Inspection on 24/10/05 for Bridge House Nursing Home

This inspection was carried out on 24th October 2005.

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

The inspector 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

Bridge House Nursing Home 21/09/07

Bridge House Nursing Home 26/05/06

Bridge House Nursing Home 26/04/05

Bridge House Nursing Home 30/11/04

Bridge House Nursing Home 05/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Bridge House Nursing Home 64 High Street Twyford Berkshire RG10 9AQ Lead Inspector Susan Burton Unannounced Inspection 24th October 2005 09:50 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 Bridge House Nursing Home DS0000010978.V249914.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. Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bridge House Nursing Home Address 64 High Street Twyford Berkshire RG10 9AQ 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) 01189 340777 Bridge House Holdings Limited Post Vacant Care Home 47 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (41) of places Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th April 2005 Brief Description of the Service: Bridge House is a listed Georgian building just off the main Twyford high street and is close to the village shops. The home is set in ten acres of grounds with an orchard and a walled garden. In addition to the extensive gardens, there is a sitting room, dinning room, library, drawing room and conservatory for residents. The bedroom accommodation available varies in style and size.The Care Home provides 24 hour nursing care for older people and is registered to provide care for six individuals with dementia. There is a range of additional facilities available by arrangement including chiropody, dental care, and physiotherapy. The homes proprieter is Bridge House Holdings Ltd who own other care homes in the UK. Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection on Monday 24th of October 2005, which commenced at 09.50 and finished at 15.50. The inspection focused on the requirements made at the last inspection and the management arrangements in the home. The inspector spoke to a number of relatives to obtain their views as to the quality of life in the home for their family members. This was a constructive and positive inspection, which was able to evidence the efforts made by the new management arrangements to improve the homes working practices and procedures. A new manager had been appointed three weeks ago who along with the Training & Operations Manager was present during this inspection What the service does well: What has improved since the last inspection? There have been a number of improvements since the last inspection. The Training & Operations Manager had worked hard to ensure that all 14 of the requirements made at the previous inspection had been addressed or actioned. Improvements were seen in care plan documentation, risk assessments, consultation and recruitment practices. The inspector commends the efforts of the organisation to improve its management arrangements in the home. Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 6 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. Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 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 Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 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): 3,5 Information recorded evidenced that full and detailed assessments take place prior to admission. Records evidenced that trials stays and review meetings following a trial stay do take place. EVIDENCE: The inspector examined the care plans and documents of two recent admissions to the home. The pre-admission documentation provided detailed information about the health care needs of the prospective resident. The information also covered the individuals preferences for mealtimes and sleeping routines and included a social history. This detail enables an effective plan of care to be developed which is good practice. Records evidenced that trial stays take place within the home, review meetings are held at the end of each trial period to ensure the resident is satisfied that the home is right for them and that the home is able to meet their needs. Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 9 Bridge House Nursing Home DS0000010978.V249914.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 Care plans have improved since the last inspection and now provide more effective information for individuals plan of care. A previous requirement that the home assessed residents psychological needs was seen to have been met. Plans now included detail on how the home was to provide appropriate care for individuals. EVIDENCE: Plans included falls risk assessments and manual handling risk assessments. Regular reviews were seen to take place. The home is actively seeking to consult with residents and relatives about the individuals care plan, documents evidenced signatures to that effect. The inspector reviewed a number of care plans for those residents with a diagnosed dementia. Documents seen evidenced that assessments had been made of individual psychological needs and the actions required by staff to maintain and monitor the individuals well-being. The care plan formats are Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 11 being evaluated by the new manager with a view to further development and improvement. Bridge House Nursing Home DS0000010978.V249914.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): 12,13,14,15 Feedback from residents and relatives confirmed that the activities programme provided meets expectations and provides a variety of social and recreational events. The activity organiser arranges events and outings to enable residents to maintain contact with the outside world. Requirements from previous inspection had been acted on in regard to residence preferences for their morning routines. A requirement that residents choice documented on whether they wish to use the dining room for their meals or not had been acted on. Feedback from relatives confirmed that residents were satisfied with the food provided; a number of positive comments were received. EVIDENCE: The inspector spent some time discussing the programme of events and activities with the homes very enthusiastic activity organiser. She spends time whenever possible chatting on a one-to-one basis with the residents as well as organising an interesting and varied activity programme. The organiser has Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 13 recently completed a two-day training course specifically designed for activity organisers. Conversations with relatives and evidence from the homes quality assurance survey evidenced a high degree of satisfaction with the activity programme provided. The activity organiser arranges trips out for the residents to such places as garden centres. Events are also organised within the home, visits take place from gospel choirs, theatre companies and musical entertainers. Holy Communion takes place every month. Events coming up included a bonfire night party, Christmas pantomime and party and a visit from local handbell ringers. The activity organiser ensures she is on duty every Christmas Day and encourages everyone get into the Christmas spirit; she will arrange a visit from Father Christmas with presents for all the residents. The care plans in the home evidenced that work had been undertaken following requirements made at the last inspection. This was in regard to the consultation and documentation of the residents choices and wishes in regard to what time they were got up in the morning. Records indicated that staff were now asking residents about their preferences. Care plans also evidenced that staff were now consulting with residents as to whether they had their meals in the dining room, in their room or on a tray in the lounge. The new manager is reviewing the dining room arrangements to ensure that all residents are comfortable and are provided with appropriate seating and assistance. The homes quality assurance survey indicated a high degree of satisfaction with the food provided. Relatives spoken to on the day confirmed that the food provided was enjoyable and appreciated by the residents. The kitchen of the home appeared clean, tidy and well organised on the day of inspection. Bridge House Nursing Home DS0000010978.V249914.