CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE
The Bradbury Centre 68 Manygate Lane Shepperton Middlesex TW17 9EE Lead Inspector
Pat Collins Unannounced Inspection 13:00 29 November 2005
th X10029.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 The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. 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. The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Bradbury Centre Address 68 Manygate Lane Shepperton Middlesex TW17 9EE 01932 226698 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) The Royal Surgical Aid Society - Age Care Mrs Lorna Veronica Brown Care Home 52 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26), of places Physical disability (32), Physical disability over 65 years of age (32), Sensory Impairment over 65 years of age (6) The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Minimum age of Service Users within catergories OP, DE, PD and SI from the age of 60 YEARS. One named service user may be accomodated from the age of 57 years. Date of last inspection 30th August 2005 Brief Description of the Service: The Bradbury Centre is a purpose built care home with nursing for older people operated by Age Care: The Royal Surgical Aid Society. Service provision includes specialist dementia care and frail elderly care and facilities are suitable to meet the needs of service users with physical disabilities. Respite care may be available subject to vacancies. The building is single storey designed in 4 wings connected by a large concourse. Each living unit is domestic in scale and character affording all single bedroom accommodation, assisted bathing facilities, kitchenettes, dining, and lounge and quiet areas. Since the last inspection a new extension had been built affording two additional bedrooms. These have very modern design features and are equipped to a high standard, including overhead tracking for use with moving and handling equipment. The homes layout incorporates best design principles for dementia care and is wheelchair accessible throughout. Bedrooms each have a pleasant outlook onto the attractive enclosed well furnished grounds with suitable wide pathways, shaded areas, summerhouse, large gazebo, vegetable plot and sensory garden. The management team comprises of a full time matron/manager, assistant manager, dementia nurse specialist and senior nurse for the elderly frail units. The team includes registered nurses and care staff, a part time physio aid, activities co-ordinator, catering and housekeeping support staff and administrator. The home is located in a residential area convenient for shops, churches and all community facilities. The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over half a day for a period of four and half hours. This was the home’s second inspection for the year 2005/2006. The inspection was unannounced which meant staff and service users were unaware it was to take place. The home manager and assistant manager were present and engaged in discussions with the inspector. A tour of the premises and practice observations took place and in depth discussions took place with six service users and four visitors. Other service users and staff also engaged in discussions with the inspector and contributed information. Following the inspection 12 comment cards were returned from relatives/visitors of service users and this information also formed part of the inspection process. The inspector would like to thank service users, management and staff for their cooperation and courtesy on the day of the inspection and to all who contributed to the process. What the service does well:
The home has a committed and experienced staff team. The staff group was stable and the home had not needed to use agency nurses in the last four years. Regular agency care staff were employed as necessary to ensure continuity of care. Discussions with staff and observation of care practice confirmed staff had good insight and awareness of the individual needs of service users. Good quality care practice was observed during this inspection. The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 6 The home’s management and administration was effective and efficient and supported the service aims and purpose. The manager and all staff were professional yet friendly in their approach to service users and towards visitors. This approach created a warm, welcoming and very caring atmosphere. Staff involved in the delivery of care were perceived to function cohesively as a team. Staff collectively had the necessary skills and experience to ensure good quality care. Positive relationships were evident between individual staff and service users. Visitors and service users expressed a high level of satisfaction with standards of care and generally with the home’s operation. Comments received from service users were “staff are super”, “staff are wonderful”, “this is a joyful, wonderful place”, “staff are very kind”. A relative providing explanation as to why she and her family chose The Bradbury Centre for the care of their relative stated “the atmosphere and friendliness of everyone was striking, the family couldn’t consider our relative being admitted anywhere else once we had visited this home”. Another relative commented “ I appreciate the attention staff give to the appearance of residents, they coordinate their clothing and always engage residents in conversation”. Another stated, “ my relative is always clean and smart”. A comment received from another visitor however indicating preference for review of arrangements for liaison with relatives on the subject of clothing. Service users’ unable to express their views to the inspector about their care were observed to respond well to staff and appeared comfortable in their presence. Service users interests and hobbies were established as part of the admission assessment procedures and opportunity was available for appropriate stimulation through an extensive social and leisure activity programme. Organised activities also gave particular consideration to the needs of people with impaired memory. The activity coordinator was responsible for producing a monthly programme which was responsive to service users needs and interests. Service users benefited from regular hairdressing, aromatherapy and manicure sessions. Group and individual activities were provided and a wide range of innovative activities offered. Various excursions in the community involving relatives, staff and helpers were arranged throughout the year also social events. On the day of the inspection two service users went to the pub for lunch with a staff member and a volunteer. Staff were starting to put up Christmas decorations. The activities organiser confirmed plans to create themed areas in the home this year and Christmas decorations made and donated were very creative. An excursion was being planned to enable service users to go Christmas shopping involving staff, relatives/visitors and volunteers. The home was well maintained and a high standard of cleanliness and hygiene was evident. The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 7 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 Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. The home was found to be operating effectively in respect of standards 1 to 5 at the time of the last inspection. Standard 6 does not apply to this home. EVIDENCE: The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are 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 Personal and social care needs were being effectively met and service users benefited from good quality care practices. EVIDENCE: The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 11 Service users were in receipt of a good standard of care. This was concluded from available information and direct observation of care practice at the time of this inspection. Staff demonstrated a skilled approach to communication in all units and particularly in their interaction with people with dementia and short - term memory loss. The care and attention given to service users’ personal appearance, the management of incontinence, respect for service users privacy and dignity and in moving and handling practices was in accordance with good practice standard. The atmosphere on the living units was calm and welcoming. Staff engaged service users and visitors in conversations. Relatives/visitors expressed satisfaction with the level of consultation and communication with