Inspection on 27/09/05 for Bracken Villa Care Home

This inspection was carried out on 27th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bracken Villa Care Home 06/07/07

Bracken Villa Care Home 07/07/06

Bracken Villa Care Home 23/05/05

Bracken Villa Care Home 17/02/05

Bracken Villa Care Home 03/11/04

Bracken Villa Care Home 19/01/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Bracken Villa Care Home 6 Bracken Lane Retford Nottingham DN22 7EU Lead Inspector Jayne Hilton Unannounced 27 September 2005 at 3:00 pm th 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 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 Stationary 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 Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Bracken Villa Care Home Address 6 Bracken Lane Retford Nottingham DN22 7EU 01777 719720 01777 719645 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Voyage Limited James Simpson Care Home (CRH) 8 (Eight) Category(ies) of Learning disability (LD) - 8 (Eight) registration, with number of places Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23/5/05 Brief Description of the Service: Bracken Villa is a detached house, set within its own grounds, close to the centre of Retford. There are also 2 small self contained flats, which provide accommodation for 2 service users who are semi-independent.Car Parking is available on the drive and on the street too. There is a large attractive garden to the rear of the property, which includes a sensory area, developed with input from the residents .Six residents with learning disabilities and challenging behaviour are accommodated in single bedrooms, one of which is on the ground floor, within the main home. All rooms meet with or exceed the size requirements and show evidence of being well personalised and decorated to suit the individual resident. The manager is hoping to proceed with en-suite bathrooms for the bedrooms that this is possible for.The property benefits from a large lounge and separate dining room. In addition, there is a kitchen with a large attached conservatory. The home is well maintained and provides a good standard of homely, comfortable and attractive accommodation in pleasant surroundings. Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out on 27th September 2005, by Regulation Inspector Jayne Hilton, which lasted 1 hour 40 minutes. All of the key standards had been assessed at the previous inspection. The methodology used included a part tour of the environment, speaking with a two residents individually. The manager was unfortunately not in attendance on the day of the inspection. Two staff were spoken with briefly. A sample of records was examined including two development plans. Direct and indirect observations were also made particularly regarding staff/resident interaction. The inspection was very positive and it was clearly evident that the support given to service users continues to be, of a very high standard. The residents at Bracken Villa preferred term of address in this report is ‘residents’. The Inspector wishes to thank the residents for their hospitality and co-operation during the visit. What the service does well: The residents spoken with confirmed that they were happy at Bracken Villa and that the staff team had enabled them to develop skills and had provided opportunities they would not necessarily have had anywhere else. Clearly Bracken Villa is unique service, which balances a structured environment with the promotion of rights, respect and responsibility in meeting resident’s needs. Residents know what their support plan is and understand its purpose; they are involved in the development and review of their support. Reviews are held regularly but also when the need arises. Care plans are presented methodically and are well organised. Residents spoken with feel they are offered plenty of opportunity to participate in the day-to-day running of the home. Good risk assessments in place for all residents and these are reviewed regularly. Residents are encouraged to develop independent living skills and to take part in community activities and educational opportunities. Residents are encouraged to retain and learn new skills. Residents spoken with stated that they were happy with the meals provided and that they are involved with choosing and cooking the meals. Bracken Villa is a clean and comfortable home. Service users bedrooms are personalised. Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: 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 Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 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 standard(s) 1,2, 3, Prospective residents have the information they need to make an informed choice about where to live and know that their needs and aspirations will be assessed and met within the constraints of the service provided. EVIDENCE: An up to date Statement of Purpose and Service user guide was seen in the home. Initial assessments were seen in the two development plans examined. The manager and staff members spoken with demonstrated the necessary knowledge and skills to work with the residents. Observations of staff/resident interaction were calm and mutually respectful. The residents spoken with confirmed that they were happy at Bracken Villa and that the staff team had enabled them to develop skills and had provided opportunities they would not necessarily have had anywhere else. Clearly Bracken Villa is unique service, which balances a structured environment with the promotion of rights, respect and responsibility in meeting resident’s needs. Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 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 standard(s) 6, 7, 8, 9 Residents know what their support plan is and understand its purpose; they are involved in the development and review of their support. Reviews are held regularly but also when the need arises. Care plans are presented methodically and are well organised. Residents spoken with feel they are offered plenty of opportunity to participate in the day- to- day running of the home. Good risk assessments in place for all residents and these are reviewed regularly. EVIDENCE: All of the residents spoken with, including a recently admitted resident were familiar with their development plan and contribute to the review process, Clear evidence was seen of their contribution within the plans. The plans were noted to be reviewed appropriately. Care reviews are held regularly which involve social workers and CPNs [Community Psychiatric Nurses] as necessary. The development plans were presented methodically and are well structured. Residents have an allocated key worker Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 10 There are individualised procedures for any potential aggressive behaviour. Residents confirmed that they are involved in most things to do with the responsibility in ensuring that the environment is clean and tidy. Various rotas were observed for tasks such as cleaning the minibus and housework There are fortnightly residents meetings and this time is for anything the residents wish to discuss, including the opportunity to discuss issues regarding the dayto - day running of the home. One resident has recently moved out of the home, on to a more independent living situation, which vacated one of the semi -independent bungalows for another resident to be able to move into. The resident was delighted to have this opportunity and reported that he was very happy and that the service provided at the home is excellent. Information on advocacy groups was noted on the notice board. There were good risk assessments within the development plans, which had been reviewed regularly. There are procedures for unexplained absences on each individual residents file. Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 11 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 standard(s) 11, 12, 13, 14,16, 17 Residents are encouraged to develop independent living skills and to take part in community activities and educational opportunities. Residents are encouraged to retain and learn new skills. Residents spoken with stated that they were happy with the meals provided and that they are involved with choosing and cooking the meals. EVIDENCE: It is the culture in Bracken Villa that the residents share responsibility for different household tasks. Thus, encouraging independent living skills. Two residents live in their own independent living flats and are working towards living independently. A resident explained to the inspector how they take the temperature of the fridge and kept their flat clean and tidy. The flats were noted to be immaculate and the residents proud of their achievements and opportunities. One service user who had explained at the previous inspection that his goal was to leave Bracken Villa at the end of the year to live independently had done so. Residents spoke about doing the cleaning and taking it in turns to cook the evening meal. There is also a monthly kitchen rota, which includes loading and unloading the dishwasher. Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 12 Some residents are under guardianship orders under the Mental Health Act and therefore restrictions are imposed regarding this and are documented. Residents go out to college and also have opportunities to mix with other people, not just those they live with. If they choose to residents can attend the local college. Some of the residents had undertaken NVQ in Bird Care. It was evident from discussion with both service users and staff that access to and participation in the local community is actively promoted. A full and varied programme of activities was displayed which included, bike riding, bowling, horse riding, five a side football, monopoly, bingo, boules, quiz, and treasure hunt. Community facilities such as the swimming baths and bowling alley are regularly used and enjoyed by the service users. Residents and staff have created a quiet garden area, and one resident showed the inspector the recently acquired guinea pigs. In house entertainment systems were provided in the main lounge, such as a wide screen television, music centre, DVD and SKY television. A ‘rec room’/social club room is provided which is equipped with appropriate recreational equipment and residents can purchase sweets, and other provisions from the shop facility. From observation and discussion with residents, it was evident that all staff respect residents right to privacy. Residents were observed using keys to their rooms. Lockable facilities were available in the rooms. The atmosphere in the home was relaxed and staff and service residents were seen engaging and interacting with each other. Residents confirmed that mail is given to them unopened. The residents’ preferred term of address is now documented in the development plans. At the previous inspection one resident had a monitor alarm in his room to assist staff support for his epilepsy, and this was not documented on the individuals development plan. A staff member reported that this had been removed and not now used as it had been deemed to be an invasion of the resident’s privacy. The inspector explained the reasoning behind the need to justify any limitations imposed, and that balancing the needs of residents sometimes meant that such limitations might be reasonable and acceptable however consent and documentation regarding this is needed. With assistance from staff, residents organise a weekly menu plan and residents confirmed they take it in turns to cook the evening meal, with support. The menu is recorded on flip chart in the dining room so all residents have a say in what meals are provided. The menu’s seen showed nutritious, varied and balanced meals. Residents confirmed that are also involved in the purchasing of food by going along with a member of staff to the supermarket. A system has been introduced for stock rotation and use by dates. There is usually a monthly trip out to a local restaurant for a meal. Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 13 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 standard(s) 18, 19,20, The healthcare needs of residents are generally being met and there are systems in place for monitoring health needs, including behaviours in place The resident’s wishes regarding death and dying recorded and are very detailed and residents are, protected by, good management of medicines in the home. EVIDENCE: Both of the residents spoken with are fully aware of what their development plan is and what is its purpose. Residents spend allocated time with their key worker each month to reflect back over the previous month. This is an opportunity for residents to be involved in the reviewing of how their personal support is provided. The home maintains good links and relationships with necessary resources such as Community Learning Disability Teams and community psychiatric nurses. From talking with residents and staff it was apparent that personal support is flexible and the overall culture of the home is to promote choice, control and independence. Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 14 The system for documenting healthcare checks has been revised and information for healthcare checks was well documented but the format used did not separate out each type of medical check and still means that when information is archived this information may be difficult to locate. It is recommended that a running history be kept on each health need, such as chiropody, dentist, GP, annual well person checks etc. The system would ensure that information is at hand and that regular appointments are not overlooked. Staff can use to reference and pattern any re-occurring or ongoing health issues A brief assessment was made of the management of medicines in the home. Policies for medicines management are now kept in the office and copies of these are kept with the medication. The drug error policy is sited where staff can instantly access this, informs staff that any errors in medication procedures must be reported to CSCI under regulation 37 requirements. There was excellent medication overview information on each resident taking medication in the medicines cupboard; copies should be transferred into development plans in creating a medication profile and record of medication reviews and changes to medication. Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 15 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 standard(s) 22 The home has a complaints policy which residents are aware of, and know how to use. All complaints are responded to within 1 working day and concerns expressed are also recorded. EVIDENCE: There is a book for which all concerns and complaints are recorded in, including if and what necessary action has been taken. There were no concerns reported since the last inspection. The residents spoken with are all fully aware of the complaints procedure and one service user showed me his complaints procedure, which is framed and displayed in his bedroom. All information on the procedure is up to date and includes how to contact the Commission for Social Care Inspection. Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 16 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 standard(s) 24-30 Bracken Villa is a clean and comfortable home, which provides adequate communal space. Service users bedrooms are personalised. The toilet and bathroom provision is adequate but could be improved by further en-suite provision. The service users independence is maximised by the facilities and equipment in the home. EVIDENCE: Bracken Villa is a detached house, set within its own grounds, close to the centre of Retford. There are also 2 small self contained flats, which provide accommodation for 2 service users who are semi-independent.Car Parking is available on the drive and on the street too. There is a large attractive garden to the rear of the property, which includes a sensory area, developed with input from the residents . Six residents with learning disabilities and challenging behaviour are accommodated in single bedrooms, one of which is on the ground floor, within the main home. All rooms meet with or exceed the size requirements and show evidence of being well personalised and decorated to suit the individual resident. The manager is hoping to proceed with en-suite bathrooms for the bedrooms that this is possible for, which would further improve the promotion of privacy and dignity for individuals.The property Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 17 benefits from a large lounge and separate dining room. In addition, there is a well fitted and equippedkitchen with a large attached conservatory. The home is well maintained and provides a good standard of homely, comfortable and attractive accommodation in pleasant surroundings. Bedrooms seen were very personalised with service users own furniture and chosen décor, including personal photos, artwork and posters etc. The home has sufficient bathrooms and toilets. The ground floor bedroom now has an en-suite facility to meet the needs of the service user, Work is in process to cover a number of radiators of which those in bathrooms pose a risk and must be covered as priority. The floor covering to the floor covering in the brown bathroom, which was at risk of lifting and may cause a trip hazard has now been secured. From observation and being shown around the home, the premises appeared clean, hygienic and free from offensive odours. Disposable gloves were noted to be available in the laundry room and liquid soaps are provided in all bathrooms etc. Laundry facilities are sited appropriately to prevent risk of infections and washing machines have the specified programming ability to meet disinfection standards. A number of fabric aprons have been purchased and personalised with each residents name and a staff member was observed wearing an apron when preparing food on the day of the inspection. In the independent living accommodation, the fridge temperatures were methodically taken by, the residents living there and records were seen of one. The independent living flats were both kept immaculately clean and the residents are commended for this. Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 The resident’s lifestyle and choices are sometimes limited due to delays in staff training provision in certain areas. This is out of the manager’s hands as arranged via head office. EVIDENCE: At the previous inspection residents had expressed that they did feel there community activities had been affected as new staff were prevented undertaking certain activities until they had achieved appropriate training. Residents stated it seemed there was unnecessary delay on occasions in the provision of the training. It was reported by staff at this inspection, that the situation had not been rectified and one session had been cancelled recently. This is out of the manager’s hands as arranged via head office. Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 41 Residents’ rights and best interests are safeguarded by the homes record keeping policies and procedures. EVIDENCE: All records seen during the inspection are maintained, up to date and accurate. The home has a good system for archiving records and ‘filtering’ information from the current development plan. Accident records are kept on individual service resident’s files. The incident records were examined and regulation 37 notifications have been made to CSCI when relevant. All records are kept secure. Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 20 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 3 x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 4 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 4 Standard No 11 12 13 14 15 16 17 4 4 4 x x 3 3 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bracken Villa Care Home Score x x x x Standard No 37 38 39 40 41 42 43 Score x x x x 4 x x C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 21 No Are there any outstanding requirements from the last inspection? 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 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 YA19 Good Practice Recommendations Further improve and incorporate running history sheets in development plans for all healthcare checks for easy reference and evaluation of whether healthcare needs are being met. Use the medication profiles in the development plans and include details of medication reviews and changes of medication. Provide ensuites to bedrooms where space allows Consider residents comments regarding training delays and action accordingly. 2. 3. 4. YA20 YA27 YA35 Bracken Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Edgeley House Tottle Road Riverside Business Park Nottingham, NG2 1RT 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 Villa Care Home C53 C03 S8635 Bracken Villa V248122 270905 Stage 4.doc Version 1.40 Page 23 - 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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