Inspection on 07/11/06 for Brook House

This inspection was carried out on 7th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brook House 15/07/08

Brook House 06/05/08

Brook House 18/12/07

Brook House 18/09/07

Brook House 21/10/05

Brook House 05/05/05

Brook House 07/12/04

Brook House 11/05/04

Brook House 02/02/04

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

CARE HOMES FOR OLDER PEOPLE Brook House 72 High Street Riseley Bedfordshire MK44 1DT Lead Inspector Katrina Derbyshire Unannounced Inspection 7th November 2006 10:10 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 Brook House DS0000014887.V314517.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. Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brook House Address 72 High Street Riseley Bedfordshire MK44 1DT 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) 01234 708077 01234 709712 Riseley Beds Limited Mrs Lesley Atkinson Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20), Physical disability over 65 years of age (20) Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is permitted to accommodate one named service user (Variation V26762) in the category of DE from 01 December 2005 up to their discharge from the home. 22nd June 2006 Date of last inspection Brief Description of the Service: Brook House is a listed building located in the village of Riseley in North Bedfordshire. The building was extended during 1995 and now provides accommodation for up to 20 older people. The ground floor is split level the lower part housing two communal areas and the higher level some bedrooms a dining room, kitchen, laundry, bathing and toilet facilities. Access to the top floor of the home is via a staircase fitted with a stair-lift, the remaining bedrooms, bathrooms and toilets are located on this floor. A day care facility for the use of residents and people in the surrounding area is available in an adjacent building. Car parking spaces for several vehicles is available to the front and side of the home. To the rear of the building is a raised garden that is accessed via a slope. The statement of purpose for the home identifies that the home is unable to accommodate residents who are unable to manage the stairs, which connect the split-level lower floors. The fees for this home are £400.00 to 440.00 per week. Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was to undertake a key inspection. This unannounced inspection was carried out on 7th November 2006. The Registered Manager Mrs. Lesley Atkinson was present throughout the inspection. During the inspection areas of the home were visited and the inspector spent time with many of the residents’ mainly in one of the ground floor sitting areas of the home. The care of three residents’ was examined by looking at their records and interviewing the residents’ and staff who look after them. The views of residents and their feedback has been used alongside information from the home through written evidence to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well: Most of the residents believe that the standard of food is very good. One resident said “Yes l always enjoy the food” another resident said, “ its very good food”. Residents have a choice at mealtimes, and fruit and vegetables are also available daily. Those residents who need a specialist diet are catered for, for example a diabetic diet. This means that residents receive a balanced diet that meets their nutritional needs. Residents at this home benefit from regular access to specialist services to ensure their medical needs are met. This is because staff at the home are good at accessing healthcare support for residents when they need it. Residents are helped to visit Doctors, and District Nurses come to the home if a resident needs nursing support with wound care, for example. The staff also arrange for a chiropodist, dentist, hearing support professional and optician to visit the home on a regular basis. There is a Day Centre within the grounds of this home; residents if they want to, can attend this service. A variety of activities are available at the centre and within the home. These include domino’s, indoor bowls’; religious services and trips out using the homes mini bus. One resident said, “ lf you want to join Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 6 in there is something going on most days”. Residents feel that the home provides sufficient activities to meet their social preferences and needs. What has improved since the last inspection? What they could do better: The home needs to change and improve in several areas; examples of some of these areas are as follows. The documents known as care plans and other records, where staff receive guidance and direction on how they should support and care for residents still need to improve. One resident had been identified as being at risk of falling; the resident had fallen several times since living at the home. However no entries had been made within their care records to let staff know what they should do to reduce this risk of falling, or if any measures had been undertaken to protect this resident. Another residents plan of care stated that the resident was able to wash and dress with no assistance, however the residents needs had changed and they now required assistance from a staff member with this area of care. The care records must be up to date and clear enough to make sure all residents receive continuity of care. Staff at this home have received training in some areas, for example moving and handling and first aid. However not all staff have received training in the protection of vulnerable adults. This is where staff would be trained in identifying all types of abuse, and if they witnessed any, how they should report this following the local policy for Luton and Bedford. Although six staff had undertaken training some staff had not received training in working with people who may show violent or aggressive behaviour. There are residents living at this home who have needs in this area. This places both residents and staff at risk of injury. The home should test the fire alarm system every week, this would make sure that any faults would be identified very quickly so action could be taken to ensure all residents and staff are protected by a fully operational fire system. Staff at the home had not tested the alarm since 20th September 2006. This meant that over six weeks had passed, in which any fault would not have been detected and placed everyone at the home at risk. Brook House DS0000014887.V314517.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. Brook House DS0000014887.V314517.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 Brook House DS0000014887.V314517.