them by staff. Individual service users confirmed that they were involved in decision making regarding their care plans and most considered their preferences were taken into account by staff in the delivery of care. One service user however commented that some agency care staff were less receptive to her wishes regarding her care. This individual felt able to assert her wishes however and did not wish to make a formal complaint. It was positive to observed staff using reminiscence techniques and life history information as a means of initiating conversation. They conveyed genuine interest and empathetic understanding in their interaction with service users. Observations concluded that the home was comprehensively meeting the assessed needs of service users. The manager and senior staff evidently provided strong leadership and direction to the staff team. The care approach and philosophy of care embraced and respected family relationships. The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the 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. Links with families and friends of service users and with the local community serve to enrich the lives of service users. The activity programme and arrangements for social care and stimulation were commendable. EVIDENCE: The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 13 The home’s ethos gave due recognition to the therapeutic benefits from being mentally and physically active whilst respecting service users wishes not to join in organised activities and social events. There was clear recognition by the team of the valuable role and important contribution to the well being of service users made by relatives and friends. Visitors were welcomed by staff and unrestricted in their length of their stay. Visitors may dine with service users by arrangement. Individual visitors present at the time of the inspection expressed positive views regarding the home’s general operation and standards of care. Organised activities and activity resource materials included those suitable to the needs of people with impaired memory due to dementia or other illnesses. The activity coordinator was responsible for producing a monthly programme which was responsive to service users needs and interests. Service users benefited from regular hairdressing, aromatherapy and manicure sessions. 12-1 activities with service users were organised in addition to group sessions of music, art and quizzes. Opportunity was made for excursions in the community involving relatives, staff and helpers. The home operated three day care places and this service delivered by a day care coordinator. The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. At the time of the last inspection it was found that these standards were being effectively met by the policies and procedures of the home. EVIDENCE: The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) 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, 20, 22, 24, 25, 26 The design and layout of the premises was domestic in character, affording a comfortable, safe and homely care environment appropriate to meeting the needs of service users. EVIDENCE: The premises offered a comfortable, domestic style environment suited to meet the needs of older people. The building design responded to the specialist needs of service users with physical disabilities and cognitive and behavioural
The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 16 manifestations of dementia. Since the last inspection an additional two en suite bedrooms had been provided with design features that included overhead tracking facilities particularly suitable for caring for people with high dependency physical needs impairing mobility. Aids, hoists and grab rails were available throughout the home, also orientating information to assist service users in finding their way around the home. The group living units were homely in their decoration and furnishings. The bedrooms sampled were suitably furnished and personalised. Bedrooms could be secured for privacy and the environment and external grounds was secure and safe. A programme of routine maintenance and renewal of the fabric and of redecoration was evidenced. The garden was well designed, attractive for the time of year and tidy. The home was clean and hygienic throughout and odour control was effectively managed. The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Service users needs appeared well met by the numbers and skill mix of staff at the time of the inspection. Comments from some relatives/visitors following the inspection however confirmed their opinion that staffing levels were not always adequate and recommendation made for review. Staff were observed to be enthusiastic and committed to good quality care provision. They also demonstrated good understanding of service users needs. EVIDENCE: At the time of the inspection it was concluded that staffing levels were adequate based on the information available at that time. Service users stated that they felt there was enough staff on duty on each shift from their perspective. Information from visitors/ relatives on the day of the inspection did not indicate staffing shortfalls. The morning shift consists of at least 2 RGNs (One for each section) and 10 to 12 care staff, bringing the total of staff on duty to a minimum of 12. The afternoon shift consists of 2 RGNs and 8 care staff and night staff consists of 2 RGNs and 6 care staff. The home occasionally
The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 18 used regular agency staff to cover shifts, usually due to sickness. An observation in a comment card from a visitor received after the inspection however made the point that staffing levels had not changed in response to a higher proportion of service users being of high dependency. A further two comments received also expressed the view that staffing levels were not in their opinion adequate, particularly at weekends. It was stated by one visitor that staff were at times under pressure through staff absences, though emphasised by this person that this did not impact on standards of care. Comments about staff from visitors were without exception very positive. One visitor said “ staff are really attentive and know all the residents so well, it is a warm and friendly environment, providing excellent care”. The home had a large ancillary staff team consisting of a receptionist, deputy manager/bursar, laundry assistant, kitchen staff and housekeeper. At the time of the inspection interviews were planned to fill the vacancy for a maintenance person following the retirement of the former post holder. Service users benefited from the involvement of a group of volunteers who were members of the Friends of Bradbury Centre. They tirelessly gave their time enabling service users to go out, befriending individuals and were pro-active in fundraising activities. Relationships between staff and service users were evidently very positive based on observations of interaction and feedback from service users and relatives/visitors. The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32 These standards were met ensuring effective management of the home and provision of strong leadership and direction to staff. Management and senior staff created a positive, inclusive, supportive atmosphere. EVIDENCE: The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 20 The home was being effectively managed and administered at the time of the inspection. The registered nurse manager was suitably qualified and the senior team provided consistent leadership and direction to staff to service users benefit. Service users, their relatives and visitors, also staff informed the inspector that the manager and senior staff were approachable and supportive. It was concluded that the management style operating in this home created an open, positive and inclusive atmosphere. The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 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 x 2 x 3 x 4 x 5 x 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x ENVIRONMENT Standard No Score 19 x 20 3 21 x 22 3 23 x 24 3 25 3 26 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 x 34 x 35 x 36 x 37 x 38 x The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP27OP 27 Good Practice Recommendations For staffing levels to be reviewed. The Bradbury Centre DS0000017595.V267191.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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