. Service users are encouraged to participate in a range of activities organised within the home. An inter-denominational service is held in the lounge every two weeks and service users are welcome to participate if they wish. Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 2 3/4 hours on the 22 February 2006 and was one of two statutory inspections carried out each year. The main purpose of the inspection was to check that the service users living in the home were safe and properly cared for and requirements made at the previous inspection had been met. The previous inspection took place during July 2005; since that inspection no complaints about the home have been received or investigated. A tour of the premises took place and the inspector spoke with four service users, two staff and together with registered manager, Ms V. Flemming, considered other evidence relating to the National Minimum Standards, as described in this report. Additional information used to inform the inspection process included the reports periodically sent to the Commission by the registered provider, Mr OFlaherty. The Inspector also spoke with Mr OFlaherty by telephone during the inspection. At the last inspection, most of the National Minimum Standards examined were met, so this inspection was brief in duration and focussed on assessment of only the most essential Standards. The majority of Standards assessed and found met during the previous inspection were not reassessed during this inspection; this report should therefore be read in conjunction with the report of the previous inspection of 27th July 2005. As part of the inspection process, comment cards were distributed to the care home by CSCI for completion by service users, relatives, G.P.s, health and social care professionals etc. The following comment cards were received; 0 from service users, 0 from relatives, 0 from care managers, 0 from health/social care professionals and 3 from General Practitioners. Those comment cards received expressed satisfaction with the care provided. What the service does well: All service users are supplied with terms and conditions of residence at the point of admission to the home. These are clearly laid out and easy to read. Prospective service users and their relatives or representatives are encouraged wherever possible to visit the home prior to admission. This gives an opportunity to look round the home, meet with other service users and staff and assess the facilities on offer, as well as ask any questions. A trial period is available before taking any decisions about making residence permanent. The evening meal on the day of inspection was soup of choice, followed by an assortment of sandwiches, then fresh fruit with strawberry whip. Alternatives Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 6 are available to suit individual preference. Special diets are catered for. A service user commented, I am looking forward to teatime, I like my tea. Service users have their legal rights protected and are assisted in exercising their rights. The home has an Adult Protection policy in place to ensure service users are protected from possible abuse. All staff have received in-house training in Adult Protection issues, to ensure a proper response to any suspicion or allegation of abuse. The home seeks to provide a safe environment to ensure the protection of service users. Measures are in place to promote the health and safety of service users. For example, equipment is regularly serviced and maintained. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place. What has improved since the last inspection? What they could do better: Ms Flemming says it is now her policy to make random checks upon medication administration and records, to ensure a proper audit trail. It is recommended that the medication policy be updated to reflect these changes. Ms Flemming says she is working to enrol more staff for National Vocational Qualification (NVQ) training, so she can achieve the minimum ratio of 50 trained members of care staff at NVQ level 2. This will help ensure service users at Bracken Lodge are in safe hands. Staff training is taking place, but the records for induction and foundation training are still poorly maintained. These must be kept fully up-to-date in order to evidence the satisfactory completion of such training. Ms Flemming is an experienced Level 1 Registered Nurse but is still working to achieve the National Vocational Qualification (NVQ) Level 4 in management, which she hopes to complete by April 2006. (Recent difficulties with the course have lead to delays which have been beyond Ms Flemmings control.) Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 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. Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 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 Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 (Standards 1 and 3 were found met at the previous inspection) The home does not provide intermediate care so Standard 6 does not apply. Service users are issued with a contract describing Terms and Conditions of occupancy at the point of admission to Bracken Lodge. Prospective service users and their relatives or representatives are invited to visit the home prior to admission to enable them to assess the facilities and services provided. A trial period is also available before making any decision about whether or not to stay. EVIDENCE: All service users at Bracken Lodge are issued with terms and conditions of residence. This document is clearly laid out and easy to read. The terms and conditions are signed by the service user or their representative and the registered provider. The service user and/or their representative retain a copy and a copy is held on file. Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 10 Ms Flemming says that, where possible, she always encourages prospective service users and their relatives to visit the home prior to admission. She feels it is helpful for them to have opportunities to look round the home, meet with other service users and staff, assess facilities and ask any questions. It also helps with the assessment about whether the home can provide for the prospective service users needs. A trial period is available before taking any decisions about making residence permanent. At the last inspection, it was recommended that more information about the trial period been made available in the Service User Guide. This has now been achieved with the use of an addendum on a separate sheet of paper, but this will be incorporated into the Service User Guide when further copies are next printed. Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 (Standards 7, 8, 10 and 11 were found met at the previous inspection) There are satisfactory arrangements in place for managing medication and ensuring that the medication needs of service users are met. EVIDENCE: Only qualified nursing staff are involved in the administration of medication. A sample of Medicine Administration Record (MAR) charts was checked and the dispensing of medicines observed. Staff sign to record that medicines have been given as prescribed or record the reason for non-administration. Information on the medicines used is available for staff reference or for the service user or their representative if requested. Ms Flemming says it is now her policy to make random checks upon medication administration and records, to ensure a proper audit trail. Satisfactory arrangements have also been made for the disposal of unwanted/unused medication. It is recommended that the medication policy be updated to reflect the above changes. Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 (Standards 12, 13 and 14 were found met at the previous inspection) Bracken Lodge serves a balanced and varied selection of food that meets service users’ tastes and special dietary needs. EVIDENCE: There is no separate dining room at Bracken Lodge but staff make the best use of available space. A table and chairs is available in the lounge, but the majority of service users remain in their armchairs to eat their meals, or have meals in their bedrooms. Breakfast is served from 7 00am –7.30am, or later to fit in with the wishes of service users. Morning coffee or tea with biscuits is served at 10.00am. Lunch is served at around mid-day and afternoon tea with cake/biscuits at 3.00pm. The evening meal is served at 4.30pm - 5.00pm and hot drinks with biscuits or a snack are available from 8.30pm. Mealtimes can be flexible to fit in with care needs, appointments etc. Staff confirmed that drinks and snacks are available throughout the night from night staff. The evening meal on the day of inspection was soup of choice, followed by an assortment of sandwiches, then fresh fruit with strawberry whip. Alternatives are available to suit individual preference. Six service users need assistance with feeding and four of these have a pureed diet. The home also caters for two other service users with special dietary requirements. A service user commented, I am looking forward to teatime, I like my tea. Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 and 18 (Standard 16 was met at the previous inspection) Service users have their legal rights protected and are assisted in exercising their rights. The home has an Adult Protection policy in place to ensure service users are protected from possible abuse. EVIDENCE: Ms Flemming confirmed that all service users are on the electoral roll. During local and national elections, opportunities are made available to service users to either vote in person, by proxy or by post. Transport to the polling station is provided if necessary. Information about advocacy services is available on request. During the last inspection, a few minor amendments were found necessary to the homes Adult Protection policy. These have now been achieved. The Adult Protection policy makes reference to the Department of Health No Secrets document and is in line with this guidance, thereby ensuring that any allegations of abuse can be managed effectively. All staff have received inhouse training in Adult Protection issues, to ensure a proper response to any suspicion or allegation of abuse. Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 24 (Standards 19, 20 and 26 were met at the previous inspection) A suitably qualified person has carried out an assessment of the premises as a whole, to ensure that service users have the equipment they require to maximise their independence. Bedrooms are comfortable and service users can bring their own possessions to create a more homely feel. EVIDENCE: A suitably qualified person, (an Occupational Therapist,) has carried out an assessment of the premises as a whole. Advice is also sought from suitably qualified persons if specialist equipment is needed for individual service users. Bracken Lodge has a passenger lift to assist service users in accessing the ground/first/second floors. However, access to some parts of the home is more difficult, due to the constraints of the building. Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 15 Suitable equipment is provided throughout the home such as grab rails, raised toilet seats and commodes to help maximise the independence of service users. The service users bedrooms at Bracken Lodge are, in general, comfortable, pleasantly decorated, light and airy rooms. They are adequately furnished and individualised with some personal possessions. Not all of the furniture and equipment detailed in this Standard is available in every bedroom. Service users are risk assessed and this determines the range of furniture provide. E.g., there may not be a bedside lamp for reasons of safety. Curtains are available in shared rooms to assist with privacy and the preservation of dignity. Most bedrooms are carpeted, with a few exceptions where vinyl floor coverings are in place to assist in dealing with serious incontinence. Some bedroom windows had in the past been fitted with bars for safety reasons. Mr OFlaherty has been able to arrange alternative methods to limit opening of these windows, keeping service users safe, but making these rooms much more welcoming in appearance. Since the last inspection, four new height adjustable beds have been purchased and a new air mattress. Redecoration of the hall and lounge has taken place and redecoration of a bedroom is planned shortly. Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 30 (Standards 27 and 29 were met at the previous inspection) Bracken Lodge is still working to achieve the minimum ratio of 50 trained members of care staff at NVQ level 2, to ensure service users are in safe hands. A training programme for all staff has been implemented, to make sure that staff are competent to do their jobs. The home has a staff induction programme in place for new employees but these records still need improvement to fully evidence that training is taking place. EVIDENCE: A total of 10 care staff are employed at Bracken Lodge. At present, none of the care staff have achieved National Vocational Qualifications (NVQ) in Care, level 2. However, three staff have commenced NVQ level 2 and a further four staff have expressed an interest in NVQ level 2 training, to be arranged later in 2006. Ms Flemming says she is working to achieve the minimum ratio of 50 trained members of care staff at NVQ level 2, to help ensure service users at Bracken Lodge are in safe hands. At the last inspection, it was noted that a considerable effort had been made to ensure that staff had the training necessary to meet the needs of service users. Care staff had undertaken training in Health and Safety, Abuse Awareness, First Aid, Basic Food Hygiene, Infection Control, Care of the Dying Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 17 and Incontinence Care. Nursing staff had undertaken training in influenza immunisation/anaphylactic shock and suprapubic catheters. All staff had also undertaken training in Moving and Handling, Dementia Care and Dealing with Challenging Behaviour and Aggression. Much of the training is in-house, including the use of videos, with some support from external courses. A requirement was made with regard to the improvement of induction and foundation training records, as details of training could not be evidenced from training records. This has still not been fully achieved, so the requirement is repeated at the end of this report. Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 38 (Standards 32, 33 and 35 were met at the previous inspection) Ms Flemming leads by example to ensure that service users receive a good standard of care. She is well supported by a team of nursing, care and ancillary staff. The home seeks to provide a safe environment to ensure the protection of service users. EVIDENCE: Ms Flemming is an experienced Level 1 Registered Nurse and is currently undertaking the National Vocational Qualification (NVQ) Level 4 in management, which she hopes to complete by April 2006. (Recent difficulties with the course have lead to delays which have been beyond Ms Flemmings control). Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 19 Ms Flemming says she is a very hands on manager and operates an open door policy, which ensures that anyone can have access to her at any time. She says feels it is important to remain open and accessible and this was demonstrated during the inspection. Ms Flemming feels that she is well supported by the registered person, Mr OFlaherty. He visits the home at least once a month and prepares a written report on the conduct of the home, a copy of which is forwarded to the Commission. The Inspector was also able to speak with Mr OFlaherty by telephone during the inspection, when he expressed satisfaction with the management of the home. From touring the premises, looking at records and speaking with staff, it is evident that measures are in place to promote the health and safety of service users, e.g. equipment, such as the lift, portable electrical appliances, hoists etc are regularly serviced and maintained. All substances that could be potentially hazardous to health are handled and stored safely. Radiator surfaces are guarded and limiters have been fitted, to restrict the opening of windows for service user safety. The bars that were in place at some windows have been replaced, creating a much more homely impression. Examination of the fire records shows that appropriate procedures are in place to ensure the safety of service users and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place. Routine checks are carried out at appropriate intervals and staff confirm this. Staff and records confirm that fire training is being carried out at the required intervals, to ensure that staff are fully aware of what to do in the event of fire. However, the fire drill is overdue, but planned for next week. Care must be taken to ensure fire drills are always carried out at six monthly intervals. Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 X X X 3 X 3 X X STAFFING Standard No Score 27 X 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X 2 Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP30 Regulation 18(1)(c) Requirement It is required that all members of staff receive training appropriate to the work they are to perform. Detailed records must be kept to evidence that staff are receiving induction and foundation training. (Previous timescale of 30/11/05 not met.) It is required that the registered person continues to ensure the manager receives suitable assistance, including sufficient time, for the purpose of obtaining the NVQ level 4 in Management. (Previous timescales of 31/5/05 and 30/11/05 not met.) It is required that the registered person ensures that those working in the home are aware of the procedure to be followed in the event of fire. Fire drills must take place every six months. Timescale for action 31/05/06 2. OP31 9(2)(b)(i) 31/05/06 3 OP38 23(4)(e) 31/03/06 Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP28 Good Practice Recommendations It is recommended that the medication policy be updated to reflect recent changes. It is recommended that a minimum ratio of 50 per cent trained members of care staff at NVQ level 2, or equivalent, is achieved. Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Bracken Lodge DS0000020429.V274780.R02.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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