Inspection on 02/04/07 for Broomfield Nursing Home

This inspection was carried out on 2nd April 2007.

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 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

Broomfield Nursing Home 02/09/08

Broomfield Nursing Home 27/09/07

Broomfield Nursing Home 24/05/06

Broomfield Nursing Home 05/01/06

Broomfield Nursing Home 28/04/05

Broomfield Nursing Home 25/01/05

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

CARE HOMES FOR OLDER PEOPLE Broomfield Nursing Home Yardley Road Olney Bucks MK46 5DX Lead Inspector Kate Harrison Unannounced Inspection 2nd April 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Broomfield Nursing Home DS0000062501.V330652.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. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broomfield Nursing Home Address Yardley Road Olney Bucks MK46 5DX 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 711619 01234 717054 Atlantis Healthcare Ltd Care Home 49 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Elderly physically frail 20 of whom receive personal care 5 (five) of the above places are designated for EMI care One service user under the age of sixty five Date of last inspection 29/09/06 Brief Description of the Service: Broomfield Nursing Home is situated in the town of Olney and is privately owned. Local amenities are within walking distance to the home. The home is registered for 49 residents, and provides nursing and care for frail elderly people, and in addition the home is registered to care for five residents diagnosed with dementia. There is an established staff team to meet the needs of residents, although the post of manager is vacant. Residents are registered with local general practitioners and other health professionals are available to support the care of the residents. The original house has been extended and renovations are taking place to improve the environment. The fees range from £425 to £600 per week. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the service was an unannounced ‘Key Inspection’, and was conducted by two inspectors. One specialist inspector assessed the management of medication and was in the home for 2.5 hours, while the other inspector was in the home for 8 hours. There were 36 residents in the home on the day of the inspection visit, and this inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the operations manager, and any information that CSCI has received about the home since the last inspection. The inspector saw all areas of the home and looked at records and documents relating to the care of the residents. The specialist inspector checked medication procedures, medication storage, dispensing of medications to residents, and record keeping. The Commission met with the provider four months ago to hear how the home was to be improved following the previous inspection report. The home has been without a registered manager since February 2007, but the operations manager is based at the home and the acting manager is responsible for the delivery of care. Several improvements have been made to the environment since the last inspection visit, and the refurbishments are continuing. Meetings have been held with health professionals to improve the delivery of care and the community pharmacist has carried out an assessment of the medications system. The inspector asked the views of the residents, relatives and health and social care professionals about the home through questionnaires (comment cards) that the Commission had sent out. Nine individuals replied to the Commission’s comment cards and their views are reflected in this report. The inspector met several residents on the day, and also spoke to relatives and staff, including the operations manager, the chef and some of the home’s housekeeping staff. Relatives who replied via the Commission’s comment cards or who spoke to the inspector praised the qualities of the staff and commented on the recent improvements to the management of the home. What the service does well: Residents and relatives said that the care was ‘very good’, and ‘wonderful’, and one relative praised the ‘care and compassion, skill and cheerfulness’ of the staff members. Another relative said that there was ‘always a friendly face to greet you’, and another said that staff members were open to listening to her views, and that communication with relatives was ‘excellent’. Residents said that the food was good and improving. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. The home does not provide intermediate care. Quality in this outcome area is good. Residents’ needs are assessed from all the available information before admission to the home, so that the home knows their needs can be met at Broomfield. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three individual’s records were assessed to check the residents’ admission process. One resident had been admitted recently, and information was available to show that the acting manager had carried out an assessment in hospital with the individual before the admission was agreed. The social worker’s assessment and care plan regarding the individual was also available. Two relatives said that since coming to the home the resident’s care needs had been met, and that s/he was gradually settling to life in the home. Both the other residents’ needs had been assessed prior to admission, and appropriate information was available to show that all the care needs were identified before admission to the home. A review of the home’s admission process and documentation is currently taking place. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 9 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. Quality in this outcome area is poor. Health care needs are not adequately assessed and the handling and recording of medication is not adequate, so putting at risk the health and wellbeing of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and relatives said that they appreciated the caring attitude of the staff members. All the residents are registered with a general practitioner, and a physiotherapist visits weekly. All staff members who use English as a second language have attended language classes, and the operations manager continues to monitor language issues. One health care professional commented that there were communication problems with staff members and that the overall care provided was not good. The operations manager investigated the issues, and she has sought professional advice about how to improve care. All the residents have care plans detailing their care needs. Some reviews take place, and the operations manager is aware of the need to develop a system so that all the residents have reviews of their care regularly, and have an opportunity to choose who should be present at the review. