CARE HOMES FOR OLDER PEOPLE
Bramble Down Nursing Home Woodland Road Denbury Newton Abbot Devon TQ12 6DY Lead Inspector
Clare Medlock Unannounced Inspection 30th November 2005 10:00 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 Bramble Down Nursing Home DS0000058730.V262430.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 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. Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bramble Down Nursing Home Address Woodland Road Denbury Newton Abbot Devon TQ12 6DY 01647 440129 01647 440884 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) Peninsula Care Homes Ltd Care Home 36 Category(ies) of Physical disability (36), Physical disability over registration, with number 65 years of age (36), Terminally ill (36), of places Terminally ill over 65 years of age (36) Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th April 2005 Brief Description of the Service: Brambledown is a care home which provides personal and nursing care to a maximum of 36 Residents. The home is a purpose built care home which has two floors. The home has a passenger lift and variety of equipment, adaptions, grab rails and ramps to ensure Residents are able to maintain independence. The home have 20 single rooms and 8 double rooms. All rooms have ensuite, telephone point, radio and television and residents have an option to bring in items from home to personalise their room. There is a registered nurse on duty at all times and the home have a call bell system. There are two communal lounge areas, a conservatory and separate dining room. There are four bathrooms which are fitted with hoists. Residents have their clothes laundered in the on site laundry. There is an activities programme which Residents are able to access if they choose. Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over four and a half hours on Wednesday 30th November 2005. The inspection consisted of speaking with Service Users (who like to be called Residents), family and friends, staff and management within the home. A full tour of the premises was conducted. Care records, staff files, and other records were inspected. five of the 32 Residents, two relatives, and three staff were spoken to. Not all standards were inspected on this occasion, therefore it is recommended that previous reports are obtained to gain a broader picture of events within the home. What the service does well: What has improved since the last inspection?
Many improvements seen at the inspection were within the environment. Building work at the home is in progress and will result in a brighter, fresher
Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 6 more accessible home for residents. New bathrooms will enable residents to have an assisted bath in pleasant surroundings. New furniture, curtains, tablecloths, mirrors and pictures throughout the home provide a fresh clean environment for residents to live in. All furnishing has been provided to a high standard to provide a pleasant place for residents to live. Residents also benefit from infection control measures seen at the home. Staff now wear tabards at mealtimes and have access to gloves, aprons and hand cleansing gel for when personal care is given. Staff are now also received infection control training. These changes help to protect residents from getting infections from staff and other residents. Hygiene within the kitchen has also improved by the introduction of a staff kitchen upstairs. This means staff do not have to enter the kitchen which helps maintain hygiene standards within the kitchen. Residents now benefit from the newly appointed activities coordinator, who has restarted an activities programme. A training programme has restarted at the home. This ensures residents will be in safe hands at all times and will ensure staff have the skills and knowledge to perform their roles correctly. Staff also now have a formal induction programme which makes sure they know all about the home and how care should be given. Care Plans are also being changed. These changes will reflect the standard of care that is given and notice changes in residents conditions. Changes will also assist new staff quickly identify what specific needs residents have. What they could do better:
Residents wishes and feelings must be the main priority within the home. Whilst this is generally the case at the home, this is an area that could be improved upon. Residents have been aware of the low staffing levels recently and are glad they have been improved. Residents are aware that the staff are kind and work hard, but residents have waited for longer times for call bells to be answered at certain times of the day. The Manager should ensure residents care needs are not being delayed unnecessarily because of inadequate staff at peak times of the day. Records and record keeping must also be improved at the home to protect residents and provide evidence that care has been given. Risk assessments, consultation and safety checks must be performed before bed rails (cot sides) are used for residents. This will ensure this decision is the
Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 7 best one for the resident and that safety checks ensure the resident is safe at all times. Staff files require urgent attention to show that all checks have been performed and that files contain all the correct information. This will make sure residents are cared for by suitably qualified and fully checked staff. Staff supervision and appraisals must also be recommenced to show all staff have received adequate support and management. Resident and staff meetings should continue but records of these meetings should be made to provide evidence and refer to ensure the opinions and requests of residents, their families and staff are listened to and acted upon. Small changes to the way records are kept can also be a backward step. Staff at the home should make sure that any changes to the care plans do not prevent information being provided. The Manager must also ensure existing requirements and recommendations are acted upon within the agreed timescale. Training programmes must be completed to ensure staff are in safe hands at all times and to ensure they have all the skills and knowledge to care for 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. Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 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 Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 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): None of these standards were inspected on this occasion. Standards 1-5 were all met at the inspection in April 2005. EVIDENCE: Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 10 A clear and consistent care planning system means that the health and social needs of Residents are fully planned. Staff communicate well with the multi disciplinary team, which safeguards Residents. There is an ethos within the home that promotes the privacy and dignity of Residents at all times. EVIDENCE: Four Care Plans were inspected on this occasion which clearly demonstrated that Residents have all their needs met and make sure staff are aware of all aspects of the care. The system of Care Plans was being changed during the inspection. Newly changed care plans were inspected and were seen to be up to date, well written and complete. A new system of care planning at night was being introduced. This did not reflect in detail specific care needs, routines and likes of the residents. The deputy Matron stated that the previously used document was better and clearly identified needs. It was suggested that this document be re introduced. Records confirmed that any changes in the general or specific needs of the Residents are identified and trends monitored. Observation confirmed these documents were ‘working documents’ and reflected the high standard of personal care given. Documents show that referrals to continence specialist are made if necessary and risk of falls and
Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 11 pressure sores are made on residents. Weight charts monitor weight gains and losses in those residents at risk. All resident seen on the day of inspection appeared well cared for. Residents being cared for in bed appeared warm, pain free and had call bells within reach. Residents were seen to have clean eyes, teeth, and were dressed in their own clothes. Residents who wore glasses had them on and footwear appeared appropriate. Residents stated that they felt very well cared for and ‘you only have to ask’. Residents stated that they have been seen by other health care professionals including the General Practitioner and physiotherapist. Residents spoken to said they receive NHS services and have recently had ‘flu jabs’. During the inspection an incident within the home was dealt with calmly and efficiently. All residents said they felt that the care was very good and that it had improved in recent times because of more staff being available. Staff spoken to said standards had fallen since the last inspection because of low staff levels. Residents spoken to said waiting for call bells to be answered is better than it has been but sometimes they ‘just have to wait’ when staff are busy. One resident said she had to wait to go to bed because staff are busy. All residents said staff were very kind and caring. All residents said staff knock before entering their room and receive their post unopened. Some residents chose to have a telephone in their room. Rooms where residents share have screening which was seen to be used by staff. Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 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): 12,13 and 15 Social activities are creative, well managed and varied. Residents have choice and control over their lives whilst living at the home and enjoy the meals that are provided. EVIDENCE: When asked about the food comments included: ‘Marvellous’ ‘Beautiful’ and ‘very good’. Residents stated that there is plenty to eat and it is hot when it is served. Observation confirmed that residents eat their meals either in the dining room or in their rooms if they chose. Residents stated that there are hot drinks served early morning, mid morning, with lunch, mid afternoon, early evening and at bed time. Fresh fruit was offered after lunch. Observation of the visitors book confirmed that friends and family have access to the home at any reasonable time. Observation confirmed relatives are able to join their families for lunch with minimal notice to the home. A tour of the home confirmed that Residents rooms are personalised by bringing in personal possessions with them to the home. Residents spoken to said they are able to go out for lunch with family and friends. Residents spoken to said they always receive post unopened and are able to make and receive telephone calls in private.
Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 13 Discussion with the Manager and observation confirmed that the home have a new activity co coordinator who has recommenced the activities programme. Residents spoken to said they were able to join in with these activities if they chose. The Manager stated that Christmas entertainment included carol singers, musicians, local school children and Christmas bingo and quizzes. Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. 16 and 17 were met at the previous inspection. The recent training in adult protection awareness is beginning to protect Residents. EVIDENCE: The existing requirement that the Manager must implement adult Protection training is being implemented. The Manager stated that she anticipated that all the staff would have received adult Protection training by the beginning of 2006. The Manager stated that an external trainer is being used for the adult protection awareness training. Residents spoken to said they felt safe at the home and that staff were kind and gentle. Discussion with staff confirmed that they are aware that the use of bed rails (Cot sides) is a form of restraint. Examination of records confirmed that not all residents had a consent or risk assessment in their care plans showing that the decision had been made following risk assessment and discussion with residents, relatives and other health care professionals. Records of safety checks were not recorded although staff stated that these are done. Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21 and 26. 20,22,23,24 and 25 were met at the previous inspection. Brambledown is a purpose built and provides a safe comfortable home in which Residents are able to stay as independent as possible. The home has a good standard of décor, furnishings and fittings which provide a comfortable pleasing environment for residents to live in. EVIDENCE: Brambledown is a two story purpose built Care Home which has adaptations and equipment to ensure Residents needs are fully met. A tour of the building confirmed that the home employ a maintenance man who was observed to carry out routine and ad hoc repairs. On the day of inspection there was a lot of activity within the home. Building work was being carried out to provide three extra single ensuite bedrooms. A request to move a door was suggested to the Provider and this was actioned immediately. All work was being done behind doors to ensure the safety of the residents. Two residents were asked about the work and said although it was noisy the work had to be done.
Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 16 A tour of the building confirmed many improvements had been and were being made. A wall within the entrance hall had been removed to provide a brighter, more accessible entrance to the home. Bathrooms were being re decorated and fitted with assisted baths. New tablecloths had been provided. One resident said she thought this made the dining room look lighter. New curtains were being fitted throughout the home. The downstairs lounge had been modernised by removing a fireplace and inserting double doors for easier access. A patio door had been removed leading from the dining room to the conservatory to provide a larger communal space. Staff at the home have a new kitchen to make refreshments and have lunch, to prevent staff entering the kitchen area unnecessarily. All decoration appeared to being done to a high standard. Infection control measures have been improved within the home. Hand cleansing gel was available throughout the home, and further hand dispensers and towels were available. Tabards are now used at mealtimes and staff have received infection control training. Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30. 28 was met at the previous inspection. The stable staff group generally meet the needs of the residents, but at peak times of the day residents sometimes wait for care to be given when staff are busy. The staff files and recruitment procedures are poor. This has a potential to place Residents at risk. EVIDENCE: Discussion with staff and residents confirmed that staffing has been a real issue since the previous inspection. Staff spoken to said staffing had been a problem. Staff said that sickness and absence meant that often shifts were often running with not enough staff but this has been improved in recent weeks. Staff said although generally there were more staff it would be better to have more in the evenings to put residents to bed when they wanted. Residents said that at times over the past few months there have not been enough staff but that ‘it is better now and they seem to be coming out of the problem.’ One resident said she calls the bell if she needs anything and staff ‘get there when they can’. One resident said she now rings the bell before she needs assistance so staff get to her in time so it is never a problem. Another more able resident said he did not have a problem with waiting for staff and that all the staff are ‘wonderful’. All residents were very positive about the staff. Comments included ‘wonderful’ ‘always kind and polite’ ‘cheerful and full of fun’ and ‘Terrific’. Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 18 Four newly appointed staff files were inspected on this visit. None of the files contained all the information required. Three staff files did not have a photograph. None of the files contained a copy of the terms and conditions, Three files did not contain a second written reference. One file was for a trained nurse. This file did not contain evidence of qualification or entry to the Nursing Midwifery Council register. This information was found by the end of inspection. The Manager produced the new formal induction programme at this inspection. This programme appeared to be equivalent to a national induction programme but had been tailor made to meet the specific requirements of the home. Staff and new staff are asked to sign when they are happy that the new member is confident and capable to perform the task. Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Elements of 31,32,33, 35,36 and 38. 37 was met at the last inspection. The manager is supported well by staff within the home with all staff demonstrating an awareness of their roles and responsibilities. The home is generally well managed and provides a safe place to live. EVIDENCE: Brambledown have had a new Manager since the last inspection. Residents appeared to be at ease approaching the Manager at times during the inspection. Residents said they would go to the Manager if they had any issues. The new Manager is part way through becoming registered with the Commission for Social Care Inspection. Discussion with the Manager confirmed that quality assurance was performed in a variety of ways and this was mainly done by speaking with Residents and their families, meetings, and visits where the area manager for the company visits the home on an unannounced basis. The questionnaires produced at
Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 20 inspection were the same as at the last inspection. No new questionnaires were produced and the Commission for Social Care Inspection have not received a summary of any audits performed. Residents and staff spoken to said they felt as if they could suggest new ideas. Staff said there had been several staff meetings since the last inspection. The Manager said minutes of these meetings had not been typed up. Discussion with Residents and Relatives confirmed that the home do not manage the financial affairs of the Residents and that this is done by the Residents, their families or a solicitor. Relatives spoken to said a small amount of cash is given to the administrator to pay for sundries such as hairdressers and that they are given receipts and shown records. Records for these ‘pocket monies’ were inspected and found to be correct. However, the recommendation that the administrator obtained two signatures on receipt or removal of the money was not obtained in all cases. Discussion with staff confirmed that staff supervision has occurred informally recently but that this programme is due to resume. Generally the records seen within the home were well maintained. Accident books allow for the reporting of dangerous incidents to RIDDOR and allow follow up and action. All records seen were secure and stored in a safe manner. Training records and discussion with the Manager confirmed the training within the home has either been completed, is booked or being organised. The Manager stated she was confident that all staff would be up to date with mandatory training by the beginning of 2006. A tour of the building confirmed that the staff within the home maintain a safe environment for the Residents despite the building work being performed. Observation confirmed that the builders informed staff when the fire detection system was switched off for a short period. A warning tone was heard during this period. Bramble Down Nursing Home DS0000058730.V262430.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 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 3 x 3 X X X X 3 STAFFING Standard No Score 27 2 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 x 1 2 3 2 Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 22 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 OP18 Regulation 13(6) Requirement Timescale for action 01/01/06 2 OP18 3 OP27 4 OP29 Existing Requirement: The Manager must ensure that the adult protection training is complete 13(4a,b,c) The Manager must ensure that 31/03/06 all residents who are cared for with bed rails have: 1. Risk assessment to show this is appropriate 2. Consultation and consent from residents, relatives and relevant health care professionals 3. Safety checks performed to show any risks of entrapment or other dangers are eliminated. 01/01/06 18(1a) The Manager must ensure: 1. There are sufficient staff on duty at peak times of the day to ensure residents needs and requests are met. 2. There are sufficient staff on duty when three extra residents are cared for within the home. 19(4) Existing Requirement: 31/03/06 The Manager must ensure that
DS0000058730.V262430.R01.S.doc Version 5.0 Bramble Down Nursing Home Page 23 5 OP35 18(4) 6 OP38 13(4) staff files all contain the information listed in schedule 2 prior to employment. This includes: Two written references, photograph and evidence of trained nurse qualification (Statement of Entry and recent Nursing Midwifery Council PIN cHeck) Previous unmet 31/03/06 recommendation: The Manager should obtain two signatures when adding and taking money from the residents pocket money envelopes Existing Requirement: 01/01/06 The Manager must take steps to ensure that there is a qualified first aider on duty at all times. 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 3 Refer to Standard OP7 OP8 OP18 Good Practice Recommendations The Manager should consider the use of the previous night care plan. The Manager should consider ways to reduce the time residents wait for call bells to be answered. Existing Recommendation: The Manager should consider accessing the external adult protection training provided by the local multidisciplinary adult protection team. The Manager should make a record of meetings held at the home. Existing Recommendation: The summary of quality assurance audits and Resident questionaires should be sent to the Commission for Social Care Inspection The Manager should ensure the programme of supervision and appraisals is recommenced. 4 5 6 OP32 OP33 OP36 Bramble Down Nursing Home DS0000058730.V262430.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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