Inspection on 03/07/08 for Britannia Care Home

This inspection was carried out on 3rd July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Britannia Care Home 30/08/07

Britannia Care Home 23/01/07

Britannia Care Home 16/05/06

Britannia Care Home 10/01/06

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Britannia Care Home 4 Thorn Street Girlington Road Bradford BD8 9NU Lead Inspector Sughra Nazir Key Unannounced Inspection 3rd July 2008 10:30 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 Britannia Care Home DS0000061941.V367666.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. Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Britannia Care Home Address 4 Thorn Street Girlington Road Bradford BD8 9NU 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) 01274 770405 britcare@hotmail.co.uk Girlington Nursing Home Ltd Ms Shaheen Kauser Care Home 25 Category(ies) of Dementia (25), Old age, not falling within any registration, with number other category (25), Physical disability (25) of places Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE and Physical disability - Code PD The maximum number of service users who can be accommodated is: 25 30th August 2007 2. Date of last inspection Brief Description of the Service: The home offers personal care to people from a wide range of cultural backgrounds, predominantly, but not exclusively, people of Asian origin. It is situated in the Girlington area of Bradford, which is approximately 1 mile from the city centre. There is a very good range of amenities available locally including shops, public houses, churches, and mosques. The home is well served by public transport. The home has 3 floors; the communal rooms are on the ground floor and consist of two lounges and dining room/lounge. There are 17 single and 9 doubles rooms; none of the rooms have en-suite facilities. There are four communal bathrooms located on the first and second floors, and communal toilets are located throughout the home. The second floor is no longer used. There is a passenger lift to all floors and a ramp for disabled access at the front of the home. There is a small parking area at the back and street parking is available. In July 2008 the owner told us the fees ranged from £351.18 to £454.93 per week. Hairdressing and the cost of outings are not included in the fees. Information about the service is made available on request. Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 stars. This means the people who use this service experience adequate quality outcomes. This report is based on information gathered in a number of ways. • • • • A review of the information held on the home’s file since its last inspection. Information sent to us after the inspection by the registered provider in a document called the Annual Quality Assurance Assessment (AQAA) We spoke to two relatives before the inspection and one visitor during the visit. An unannounced visit to the home. This visit included a tour of some of the premises and talking to people who live at the home, their friends/relatives, staff and management. We also looked at menus, staff rotas, people’s care plans and watched staff looking after people over lunchtime and throughout the day. The information we received helped us to form a judgment about the quality of care people who live at the home receive. In each of the sections in the main report we look at whether the quality of care is poor, adequate, good or excellent. Overall this home provides an adequate quality of care for the people who live there What the service does well: As there are not many people in the home staff have plenty of time to spend with people. People said they were okay and relatives said they are kept well informed by the home. There is good interaction between staff and people living in the home. Many of the people living in the home are from an Asian background. There are also a Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 6 number of staff from Asian backgrounds and many speak a second language such as Punjabi or Urdu. This means that staff have a good understanding of people’s cultural needs and it makes it easier for people to talk to staff. The home has been awarded 5 stars (the highest rating) by Environmental Health for its standards of food safety and hygiene. What has improved since the last inspection? What they could do better: The home must make sure that information about the service is available in a range of formats so that people using the service, and those thinking about using the service, have clear and accurate information about what is being offered. The home must continue to improve the care records so that they can show that people, or those close to them, are involved in planning how care needs will be met. People should have access to a complaints procedure they can understand. This will help the home make sure it is meeting people’s needs. Staffing levels must be kept under review to make sure that people’s needs are met. Recruitment practice needs to be made more robust by having full employment histories and not allowing people to work before their checks are completed, will keep people safe from harm. More work is needed on the environment, in particular the bathing facilities to make sure that the home is properly equipped to meet people’s needs. The use of CCTV inside the home must be kept under review and specific information about this must be included in the Statement of Purpose. We must be notified of key events at the home for example the significant storm damage, as this affects the wellbeing of people who live at the home. The work needed to comply with fire safety must be completed in accordance with the timescales agreed with the fire authority. This will reduce the risk of harm. Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 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 Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 does not apply People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s needs are assessed before they move in. More needs to be done to make sure that people thinking about choosing the home are given clear and accurate information in a format that they can easily understand. EVIDENCE: The home has a Statement of Purpose and Service Users’ guide. Some parts of the Statement of Purpose need to be changed to make sure people are given clear and accurate information about the range of services offered by the home. It tells people that nursing care is no longer offered but does not tell people about how cultural needs will be met or about the use of CCTV in the building. To meet the needs of people using the service it is recommended that these documents are available in alternative formats. Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 10 All the files we looked at had a full assessment document telling staff about people’s needs. Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s needs are met in a way that respects their privacy and dignity. Improvements are needed to the care records to make sure that people’s needs are met consistently and to make sure that people are involved in care planning. More care needs to be taken with the way medicines are recorded to make sure that people are getting their medicines in the way that they are prescribed. EVIDENCE: The care plans set out how people’s personal and health care needs will be met. There is some information about people’s cultural and religious needs, for example the language they speak, however more detail is needed in terms of diet, dress and religious worship. Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 12 There was some detailed information in some files such as whether the person liked to sleep with the light on or have the door open etc. We saw that one person vomited after drinking. A visitor told us that the number of drinks had to be watched as this was a frequent occurrence. We looked at this person’s file and the tendency to vomit was not recorded neither was there any information to tell staff to keep an eye on how many drinks the person was having. One care plan did not have information for staff on how to manage behaviour, although it was clear from our observations that the person was at times restless and agitated and requiring a lot of support from staff. A relative who was visiting told us that she is involved in her mother’s care. The medication records showed that medicines are not always signed for, this makes it difficult to tell if people are getting their medicines as prescribed We saw a carer write in the medication records approximately 5 hours after the medication round, this is unsafe practice. Medication given or omitted should be documented straight away to avoid mistakes and to keep people safe Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are offered limited opportunities to participate in activities that will meet their social, cultural and recreational needs. Some practices in the home do not encourage or support people in exercising choice and control in their daily lives. EVIDENCE: We did not see an activities timetable. The television was on in the lounge throughout the day. There was English language programming all day even though at times people who do not understand English were the only occupants of the lounge. After lunch the home put everyone to bed. This is standard practice but is not reflected in people’s care plans. We saw that there are at least two people who do not want to go to bed. One person stayed upstairs in their room and Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 14 another was wandering around downstairs. Staff told us they use this time for record keeping. The home should review this practice. There was a daily log on some people’s files of activities such as talking about family and foot massage. One person’s activity log said the carer had been talking to a person about their daughter, the person’s care file and the manager said that this person did not like to speak about family. The activities people should match up with identified needs and preferences. One person’s activity log says they like to do their own thing. One person’s social care interests were stated as reading. Staff told us that this person’s vision had deteriorated but the care plan for social activity was not updated. We were shown pictures of people sitting outside in the yard and told about a trip to the park. We saw a picture of one person helping to tidy up the yard. There are no plans at the moment to create a garden or outdoor seating area. We saw that people had curry and rice or chapatti for lunch. One person had tinned steak and vegetables and the cook told us that there would be chicken soup made up from powder at teatime. The manager said that this person also had pies and meat purchased from the local supermarket. We asked this person about the food and they said it was good. Their weight record showed their weight had not decreased. The home has a three weekly menu displayed. In the information the home sent us they told us “ because of so few residents, if requested and everyone agrees, we will change a dish to whatever the residents feel like eating that day”. Whilst this shows that the menu is flexible, the home should make sure that people are given choice. Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Staff are trained to protect people, but better information is needed to make sure people are aware they can raise any concerns. EVIDENCE: The home has not had any complaints since the last inspection and none have been referred to us. Information about how to make a complaint is displayed in the home in a standardised format. This does not meet the needs of people with visual impairments or those who speak different languages. The only notice we saw was also displayed at a height, which is not suitable for wheelchair users at the home. We discussed the use of pictures in a simplified complaints notice that would make the information clear for people with different needs. There was one carer on duty and we saw records confirming he had been on training to tell him about protecting people from abuse. Britannia Care Home DS0000061941.V367666.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is clean and comfortable but more needs to be done to make sure it is properly equipped to meet people’s needs. EVIDENCE: The parts of the home we looked at were clean and tidy. People said it is usually clean and fresh. CCTV is used inside the home to monitor the main entrance and the entrances to the lift on all floors and the entrances from the stairs to the landings on all floors. We have discussed this at every inspection and have expressed our concerns about the implications for people’s privacy. Last year the home Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 17 consulted with people using the service and has agreed policies and procedures about the use of the cameras, the storage of the tapes and access to the tapes. However, there is no information in the Statement of Purpose about the use of CCTV and therefore new people moving into the home may not be aware of it when deciding if the home is the right one for them. The downstairs bathroom is in the process of being resurfaced. There was no toilet seat. The owner said that there was a raised toilet seat but that had been removed. One person told us this was the bathroom they used when downstairs. Britannia Care Home DS0000061941.V367666.