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): 16,18 The home has a compliments file and minor grumbles file, which are used by residents, relatives and staff. A previous requirement that residents with challenging behaviour were appropriately assessed and that guidelines were put in place for staff had been acted on. EVIDENCE: The inspector examined the homes compliments book which contained thank you cards from relatives, a complement from a resident to the staff on the care they had given her, comments were recorded from relatives about how the atmosphere in the home had improved and also from a relative on the patience and kindness of the homes activity organiser. The home has a minor grumbles book which had one entry relating to a resident having arrived in the home 30 minutes after a trip out and was still waiting for someone to take her hat and coat off. The manager had looked into the complaint and found that staff had been assisting another resident which had created the delay. One complaint had been made to the Commission for Social Care & Inspection since the last inspection. Communication with relatives in regard to their concerns had not been as effective as they should have been. The organisations Training & Operations manager had copied in to CSCI all of their correspondence to the complainant and had made efforts to discuss the concerns with the family. The inspector followed up aspects of the complaint during the inspection and could not find any evidence of serious malpractice. Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 15 The home should continue to ensure that it accurately documents the care given and any discussions undertaken with relatives in regard to their concerns. Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 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, 21, 26 A copy of the homes fire risk assessment was provided for the inspector and was seen to be appropriate. The home is still in progress with meeting a Fire Deficiency notice, which had been issued by the Berkshire Fire and Rescue Service. The home had been visited by the Health and Safety Executive recently and no major concerns were found. Risk assessments on safe working practices had been completed and were available for inspection. The homes bathing facilities appeared dated dimly lit, cluttered and not conducive to a pleasant bathing experience. The homes sluicing practices and arrangements need to be urgently reviewed to ensure that there is no risk to the spread of infection. The homes three sluices should be equipped and resourced appropriately. EVIDENCE: Requirements from two previous inspections that a copy of the homes fire risk assessment, which met Berkshire Fire and Rescue Services guidance, be sent Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 17 to CSCI. This had now been actioned and a copy was made available for the inspector. The home had been inspected by an officer from the Fire service and had been issued with a fire deficiency notice, which still required work to be done. The home is required to confirm to CSCI when these works have been actioned and completed. An immediate requirement had been issued at the last inspection following previous requirements being unmet, in regard to the radiators in the conservatory being covered. The heat from radiators was seen to be hazardous to the health and safety of residents sitting directly in front of them. These radiators had now been boxed in. The inspector visited all of the homes assisted bathrooms. The ground floor bathroom was used for toileting only as the sit in bath did not work; the room was dimly lit and uninviting. Bathrooms on other floors were seen to be full of trolleys, incontinence pads and waste disposal bins and did not present as a pleasant and inviting environment. The new manager was trying to resolve the storage issues but the home needs to give consideration to the refurbishment of these areas. The homes three sluices were visited. The sluice on the first floor is the only one equipped with a bedpan washer/disinfector. Staff from the ground and second floor have to travel to the sluice carrying used bedpans as neither is fitted with a bedpan washer. The sluice on the upper floor had washing facilities for equipment but this was not working. The ground floor sluice appears to be used as a flower room rather than a sluice. The home should urgently review its provision of appropriate and effective equipment to prevent the spread of infection. An immediate requirement was issued to the management that an action plan be sent to CSCI within 10 working days on how the home will resolve this. The laundry was also visited and found to be small but well organised. The floor in the laundry was seen to be damaged and in need of repair or replacement to ensure that it is impermeable and readily cleanable. Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 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): 27,29 Two requirements were made at the last inspection in regard to staff hours worked and the actual numbers of staff on duty, these were followed up at this inspection. The organisations Training & Operations Manager advised the inspector that she had reviewed the hours worked to ensure there was no risk to the safety and welfare of the residents by staff working excessive hours. RGN staffing levels had also been reviewed and now two RGNs were on duty during the daylight hours five days a week, this was still seen to be a minimum ratio with the dependency levels of residents in the home. The recruitment files of two new members of staff were examined and found to contain the information required by regulation, CRB checks were also in place. EVIDENCE: The home had a repeated requirement from the last inspection in regard to the number of hours some staff were seen to be working. Excessive hours were seen to present a risk to the competency of staff and a risk to the safety of residents. The Training & Operations Manager assured the inspector she had reviewed the shift rotas and practices to ensure that staff were no longer working excessive hours. The inspector examined the homes shift rotas and found that two RGNs were now on duty on the morning and afternoon shifts and this was also seen by the numbers on duty during the inspection. Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 19 The home is registered to admit residents with diagnosed dementias and although these six beds are not always used staffing arrangements should be reflective if admissions to these beds are made. The home was also seen to have a number of residents with challenging behaviour and high levels of dependency. Relatives spoken to and comments from the homes quality assurance survey also commented on the need for more staff. The staff on duty at the time of the inspection were seen to provide good levels of basic care and this was confirmed by the relatives, but there appeared to be little time for anything else. Staffing levels need to reflect the needs of the residents; where significant nursing attention is required the skill mix of the staffing establishment must be adjusted accordingly. Residents with dementia also require care from appropriately skilled staff. Staffing levels and skill mix are to be adequate to meet the assessed and recorded needs of the residents at all times. The manager is required to review the quality of care provided for the dependency levels of those currently in the home and for future admissions, and be reflective of the homes registration categories. A copy of this review is to be sent to CSCI. Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 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): 31,32,33,35,36,37 A new manager had been appointed since the last inspection. The manager has applied for registration with the Commission for Social Care and Inspection. The home has an effective quality assurance survey, which provides feedback from residents, relatives and other visitors. Residents finances were seen to be appropriately managed and safeguarded. Records indicated that staff are supervised. Residents rights and best interests are now more and effectively safeguarded by the improvements in the homes and documentation and management arrangements. EVIDENCE: At the time of the inspection the manager had only been in post for three weeks. She had already initiated her application to be registered with CSCI. Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 21 The manager had been previously registered with CSCI in 2003 for a different care home. She is a qualified nurse with many years experience and has appropriate skills and training for the post of manager. The inspector spent some time with the new manager discussing her plans for the future. The routines and practices will be reviewed to ensure that staff are providing effective use of their time while respecting residents preferences and choices. The manager was aware that all the recent changes will take some time for staff to get used to and was sensitive to those issues. The organisation, since the last inspection had asked the training manager to cover the vacancy for manager of the home, which she had done most ably. Since the appointment of the new manager three weeks ago the organisation had reviewed the training managers role and she was now acting as an operations manager as well as a training manager. The intention is that she will be the responsible persons delegate and will provide a management overview and provide support to the manager of this home as well as two others within the organisation. She will take the lead on training and health and safety. Residents, relatives and staff were complimentary about the training managers input over recent months. The organisation has also appointed a weekend administrator who will answer queries, take phone calls and complete any admin tasks as necessary, this was seen as a great support to the existing administrator and also to the staff working at weekends. Discussion also took place in regard to the consideration of appointing a Deputy Manager to ensure the home is appropriately managed in the absence of its Registered Manager. The inspector commends the efforts of the organisation to improve its management arrangements in the home. The home has placed in its reception area quality assurance feedback forms for anyone to fill in. The inspector looked at nine of these forms, there were seven complimentary and/or positive comments made. There was a negative comment made in regard to staffing levels and another about a minor repair being needed. The forms are straightforward and easy to use and will provide ongoing feedback to the management of the home, which is good practice. The inspector spent some time with the homes capable administrator. She has a methodical system in place, which records residents financial balances and any transactions made by them or on their behalf. Balance sheets are available. The inspector did a random audit with the administrator and found that money was balanced correctly with the invoices and statements. The inspector briefly reviewed the supervision records of two staff and was able to see that supervision of staff had commenced and that it met the recommended standard The inspector was able to see generally the improvements in the record keeping and documentation within the home. Pre-assessment information had improved, care plan documentation had also improved, comprehensive risk Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 22 assessments were now in place both for residents and working practices within the home. Recruitment practices and procedures had improved. New management arrangements now appear to be in place to ensure that records required by regulation for the protection of residents and for the effective and efficient running of the business will be maintained, managed and kept up-to-date and accurate. Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 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 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X 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 X 18 3 2 X 2 X X X X 1 STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 4 3 X 3 3 3 X Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 24 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 OP19 Regulation 23 (4) Requirement The home ensures fire doors are not wedged open and that appropriate devices are fitted which meet the guidance of Berkshire Fire & Rescue. The Registered Person confirms in writing to CSCI that the home has completed all works required by Berkshire Fire & Rescue. The home reviews the current state of décor and storage arrangements within the bathrooms. A copy of this review/action plan is to be available for inspection. Sluices within the home are to be appropriately equipped and resourced to ensure no risk to the spread of infection. A copy of the homes review of its current facilities is to be sent to CSCI. The home is to review the quality of care provided. Staffing levels and skill mix are to be adequate to meet the assessed and recorded needs of the residents at all times. A copy of this review is to be sent to CSCI Timescale for action 24/11/05 2 OP19 23 (4) 24/01/06 3 OP21 23 (1) (2) b, c, d 24/01/06 4 OP26 13 (3) 23 (2) c, k 07/11/05 5 OP27 24 (1) (2) 24/01/06 Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 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 Refer to Standard OP26 Good Practice Recommendations The laundry floor is to be repaired to ensure it is impermeable and readily cleanable. Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 Bridge House Nursing Home DS0000010978.V249914.R01.S.doc Version 5.0 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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