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 10 The care plans documented good detail following the assessments, but it is not clear that all the care needs are understood, due to the lack of some assessments. Important assessments, such as a nutritional assessment and a falls risk assessment, are not carried out. Evidence based tools, such as the Malnutrition Universal Scoring Tool (MUST), developed by professional bodies need to be used, so that residents’ needs are properly documented. The general manager has arranged for the MUST to be implemented soon at the home, following training of key staff. All the assessment tools used at the home should be evidence based professionally. Medication was given to residents by registered nurses. Most residents were given their morning dose at 6am, which is quite early, and it is not clear that this is through residents’ choice. A recommendation is made in this report about improving choice and independence for residents, and the timing of the morning medication needs to be included in the review. Medication procedures were available to the staff for reference. However they lacked detail to instruct staff on how to complete some of the tasks described and in parts referred to practices no longer in place in the home. This may lead to inconsistent practice by the nurses. Medicines were stored securely for the protection of the residents. However, the location of the clinical room could make it vulnerable to burglary. The provider must assess the risks and take action to minimise any identified. A Controlled Drug cupboard was available in the home. Not all of the Controlled Drugs were being stored in it, and they were consequently at an unnecessary risk of being stolen. A new cupboard had been obtained and was put up during the site visit but with fixings that were not up to the standard required in order to meet the requirements of The Misuse of Drugs Act (Safe Custody) Regulations 1973. A drug fridge was available for the storage of those medicines needing to be kept cool. The daily records showed that it had not been running within the correct temperature range for 5 days during March. This means that the home can’t be sure of the quality of the medication held in it. Records were kept of medicines received into the home, disposed of and given to the residents. There were still some gaps on the medication administration record charts and so it was not possible to tell whether at those times the residents had been given their medicines. The medication administration record charts and an audit of medicines showed that one resident had not received 3 doses of an antibiotic over the weekend. This could be putting this resident’s health at risk. The operations manager was aware of this incident and was investigating it. Topical creams and ointments were still not always recorded and so the home could not show that residents were getting these treatments. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 11 A number of residents were prescribed sedative medicines to be given to them ‘as needed’. There was no care plan for when to give these medicines, with each nurse making their own judgement. This was putting these residents at risk by not having these medicines given in a clear and consistent way, which could have an adverse effect on their welfare. The operations manager was aware of these issues. She has had a meeting with the local primary care trust, the GP and the supplying pharmacy to discuss the problems and has talked to the nurses at a recent staff meeting. As these problems are ongoing in this home, an action plan must be put in place to address the problems in medication handling. During the inspection visit, the inspector observed several instances of good respectful practice by individual staff members. However, other issues affecting the dignity of residents were observed. Some residents were escorted to sit at the dining room table forty minutes before lunch was served to them, vacuuming was carried out next to a resident having lunch, and residents are left for long periods without attention or supervision in the lounge. Most residents are given their morning medications at 6am, and it is not clear that this is through residents’ choice or because of practice in the home. These instances show that all staff members are not fully aware that routines in the home should be carried out through the choice of the resident, for the benefit of the resident, and to suit the needs of the residents. A senior member of staff should be responsible for investigating how the housekeeping and care practice throughout the home can be improved so that the needs of the residents are met in a dignified respectful way. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. Although improvements have been made, the needs of the residents are not yet the main focus of attention at the home, and the residents need to have more choice and control over daily routines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It is not clear that the routines of the home are planned around the residents’ needs and wishes, and some tasks are performed with limited awareness of the impact on the residents. A recommendation about reviewing practice in the light of respect, dignity and choice for the residents has been made in this report. Entertainers come into the home and religious services are organised, and residents can choose to attend if they wish. There are two part time staff members organising activities, and some residents had visited the local market and a nearby duck pond in the previous days. Residents who replied to the Commission’s comment cards indicated that the provision of activities has improved recently, but is not yet meeting needs, and observation on the day of the inspection visit confirmed this view. The home welcomes visitors and several were in the home during the inspection visit. None of the residents are able to manage their own financial Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 13 affairs and the details of how to contact the local advocacy service were prominently displayed in the hall. Residents said they enjoyed the food, and several said that the quality had improved recently. The chef meets regularly with the operations manager to discuss menus, and listens to comments from residents. The choice of meals in the evenings has improved, and there is always a freshly cooked dish available. Fresh fruit is available with afternoon drinks every day. The plastic jugs and tumblers used are old and worn and need to be replaced. Staff members are able to sensitively assist those residents who need help with eating. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. Improvements have taken place and now the home is able to effectively manage complaints and safeguard the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure is easy to use and relatives and residents knew how to make their concerns known. Complaints are recorded and a new system is in place so that one person manages the complaints procedure. The Commission received information about concerns from a health professional, and the home has addressed the issues, and the operations manager is continuing to monitor progress. Relatives said that the new system was working well. The need to provide training for staff members on issues about safeguarding vulnerable adults, identified at the previous inspection, has been addressed. The operations manager has referred one safeguarding matter to the appropriate authorities and an investigation has recently been concluded. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. A refurbishment plan is being implemented and improvements have been made to the environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a system in place to address day-to-day maintenance issues, so that the safety of residents and staff is safeguarded. The home is implementing a plan to improve the environment following the last inspection findings. Several rooms and some communal areas have been redecorated and new furniture and fittings provided. Measures are being taken to resolve the issue of smells in specific areas of the home. The findings of the environmental health officer’s last report regarding works in the kitchen have been mostly addressed. The operations manager is aware of the issues outstanding, including the structural damage caused by a nearby tree, and has a schedule to complete the necessary works. Storage for wheelchairs is inadequate, and as a result most are stored in the dining room. There are two adjustable baths and a shower area is being refurbished. Hoists are currently used to enable the domestic type baths to be Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 16 used, and a suitable person should carry out an assessment to determine what risks the practice places on residents and staff. Several taps and baths were encrusted with lime scale stains and this should be addressed. Eighteen staff members have attended infection control training, including laundry and housekeeping staff. The laundry is well managed by dedicated staff members. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. Significant improvements have been made in recruitment procedures and in staff training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and relatives said that there were ‘always’ or ‘usually’ staff available when they were needed, and the staff rota shows a good mix of registered nurses and carers available on all shifts to meet the needs of the residents. The operations manager has made adjustments to the weekend rota to better meet the needs of the residents. The home is not yet meeting the national minimum standard of 50 carers trained to National Vocational Qualification (NVQ) Level 2, but arrangements are in place to with a local college to significantly improve the numbers in the coming year. Three staff files were checked and all the necessary documentation regarding recruitment was in place. Improvements have been made in staff training, and several staff members have attended training on nine care topics and health and safety topics in the past six months. More training is planned so that the staff team will be better able to meet the needs of the residents. The home’s induction programme has been revised and now meets the Skills for Care standards. A local college is working with the home to help with a Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 18 backlog in induction training, as historically induction has not been well managed. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. Significant improvements have been made in the management of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As there is no registered manager at the home at present Standard 31 has not been assessed. A quality assurance survey to find out the views of relatives has been conducted recently, though the results have not been collated. Further surveys are planned, of residents and stakeholders. Audits of care issues have been conducted, as has a medications review. The operations manager is setting up a system to make sure that quality reviews of all topics in the home are carried out. Small amounts of petty cash are kept securely for a few residents, and records are kept, were seen and are accurate. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 20 The operations manager is conducting a review of the management of health and safety in the home, and has made improvements to the fire safety arrangements. The home has a health and safety policy statement, and provides training for staff on safety topics, such as moving and handling residents. Contracts are in place to make sure that services such as gas, water and electricity are regularly serviced and do not pose risks for residents or staff. Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 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 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X 2 X 3 X X 2 Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Timescale for action Clear and comprehensive policies 31/05/07 and procedures for the receipt, recording, storage, safe handling, administration, selfadministration and disposal of medicines, specific to the home, must be produced so as to provide consistent care to the residents. ALL Controlled Drugs must be 16/04/07 stored in a Controlled Drugs cupboard, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. An auditing system must be put 30/04/07 in place to ensure that complete and accurate records are kept of all medication administered to residents, and action must be taken when problems are identified. When medicines are prescribed 30/04/07 to be given ‘as needed’, when they are to be given must be included in the care plans so that residents are given these medicines in a clear and consistent way. Requirement 2 OP9 13(2) 3 OP9 13(2) 4 OP9 13(2) Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP8 OP9 Good Practice Recommendations All the assessment tools used at the home should be evidenced based, so that the needs of the residents are better understood. Security arrangements in the clinical room should be reviewed. In particular, the service provider should consider whether arrangements to prevent intrusion via the external windows are adequate. A senior member of staff should be responsible for reviewing care and housekeeping practice throughout the home, so that residents’ views are taken into account, and residents are treated with more dignity and respect. The plastic jugs and tumblers used by residents are old and worn and should be replaced. The lime scale stains on affected taps and baths should be removed. A suitable person should carry out an assessment to determine what risks the practice of using a hoist with a domestic bath places on residents and staff. 3 OP10 4 5 6 OP15 OP19 OP19 Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Broomfield Nursing Home DS0000062501.V330652.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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