Inspection on 27/06/06 for Brundall Nursing Home

This inspection was carried out on 27th June 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

Brundall Nursing Home 03/11/08

Brundall Nursing Home 11/07/07

Brundall Nursing Home 31/01/07

Brundall Nursing Home 04/01/06

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

CARE HOMES FOR OLDER PEOPLE Brundall Nursing Home 4 Blofield Road Brundall Norwich Norfolk NR13 5NN Lead Inspector Mr Jerry Crehan Unannounced Inspection 11:00 27 & 28th June 2006 th 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 Brundall Nursing Home DS0000065308.V302428.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. Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brundall Nursing Home Address 4 Blofield Road Brundall Norwich Norfolk NR13 5NN 01603 714703 01603 716652 brundall@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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) Position Vacant Care Home 48 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (28) of places Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Twenty eight (28) Service Users who are elderly may be accommodated. Twenty (20) Service Users who are elderly and have dementia may be accommodated. One (1) Service User (who is named in the Commission’s records) who is currently under 65 may be accommodated. Total number not to exceed 48. Date of last inspection 4th January 2006 Brief Description of the Service: Brundall is a care home providing residential or nursing care for up to 28 older people and care for up to 20 older people who may have a diagnosis of dementia (a total of 48 service users). The home is situated in the village of Brundall a few miles to the east of Norwich. The home is a large detached building that has been extended. It is divided into two main wings, Verne House and Norfolk House. The latter caters for service users who have a diagnosis of dementia. The accommodation is located on both ground and first floors. There are 30 single rooms and 9 shared rooms. There are garden and patio areas to the rear of the home. There are local shops, pubs and other amenities within the immediate vicinity of the home. Brundall is one of several homes in Norfolk owned by the proprietors. The range of weekly fees for the home is £325 - £650. Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection compromised an unannounced visit to the home that took place over 12.5 hours on 27th and 28th June 2006. Opportunity was taken to tour the premises, look at care records and policies, and communicate with the home’s service users in addition to its staff, the deputy manager and visitors and visiting GP’s. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. No comment cards were received prior to the inspection and general information concerning the home was only partially available prior to the inspection. This appeared to be as a consequence of the absence of a manager in post; but it is disappointing that no one else pro-actively promoted comment from the service users and visitors to the home. What the service does well: What has improved since the last inspection? What they could do better: There are a high number of requirements in this report as a consequence of a significant failure to meet many of the National Minimum Standards. Out of the 24 Standards inspected 9 (37.5 ) were met, and it is of significant concern Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 6 that 7 Standards inspected had major shortfalls. Two requirements concerning the inadequacy of staffing and quality monitoring at the home have been repeated. The proprietor and management of the home need to take urgent action to improve: • Staffing levels in the home • Staff recruitment to vacant nursing and care hours • Healthcare offered to service users • The management and supervision of nursing and care staff • Address repeated requirements In view of the seriousness of the current staffing situation the proprietor’s have agreed not to admit any further service users until such a time as the Commission indicate this is acceptable, and the proprietor will be submitting weekly staff rosters. 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. Brundall Nursing Home DS0000065308.V302428.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 Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 The assessment process for admission to the home is good. EVIDENCE: There is an admission procedure that adequately guides the manager, or registered nurse responsible for assessment, as to actions to be taken to ensure service users needs are assessed prior to a move to the home. A review of sample service user files provided evidence of assessments and preadmission assessment completed by the home. The home does not provide intermediate care. Brundall Nursing Home DS0000065308.V302428.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The overall quality outcome for these standards is poor. There are significant inadequacies in the provision of nursing care at the home affecting the healthcare of service users. EVIDENCE: A sample of service user care plans was reviewed. These set out care requirements in reasonable detail in some instances and contained ‘life history’ information that supports individualised care, though the fact that the home is in a period of transition toward another care planning format was evident. There was evidence of access to community health professionals; two GP’s were seen at the time of the inspection. There were odorous areas in the home. On the dementia care side of the home this appeared to be due to behavioural factors rather than continence factors. Staff should be helped to understand and manage this behaviour, but their ability to do this is hampered by poor staffing levels. (see requirements). The measures (understood by staff) to reduce the risk of service users identified as at risk of falling were not set out in sufficient detail in care plans (see requirements). Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 10 A sample of care plans and pressure area risk assessments were reviewed. There are concerns about the management of this aspect of healthcare for particular service users. These include lack of clarity in care plans concerning pressure area prevention, lack of clarity of recording following GP (and other health professionals) visits and advice regarding treatment, or indeed of recording why they were asked to visit and what they saw, and lack of timely reviews (see requirements). As a result of the Commission’s extreme concerns the Deputy Manager was asked to seek medical advice from the GP’s for three service users with pressure areas. All three service users were seen by GP’s during the course of the inspection. GP’s shared concerns regarding the treatment of these service users; and they considered that the home had not made a timely referral to the GP for advice until prompted to do so by the Commission, four hourly turning rather than the required two hourly turns for one service user, and in a dressing that did not fully cover the affected pressure area for a service user (see requirements). An inspection of medication records and practice in the dementia side of the home was undertaken. There are no service users in this side of the home with responsibility for their own medication. There is evidence of generally good recording of the administration of medicines, however, several instances of staff departing from the recording system used by the home (see requirements). There was evidence of the non-availability of medicines for two service users since 22nd June 2006 (see requirements). It was apparent that care staff at the home had tried to rectify the situation, including at the time of the inspection, however their efforts had been unsuccessful in obtaining medication. There is a practice of storing medication to be returned to the pharmacist in the medication trolley. This increases the risk of these medicines being wrongly administered (see recommendations). A carer was observed undertaking personal care for a service user with their bedroom door open, and there is no access for service users on the nursing side of the home to make or receive telephone calls in private. This compromises the privacy and respect of service users. (see requirements). Otherwise carers were observed to support the respect and dignity of service users, and were observed speaking to service users about the care they were being given to provide reassurance. Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The overall quality outcome for these standards is poor, although improved choice and control for service users in evidence. The overall quality outcome would be adequate if there were evidence of activities being consistently provided for service users with dementia, but this is currently compromised by staff availability. EVIDENCE: There was evidence of the activities coordinator working with service users in the nursing side of the home. For a time during the morning the television and radio were on at the same time in the main lounge area making it difficult to hear either. There was no organised activity on the dementia side of the home at the time of the inspection. The activities coordinator was rostered to work a care shift at the time of the inspection, and for the week in which the inspection took place, compromising the provision of activities for service users (see requirements). Service users spoken to confirmed that there were activities on offer even if they did not wish to participate themselves. Service users spoken with confirmed that they could have visitors whenever they wish and that their visitors were made welcome by the home. Visitors Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 12 spoken with confirmed this. There were visitors to the home throughout the inspection. Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The overall quality outcome for these standards is adequate. Arrangements for protecting and responding to the concerns and complaints of service users and staff are good. The overall quality outcome may be good though without the support of further evidence provided by the home it cannot be more fully measured. EVIDENCE: Information from the deputy manager provided prior to the inspection indicates the home has had seventeen complaints in the past twelve months. However, information provided does not indicate whether, or how many of these complaints were substantiated. Service users spoken to stated that they felt confident that they would be listened if they had a concern or complaint. One complaint was referred through the Norfolk Adult Protection Protocol, which supports an understanding of ‘whistle blowing’. The matter was subsequently referred to the proprietor to investigate, which it did, the complaint being partially substantiated. Records of staff training included training on induction and ongoing training in adult protection. Staff understanding of the principles and components of training provided is tested. Staff spoken to were aware of basic issues connected with adult protection and were aware of the home’s ‘Whistle blowing’ policy. Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 & 26 The overall quality outcome for these standards is poor, as although a reasonable standard of accommodation is provided by the home, improvements are necessary to maintain a safe environment for service users. EVIDENCE: There are improvements to some aspects of the internal and external environment at the home. The home looks attractive externally with hanging baskets and is in a reasonable state of repair. Internally the dining area in the dementia care side of the home has been replaced. However, this area can get too hot for the comfort of service users and this needs to be remedied. Other environmental issues include the fact that only one of the three baths in the dementia care side of the home is actually used. There is a query about the suitability of other baths for service users. The bath that is used in this area has four chips to its enamel, and therefore requires repair or replacement. The majority of garden furniture is either unsuitable for service users, or unsafe generally with broken plastic chairs and split wooden chairs in evidence. The external environment has various items Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 15 for disposal including old armchairs and garden furniture that need to be removed. The pathways at the rear of the home are partially overgrown and make access difficult or unsafe. The external fire escape at the rear of the old part of the building should be kept free of debris and encroaching trees cut back. (See requirement number 9 for each of these issues). Hazardous substances should be securely stored. The storage shed in the dementia care garden was unlocked at the time of the inspection and contained potentially hazardous substances. The inspector was informed that this area is usually kept locked (see requirements). There was evidence of improvement to furniture in bedrooms, and it appeared that some furniture has been replaced. The carpet in the lounge of the dementia care unit looks dirty and stained. There are two odorous areas, one by the old front door in the dementia care unit, and another in one of the bedrooms in the nursing side of the home (see requirements). This is not helped by the fact that the home’s carpet cleaner was broken at the time of the inspection. Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The overall quality outcome for these standards is poor. There are serious shortfalls in the numbers of care staff on duty to meet service user need. Staff recruitment practices do not fully protect service users. The home’s training programme (other than NVQ) address service user needs. EVIDENCE: There were 42 service users accommodated at the home at the time of the inspection, 16 of these were accommodated in the dementia unit, and 23 require nursing care, remaining service users were residential. The numbers of nursing and care staff working at the home at the time of the inspection was not adequate to meet the needs of service users. The Deputy Manager on duty at the start of the inspection was also the registered Nurse on duty that morning. There were three care staff allocated for the nursing side of the home, and three care staff for the dementia care side of the home. Staff rotas indicate an allocation of two care staff for nursing and three for dementia care for the afternoon of the inspection. Weekly rosters do not evidence adequate nursing and care staff allocation to meet service users need during the day and at night (see requirements). Minimum staffing levels for the nursing should include one registered nurse on duty at all times (who does not have management responsibilities in addition to nursing responsibilities), four care staff each early shift, three care staff each late shift. Minimum staffing levels for the dementia side that include three care staff for early and late shifts. Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 17 It is anticipated that these minimum staffing levels will be maintained in addition to the role played by activities coordinators. From information provided by the home, there are four care staff with who hold a qualification at NVQ 2 or above, which equates to just over 15 of the care staff compliment of 26 carers (see requirements). Staff files looked at did not provide evidence that service users are not consistently protected by good recruitment practices. Some files looked at were satisfactory, however, one file did not contain any references (see requirements). Training records seen provided satisfactory evidence of the undertaking of induction, statutory and dementia related training. Once management arrangements for the home have been established, it is recommended that the manager (or person in charge) of the dementia care side of the home undertake more advanced dementia training. Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 The overall quality outcome for these standards is poor. There are management shortcomings and staffing inadequacies that compromise the health safety and welfare of service users and staff at the home. EVIDENCE: A Registered Nurse with support provided by the proprietor, has managed the home since the departure of the Registered Manager at the end of March 2006. At the time of the inspection a newly appointed deputy manager was on duty in charge of the home, who had been in post for three weeks. A manager has been appointed; their anticipated start date is 10th July 2006. As no service user comment cards were received prior to the inspection, it is not known whether service users were made aware of a forthcoming inspection. However, there are some processes at the home for monitoring the service it provides, including audits by the proprietor, quality assurance questionnaires that cover different aspects of the homes practice, a comments Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 19 book and feedback cards that are promoted by the home. These and other quality assurance processes need to be developed further, reflecting a systematic cycle of planning action and review of outcomes for service users, particularly given the findings of this inspection visit. Service users financial interests are safeguarded by the home; their relatives manage the vast majority of service users financial affairs. There was no evidence of a formal approach to the arrangements for supervision of nursing or care staff. This was confirmed by an absence of supervision records and from discussion with staff (see requirements). Staffing inadequacies, poor care and care planning for service users at risk from pressure areas, the non-availability of medicines, inadequacies in staff recruitment procedures, and evidence of a lack of oversight of the arrangements for protecting against fire (see requirements), may compromise the health, safety and welfare of service users. Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 20 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 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X 3 X 2 STAFFING Standard No Score 27 1 28 1 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 1 X 1 Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 21 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. 2. Standard OP8 OP8 Regulation 16(2)(k) 12(1)(a) Requirement The registered person must ensure that the home is kept free of offensive odours. The registered person must ensure that appropriate intervention for service users identified at risk from falls is recorded in individual care plans. The registered person must ensure that appropriate intervention for service users at risk from pressure sores is recorded in individual care plans. The registered person must ensure that service users care plans are kept under review. The registered person must make suitable arrangements for the recording of medicine administration. The registered person must take steps to ensure the availability of prescribed medicines. The registered person must ensure that arrangements are made to provide appropriate telephone facilities to enable service users to use such facilities in private. DS0000065308.V302428.R01.S.doc Timescale for action 27/06/06 27/06/06 3. OP8 12(1)(a) 27/06/06 4. 5. OP8 OP9 15(2)(b) 13(2) 27/06/06 27/06/06 6. 7. OP9 OP10 13(2) 16(2)(b) 27/06/06 31/07/06 Brundall Nursing Home Version 5.2 Page 22 8. OP12 16(2)(n) 9. 10. OP19 OP19 11. 12. OP26 OP27 13. OP28 14. OP29 15. OP33 16. OP36 17 OP38 The registered person must ensure that dementia care service users recreational needs and interests are met. 23(2)(b) The registered person must & 23(4)(c) ensure that premises are kept in a good state of repair. 13(4)(a) The registered person must ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. 16(2)(k) The registered person must ensure that the home is kept free from offensive odours. 18(1)(a) The registered person must ensure that staff are working in such numbers as are appropriate for the health and welfare of service users. This Requirement is Repeated 18(1)(a) The registered person must ensure continued progress toward meeting a minimum ratio of 50 NVQ 2 (or above) trained staff. 19(1)(b)( The registered person must 1) ensure that new staff are confirmed in post only following satisfactory checks set out in Schedule 2 of the Care Homes Regulations 2001. 24(1)(a&b The registered person must ) develop a systematic cycle of planning action and review reflecting aims and outcomes for service users. This Requirement is Repeated 18(2) The registered person must ensure that nursing and care staff at the home are appropriately supervised. 23(4)(e) The registered person must ensure that staff at the home are aware of the procedure to be followed in case of fire. DS0000065308.V302428.R01.S.doc 27/06/06 27/06/06 27/06/06 27/06/06 27/06/06 31/10/06 27/06/06 31/08/06 27/06/06 27/06/06 Brundall Nursing Home 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 OP9 OP19 Good Practice Recommendations It is recommended that the practice of storing medication to be returned to the pharmacist in the medication trolley cease, and alternative arrangements made for its storage. It is recommended that solutions be sought to maintain a more comfortable temperature for service users in the dining area in Norfolk House. Brundall Nursing Home DS0000065308.V302428.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brundall Nursing Home DS0000065308.V302428.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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!