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): 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment systems in this home are sufficient to ensure the home has adequate information to make an informed decision on whether they are able to meet the needs of the residents. EVIDENCE: The homes policy for the new admissions of residents is that senior staff at the home undertake an assessment of needs. Within the care records of the residents it was noted that a system was in place that followed a pre-printed section system. The information seen within the care records support that this is followed. In addition two of the care records examined also contained an assessment by social services. Between the two assessments that had been undertaken, it was clear what the physical, social and emotional needs of the residents were. The standard of entries within the assessment records of the Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 10 home had improved since the last inspection, however further development should still continue in this area and was discussed with the manager. Intermediate care is not offered at this home. Brook House DS0000014887.V314517.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 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements in the standard of record keeping have taken place however the care plans are still not sufficiently clear and this places residents at risk, of not receiving all the care that they need. EVIDENCE: The system for care planning and other record keeping used by the home is the standex system. Care records examined showed that further entries had been made within the care planning section, since the homes last inspection. However one resident had been identified as being at risk of falling; the resident had fallen several times since living at the home. No entries had been made within their care records to let staff know what they should do to reduce this risk of falling, or if any measures had been undertaken to protect this resident for example review of medication or identification of any recurring factors or triggers. Another residents plan of care stated that the resident was Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 12 able to wash and dress with no assistance, however the residents needs had changed and they now required assistance from a staff member with this area of care. The care records must be up to date and clear enough to make sure all residents receive continuity of care Therefore a previous requirement remains with an extended timescale given for compliance. Resident care records examined showed risk assessments in place in relation to pressure area care, moving and handling, nutrition and dependency. It was observed that sufficient equipment was present in the home to maintain pressure area care for the residents who required support in this area. Care records contained documentary evidence to support that access to external healthcare professionals, for example chiropody, dentist, General Practitioner and optician had occurred regularly. Staff through discussion were clear on their responsibilities to ensure access to external healthcare professionals was maintained and residents confirmed that this took place. Those staff responsible for the administration of medication confirmed that they had undertaken training in this area. The systems for the ordering of medication showed that the home maintained clear records to ensure that the medicines ordered were received from the pharmacist. Medication administration sheets contained the balance of stock and contained staff signatures to show when medication had been given. The amount of stock kept at the home had reduced, therefore a previous requirement was noted to have been met. However prescribed eye drops being used for one resident that had been opened, were being stored in the fridge in the kitchen. These eye drops were stored next to food items and were left uncovered, this is not acceptable storage and a requirement is made relating to this. During the visit to the home the majority of staff were seen to speak to residents in a supportive manner. When drinks were being offered in the morning, residents were asked what they would like, and several staff used this opportunity to engage in a conversation with the residents. Conversation between residents and staff took place throughout the inspection; one member of staff in particular continually gave verbal encouragement and support to the residents. Staff were also seen to check with residents before they entered their rooms, gaining their consent first. However pots of creams and toiletries were seen in both the ground floor and first floor bathroom. There was no labelling to indicate that they were owned by an individual resident and been left in the bathroom. On several items it had been written that it was ‘for the bathroom’ indicating that these items were shared, this is both unhygienic and does not meet the individual needs of the residents. Brook House DS0000014887.V314517.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 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provision for the resident’s social, cultural and recreational activities is good. EVIDENCE: Residents spoke of the activities available to them both inside, and outside the home through the attendance at the homes Day Centre. Activities available included board games, social events and external outings. A notice board was in place within the dining area of the home advertising activities, alongside an orientation board showing the date and weather. The home also enabled residents to continue to make daily choices in their lives through support and encouragement from the staff, these included clothes to wear, choice of meals and daily activities. Residents are able to bring personal possessions into the home and evidence of this was seen in resident’s rooms. Residents spoken to informed said that they are consulted and are given choices as to how they conduct their lives within the home; choices offered included meals, activities and relationships. Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 14 Nutritional risk assessments were seen within the individual care records of residents’. A choice of meals was available, a brief observation of the lunchtime meal, was seen to be unrushed and enjoyed by the residents. A choice at mealtimes is available; this is displayed within the dining area of the home. Fruit and vegetables are offered daily. The homes most recent inspection by the environmental health department showed that they had met the required standards in food hygiene. Brook House DS0000014887.V314517.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 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems in place are not sufficient to ensure that all staff receive training in the protection of vulnerable adults to ensure all residents are safeguarded. EVIDENCE: The homes policy on the protection of vulnerable adults or the local policy and guidance on this matter could not be located by staff at this visit. Information was received from the home the following day, however the local policy was not provided or the reporting procedures and referral format known as an AP1, which the home must have. Staff training records also showed that several staff had not been trained in this area, although they had worked at the home for several months. A requirement is made relating to this. The home has a complaints procedure, which informs residents how they can complain. Most residents who provided written feedback to the Commission for Social Care Inspection stated that they were aware of the policy. Staff interviewed demonstrated a good level of understanding of the homes procedure. One member of staff was very clear what they should do if they received a complaint and knew their responsibilities in passing on this information to senior staff. A record of complaints received is kept at the home, on examination this showed that the home had responded to all Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 16 concerns that had been raised, and had acted upon the information and had always responded to the complainant. Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 17 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 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to be clean and free of odours making it a pleasant environment for the residents to live in EVIDENCE: There are two main seating areas for use by the residents. The standard of furnishings and decoration in these areas are satisfactory. Televisions, music centres and books were available for the residents within these areas. Bathrooms available have equipment in place to assist residents, through the use of grab rails and lifting equipment. The carpet to the front area of the home and staircase requires replacement as this is now worn, faded in some areas and frayed, the manager confirmed however that its replacement is part of the homes renewal programme and is the next project to be undertaken. Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 18 All areas seen during this inspection were clean and no odours were detected. All residents spoken with and who provided feedback to the Commission for Social Care Inspection, feel that the home is clean and hygienic. Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 19 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 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems in this home for the recruitment of staff are robust and lower the risk of appointing unsuitable people to work at the home thus protecting the residents. EVIDENCE: The examination of staff files demonstrated that references had been obtained before an appointment was offered. The files also contained proof of identity and that Criminal Reference Bureau clearance had been obtained. Further documents seen showed that the home had followed its own policy in the recruitment of staff; application forms, contracts and information from staff interviews were also in place. Both staff and residents said that they felt that there were sufficient staff numbers to meet the needs of the residents. Feedback received through resident questionnaires indicated that residents did not have to wait very long to receive assistance if they needed to. Information provided by the home through the pre inspection questionnaire show that 50 of staff hold a National Vocational Qualification in Care at level 2 or above. Training records show that staff had undertaken moving and Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 20 handling, first aid and fire safety training in 2006. Further training is planned in food hygiene and infection control. However staff confirmed that they had not received training in caring for residents who may have challenging or aggressive behaviour. Care records showed that incidences of this were occurring in the home, this places both the residents and staff at risk of injury therefore a requirement is made in this area. Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 21 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 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The system at this home for the management of resident’s monies is good and ensures resident’s financial interests are safeguarded. However sufficient fire safety checks are not in place to ensure residents are protected from possible hazards in this area. EVIDENCE: The Home Manager has many years experience, which is directly relevant to the role of manager in the home. The Home Manager holds the Registered Managers Award. Residents spoken with stated that they felt the manager was both kind and supportive to them, one resident said, “She always has a chat when she comes through”. The interaction observed between the manager and Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 22 staff showed that a friendly relationship existed between them. Staff were seen to approach her regularly to clarify matters and seek guidance. The management of monies held on behalf of residents continues to show that a robust system is in place that provides a clear audit trail. Balances seen were correct and receipts of all expenditure are maintained and available for inspection. The Responsible Individual to the home undertakes monthly monitoring visits in accordance with Regulation 26. Reports of these are submitted to the Commission for Social Care Inspection, and show that support is available to the management at the home. In addition to these specific reviews she also visits the home more frequently than the statutory monitoring visits as shown within her reports. A relative survey had been undertaken, however it has been over a year since a resident survey has been undertaken. A requirement is made for the management to seek the views of the residents, and show how they use this information to influence the running of the home. The home has a Health and Safety policy. Staff confirmed that they had undertaken fire, manual handling, food hygiene and first aid training. Risk assessments had been undertaken and were seen on the residents care files. All major equipment is serviced regularly and the home maintains documentation to support this and when safety checks such as recording water temperatures have been undertaken. However on examination of fire safety records it was noted that the fire system had not been tested since 20th September 2006. This should have been undertaken weekly and placed the residents and staff at the home at risk, a requirement is made relating to this. Brook House DS0000014887.V314517.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15(1)a Requirement Care Plans must be reviewed monthly and alongside daily notes must provide sufficient information to establish the current wellbeing of all residents. (Previous requirement timescale of and 31/08/06 not met). Medication that requires refrigerated storage must be kept in a safe manner. The use of shared creams and toiletries must cease. The home must have the local Protection of Vulnerable adult’s policy available and all staff must be trained in this area. Staff must receive training to care for residents who may show violent or aggressive behaviour. The home must seek and show how the views of residents influence the running of the home, and report on and supply a copy to all residents. The home must ensure the DS0000014887.V314517.R01.S.doc Timescale for action 31/12/06 2. OP9 13(2) 30/11/06 3. 4. OP10 OP18 12(4) 12, 13 & 37 12 & 18 24 15/12/06 15/01/07 5. 6. OP30 OP33 31/01/07 31/01/07 7. OP38 12, 13 & 30/11/06 Page 25 Brook House Version 5.2 23 testing of the homes fire system is undertaken weekly. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brook House DS0000014887.V314517.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Brook House DS0000014887.V314517.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. 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