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Staff are caring but people may be at risk from unsafe recruitment practice EVIDENCE: We saw that staff were respectful towards the people who they looked after. The owner said that they had an unwritten plan in place for additional staffing in the event of occupancy increasing. The rota did not accurately reflect who was on duty at the time of inspection. The cook was listed as a night time carer this was incorrect, the rota also showed the owner as working Tuesday afternoons when he is at college. Current staffing levels for six people are two carers (including the owner), a part time manager and part time domestic staff. We saw that the cook and handyperson left after lunchtime and that the manager finished at 4pm. The owner was occupied in meetings and this left the carer on their own to manage care and teatime. This arrangement should be reviewed. We looked at three staff files. All the files we looked at did not have a full employment history. One file we checked showed that the checks done to Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 19 make sure they are safe came back in January 2008. We saw a letter to say that the person had been working for the home since December and when we looked at the rotas for Christmas 2007 these showed that the person had worked nights as the only waking member of staff. This is unsafe practice and exposes people to risk. We were told about lots of training at the home including palliative care, Liverpool pathway and diabetes, this will help staff meet people’s needs. We asked a carer about a specific mental health condition that affects one person. The carer did not understand what the condition was or how it could affect people’s behaviour. Britannia Care Home DS0000061941.V367666.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service People live in a home where their care may be compromised by a lack of action to meet legal responsibilities. EVIDENCE: Since the last inspection the manager has passed the Registered Managers Award this should give her the training to improve quality at the home. Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 21 The information the home sent us was brief and did not give us a clear picture of what the home actually does. For example where we ask for a summary of what the home does well, we are told “Service User is the purpose of our reason to exist as a business” The home continues to operate on very low occupancy. The work needed to meet a number of requirements including revising the statement of purpose, complaints procedure and individual care plans has not been done. The manager showed us an example of a survey conducted about portion sizes and meal timings. This practice should be extended to other aspects of daily living and the outcomes of such consultations should be shared with interested parties including the Commission. The manager has not kept us informed of key events at the home, for example there has been significant storm damage at the home. They should send us a notification under Regulation 37. There is work outstanding to meet fire safety requirements. This includes reinstatement of the fire alarm on the top floor. No one lives on the top floor as there is no electricity but a fire starting there could present a risk to people in the rest of the building. Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 22 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X 2 X X X 3 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 2 X 2 X 3 X X 2 Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 23 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 OP1 Regulation 4 Requirement The Statement of Purpose must be kept up to date. It must include information on the use of CCTV inside the home and must make it clear that nursing care is no longer provided. This is to make sure that people have up to date and accurate information about the range of services being offered. In order to meet its stated objective of providing a multi cultural service the home must make information available in alternative formats appropriate to the needs of people using the service. Previous timescale of 30/04/07 not met. The care plans must continue to be developed to make sure that they set out in detail how people’s assessed needs in relation to personal, health, and social care will be met and so that there is evidence that people or their representatives DS0000061941.V367666.R01.S.doc Timescale for action 30/11/08 2. OP7 15 30/11/08 Britannia Care Home Version 5.2 Page 24 are involved in care planning. This is to make sure that people’s needs are met consistently in a way that takes account of their preferences. Previous timescale of 30/04/07 not met. Care plans must also show how staff must respond to individual needs including those arising from mental health problems. Medication records must be kept 30/11/08 up-to-date with all medication given or omitted signed for straightaway. This will help make sure that people get the medication they need and as prescribed. 30/11/08 The home must prepare a plan setting out how it is going to make sure that there are always enough staff to meet people’s needs. Specifically the plan must state: How staffing levels will be increased to take account of increasing occupancy and changes in the dependency of people living in the home and How staffing levels will take account of the needs of the people receiving day care. A copy of this plan must be sent to the CSCI. Previous timescale of 30/04/07 not met. The rota must accurately reflect the staff available for work on that day. The numbers of care staff must be kept under review. This will make sure that people get the care they need. DS0000061941.V367666.R01.S.doc 3. OP9 13(2) 4. OP27 18 5. OP27 18 31/10/08 Britannia Care Home Version 5.2 Page 25 6. OP29 18 7. RQN 37 8. OP38 23(4) A full employment history must 30/09/08 be obtained for new staff. Staff must not start work before the home has confirmed they are safe to work with vulnerable people. This will help protect people from abuse The Commission must be notified 30/09/08 of key events that affect the wellbeing of people who live at the home. This will help us to make sure that the home is taking the right action to keep people safe and well Action must be taken to comply 31/10/08 with fire safety requirements. This will help keep people safe from harm. 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 OP12 Good Practice Recommendations Activity plans should be reviewed especially where people’s needs and abilities change. The activities provided should meet people’s identified needs and preferences. The practice of putting people to bed after lunch may not be in people’s best interests or be their choice and as such should be reviewed. The home should demonstrate that it can offer and meet choices in relation to food through planning and that the nutritional content of food of meals for everyone is kept under review. Information about the complaint’s procedure should be made available in alternative formats appropriate to the needs of people using the service. The raised toilet seat or other suitable alternative should be reinstated in the downstairs bathroom. Care staff should receive training on bipolar syndrome and related symptoms. This will help them care for people with DS0000061941.V367666.R01.S.doc Version 5.2 Page 26 2. OP15 3. 4. 5. OP16 OP19 OP22 OP30 Britannia Care Home 6. OP33 this condition The quality assurance methods used should be used more widely and the outcomes shared with people who live at the home and other interested parties, including the Commission. Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Britannia Care Home DS0000061941.V367666.R01.S.doc Version 5.2 Page 28 - 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. 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