Inspection on 08/06/06 for Braunton

This inspection was carried out on 8th June 2006.

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

The inspector 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

Braunton 06/01/09

Braunton 24/01/08

Braunton 12/10/07

Braunton 06/02/06

Braunton 10/08/05

Braunton 21/02/05

Braunton 20/08/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

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

CARE HOMES FOR OLDER PEOPLE Braunton 23 Grove Avenue Yeovil Somerset BA20 2BD Lead Inspector Pippa Greed Key Unannounced Inspection 8th June 2006 09:30 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 Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Braunton Address 23 Grove Avenue Yeovil Somerset BA20 2BD 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) 01935 422176 01935 422176 Braunton Residential Home Limited MRS ALEXANDRA VICKERY Care Home 9 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (8) of places Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user with learning disabilities under the age of 65 Date of last inspection 6th February 2006 Brief Description of the Service: Braunton is a family run home providing accommodation and support for nine older people in domestic scale accommodation. Mr & Mrs Lambert, the owners, continues to be directly involved in the management of the home. Their daughter Alexandra Vickery is the registered manager and another daughter provides administrative support for the home. The management team, are supported by a small staff team. Residents are encouraged to maintain links with family and the wider community. The emphasis is on providing care within a homely environment. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was conducted over one day (7.5hrs) by CSCI Regulation Inspector Pippa Greed. This followed a satisfactory unannounced inspection in February 2006. During this time the Inspector spoke with six service users, with the owner Mrs Lambert, the secretary, and two staff members. A tour of the premises was conducted and a range of records and care plans were examined. This inspection confirmed previous judgements – this home is a well-run service, providing a good standard of care to older people. There are good systems in place underpinning administration and overall a satisfactory standard of record keeping. Service users spoken with were very positive about the service they receive. The current fee for the home is £361.00per week. The Inspector would like to thank the service users, staff and owner for their time and cooperation with the inspection process. Three requirements and three recommendations have been raised at this inspection. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: The home has a relaxed and homely feel. It is a family run home and the service users have regular contact with the owner, and manager and this makes them feel involved, and part of a large family. Staff were observed to demonstrate a good rapport with the service users and check frequently those who choose to remain in their rooms. Service users spoken to liked the staff and felt that they looked after them. Staff were familiar with the preferences and individual needs of people living at the home. The Inspector sampled the activity folder, which listed completed weekly activities. This includes resident’s choice, which allows the service users to propose ideas for entertainment. The service users spoken with informed the Inspector that they had enjoyed a day trip to Ham Hill the day before. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 6 The service users spoken to were confident that any problems or concerns would be listened to and taken seriously by the staff and manager. The standard of the meals served at the home was good and service users were offered varied teatime choices as well as the main meal of the day. 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. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Pre admission procedures are robust to ensure that the home can meet the service users needs before they are admitted to the home. The quality for this outcome group is good. EVIDENCE: The Inspector checked the files of three service users who had recently been admitted to the home. The manager meets the service users to carry out an assessment to determine if the home is able to meet their needs. This is conducted prior to admission. The management team visit the prospective service user in their own homes or hospital then carry out a trial admission period. The trial period allows for in-house monitoring and further assessment until the placement is confirmed. A visit to the home by the prospective service users is actively promoted. The home provides all service users with a contract. This was checked during the inspection process. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 9 The manager implements a detailed risk assessment of service users needs with detailed medical history which complements information received through Single Assessment Tool for adults (NHS). The care plans includes detailed checklist to monitor a range of health and behavioural symptoms. This also includes informative profile of the new service user such as background history, physical description, idiosyncrasies, likes and dislikes. However, the home had experienced two emergency admissions in the last five years. The admissions were placed out of category therefore the trial admission period was terminated. The manager dealt with the situation and safeguarded the needs of the service user and staff team appropriately. It is recommended that future emergency admission be vetted more thoroughly regarding mobility and mental health. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9,10, 11 Care plans contained sufficient information for staff to meet service users health, personal and social care needs. Risk assessments to ensure the health, safety and well being of the service users are implemented. Medication is administered and stored in the correct manner. The quality for this outcome group is good. EVIDENCE: The Inspector checked selected service users care plan. These evidenced clear checklist in place to monitor: falls, trips, invasion of privacy, confusion, aggression, violence, diabetes, dressing, denture care, front door/ missing person, theft, use of bath and hoists. The care plan included clear detailed accounts of the service users background history, physical description, idiosyncrasies and likes/ dislikes. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 11 The care plan also has a health checklist to record weight, nail care and pressure sores. These were being maintained regularly. The service users had access to local medical and health care professionals as and when necessary. During the inspection process, a GP visited a service user in the home. The staff on behalf of the service user arranged this. The staff team were observed to check on the welfare of a service user who chose to remain in their bedrooms. The staff was respectful and caring towards the service user. Four designated members of staff have responsibility for administering medication, and prior to the last inspection some additional training from Yeovil College on the safe handling of medication has been provided. The administration and storage of medication was examined and found to be robust. The Medication Administration Record included a photograph of all service users who reside in the home. The record showed a list of signatures of approved staff that administer medication. All handwritten entries were signed by two staff member. There were no gaps and no variable dosage. The record also listed medication taken, reasons for medication, and common side effect. The owner and Inspector discussed the home’s normal practice when offering care and support to service user’s family who are experiencing bereavement. The owner and manager provide appropriate support for service user’s families. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The routine in the home is relaxed and informal. Care is taken to ensure that service users wishes are met. Service users are enabled to make choices in their daily lives. The quality for this outcome group is good. EVIDENCE: The Inspector viewed the activity file, which evidenced a good selection of activity provision. This covers both in-house and outdoor activities such as singing performances, exercises, cards, dominoes, hairdressing once or twice a week, bingo, snakes & ladders, nail & beauty makeover, ‘play your card right’, quiz, and themed video showings. The home also arranges for day excursions such as cream teas outing and trips to local scenic spots. The management team have implemented a system that continually reviews and reflect on the activity provision. This is monitored through service users feedback and staff observation of service users participation or enjoyment. This is an excellent evaluation tool. Service users have opportunity at regular intervals throughout the activity timetable to nominate an activity or event of their own choosing. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 13 One service user spoken with confirmed that he has regular contact with his family. Staff also confirmed this as a family visit was planned for the next day whilst the inspection was carried out. The service user also described to the Inspector his recreational interests and reminiscences such as favourite films and childhood holidays. The bedrooms were personalised with the service user’s own belonging and favourite items of furnishings. One service user with multi sensory impairment has her own personal telephone in her bedroom, which enabled her to maintain contact with people she knows. It is advised that the Royal National Institute for the Blind (RNIB) and the Royal National Institute for the Deaf (RNID) offer a wide range of equipments to assist hearing and vision impairment such as amplification or magnification aids. The Inspector met with several service users during lunchtime and discussed mealtime options. The main meal of the day appeared appetising, and well balanced. The dining table was nicely laid with napkins. The service users told the Inspector that they enjoy the meals provided at Braunton. One service user commented ‘would recommend this place – very good here’. The service users confirmed that if they did not like what was offered, they would be provided an alternative. Whilst inspecting the kitchen, records of service users food preferences and dietary needs were seen. Later on that day, staff were observed offering service users a choice of several cold or hot teatime snacks. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Service users confirmed that they were confident in approaching the manager or owner if they had any concerns. Service users felt that their complaints will be listened to and acted upon. However, they were not fully aware of CSCI’s role and function. The home has an appropriate complaints procedure in place and complaints are fully investigated and managed appropriately. The quality for this outcome group is good. EVIDENCE: The home had received one complaint since the last inspection. This was concluded in an appropriate manner. A minor informal complaint from the service users was recorded and resolved effectively. The home has a Concern, Complaints, and Compliments file. This evidenced feedback sought from family members. This file included complimentary cards and thank you letters received from service users and their families. The Inspector suggested keeping copies of letters sent out to evidence and record what has been sent as well as received such as feedback questionnaire or complaint response letter. All current service users finances are managed by family appointee. One service user has a small amount of spending money provided by her family. Although she manages this well, she has dual sensory impairment therefore Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 15 poses some risk. It would be good practice to support the service user to safeguard her money through a lockable tin and record how much and when she receives it. Additional costs such as hairdressing and chiropody are funded by the home in the first instance and reimbursed through invoices sent to the families. Staff spoken with confirmed that they knew and understood Adult Protection Procedures. The management team have attended Protection of Vulnerable Adult training. It was a previous inspection requirement to ensure two written references are provided prior to a new member of staff commencing work. Two written references are evidenced but some are undated. The management team needs to ensure that all written references are dated. Service user have a contract in place with Braunton which protects their legal rights. The home has also recently joined the Care Aware Advocacy Service. This is positive and pro-active step towards supporting service user rights. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 16 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, 20, 21, 22, 23, 24, 25, 26 The home provides a comfortable environment for the service users. The quality for this outcome group is adequate. EVIDENCE: The home was clean, tidy and odour free on the day of the inspection. The home is decorated comfortably and service users are able to personalise this rooms in line with their choices and preferences. The service users have access to a pleasant, well-established rear garden with benches, patio table and chairs. The home also has a conservatory, which provides service user additional communal space to relax in. The bedrooms seen all have en-suite facilities. All rooms were modified to ensure service user’s safety such as radiator covers and call alert pull cord. Some hot water taps throughout the home were identified as exceeding the recommended Health and Safety Executive limits. The taps will require fitting Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 17 with thermostatic mixing valves in order to minimise risk of scalds. Water temperature checks should be carried out and recorded at least monthly in order to minimise risk of scalding injury. This was recorded as last checked by a general gas and central heating servicing on 14th March 2006. The water system should be routinely checked and inspected by a competent person, in accordance with risk assessment to prevent and protect against Legionella. It is required that flip top pedal bins are provided along with paper towels as part of infection control strategy. The home is domestic in size as it was previously the family home belonging to Mr and Mrs Lambert. The owner informed the Inspector that the home is currently undergoing a refurbishment and maintenance upgrade programme. The home would benefit from a refurbishment upgrade in the communal bathroom, communal toilets and laundry area with repairs made to tiling and new linoleum flooring. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 18 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, 28, 29, 30 Staffing levels are sufficient in order to meet the needs of the service users. Staff receives some mandatory training and some are undergoing NVQ studies. The home operates an adequate recruitment procedure. The home provides support and some 1:1 formal supervision for staff. The quality for this outcome group is adequate. EVIDENCE: On the day of the inspection, the home was staffed by one senior member of staff and two care assistant. Staffing levels were sufficient in order to meet the needs of the service users. Three staff personnel files were sampled during the inspection. These personnel records evidenced that no staff member have been recruited without a Criminal Records Bureau disclosure clearance. Staff spoken with demonstrated clear understanding of the Adult Protection procedure and what constitutes as ‘abuse’. The personnel files evidenced that two written references are sought prior to recruiting a prospective employee. However, some of these were not dated. It Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 19 is required as detailed in the National Minimum Standards that written references are dated. Some staff spoken with during the inspection process confirmed that they are currently completing their NVQ in Care. Staff are supported to study for their NVQ through a joint agreement with the home who partially fund the NVQ. The home have sourced additional NVQ funding from Business Link. There are six members of staff who have qualified in NVQ Care, which achieves the recommended target of 50 . Staff spoken with confirmed that they felt well supported by the management team. The manager operates an ‘open door’ approach with the team. Staff has been offered formal 1:1 supervision on average quarterly. However, it is recommended that the home increase the supervision frequency to the recommended six times a year. It is required that all staff receive up to date mandatory training in First Aid, Basic Food Hygiene and Health & Safety. The staff personnel file demonstrated a thorough induction training provision. Newly recruited staff were tested on their knowledge and understanding on the following subjects: - policy & procedures and where to find these, service user’s rights, dignity and equality, health & safety, service user’s care plan, service users care and choices, conduct and courtesy towards others, as well as staff’s own suggestion and contribution. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 20 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, 33, 34, 35, 36, 37, 38 An experienced management team manages the home. The home is run in the best interests of service users. The accounting procedures are satisfactory. Staff are inducted, supported and supervised. The promotion of health and safety procedures is adequate. The quality for this outcome group is adequate. EVIDENCE: The management team are well trained. The manager has completed her NVQ 4 in management and care and also the owner has attained HNC in management. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 21 The management team has attained a wide range of relevant subjects such as Ageing process, Activities & Stimulation, Catheter care, Positive Dementia, Safe handling of medication and RSA counselling skills. The management team provides in-depth induction training for newly recruited staff. This is detailed in the section relating to staffing. The management team seek the views of service users and their families, through the use of questionnaire. Questionnaire are given initially to service users with the involvement of relatives as necessary. The management team also seeks service user’s feedback on activities and staff’s feedback through a post induction questionnaire. The home does not currently act as appointee for any service user. All service users are presently supported in all financial matters by their families. The home pays for hairdressing and invoices are sent to the families. The Inspector was shown samples of invoice records and these were satisfactory. One service user has access to small allowances provided by her family. This is detailed in the section Complaints and Protection. Six members of staff have left the home in the last 12 months. The management team have been proactive in recruiting new staff and maintain appropriate staffing levels. Staff supervision is detailed in the section relating to staffing. Mandatory Health and Safety training is detailed in the section relating to staffing. Service users’ rights and best interests was deemed to be safeguarded by the home’s policies & procedures. The Inspector viewed the Safeguarding policy and Abuse policy. These policy included CSCI contact details. The following Health & Safety checks were noted: Fire check – 8th May 2006 Fire drill & training – March 2006 Passenger lifts – 5th April 2006 Gas Appliances – 14th March 2006 Hoists – May 2006 Electrical Wirings – 20th January 2006 The cleaning schedules for the home were sampled and fridge/ freezer temperatures were also checked. The records evidenced that the temperatures are within the recommended range. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 22 The Environmental Health officer visited the home on 3rd January 2006. The outcome was satisfactory and no requirements or recommendations were made. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 3 3 2 3 2 Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13(4)(c) Requirement The registered person must ensure that the temperature of the hot water must not exceed 43 C. The temperature must be recorded at least monthly in order to assess risk of scalding injury. The registered person must ensure that flip top lidded pedal bins are provided along with paper towels as part of infection control strategy. The registered person must ensure that all staff receive updated mandatory training in Basic Food Hygiene, Basic First Aid, Manual Handling, Fire and Basic Health & Safety. Timescale for action 10/07/06 2. OP26 13 (3) 31/07/06 3. OP30 18 (c) (i) 13 (4c) 13 (5) 30/09/06 Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 25 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 OP29 OP36 OP25 Good Practice Recommendations The registered person should ensure that all staff references are dated. All staff should be formally supervised at least six times per year. It is recommended that the water system in the home be tested at least annually for the presence of Legionella micro-organisms in the water supply and a strategy for the prevention of this disease be developed. Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Braunton DS0000054718.V296381.R01.S.doc Version 5.2 Page 27 - 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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