Inspection on 28/02/06 for The Salvation Army (Bristol) Bridge Programme Detox

This inspection was carried out on 28th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Salvation Army (Bristol)... 09/09/08

The Salvation Army (Bristol)... 27/09/07

The Salvation Army (Bristol)... 15/09/06

The Salvation Army (Bristol)... 21/09/05

The Salvation Army (Bristol)... 18/01/05

The Salvation Army (Bristol)... 26/10/04

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Clouds House

Closereach

Westcliffe House

Hilldales

Longreach

Chandos House

Cherry Orchards Camphill Community Ltd

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Salvation Army Bristol Bridge Detox Unit 2 Little George Street St Judes Bristol BS2 9EL Lead Inspector Sandra Gibson Unannounced Inspection 28th February 2006 10:30 The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 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 Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 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 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 Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Salvation Army Bristol Bridge Detox Unit Address 2 Little George Street St Judes Bristol BS2 9EL 0117 9550074 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) Salvation Army Mr Peter Bollam Care Home 4 Category(ies) of Past or present drug dependence (4) registration, with number of places The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A Clinic facility for the detoxification of clients with alcoholism or drug dependency Staffing Notice dated 04/09/2001 applies Manager must be RN on Part 1, 3, 5, 12, 13 or 14 of the NMC register Date of last inspection 21st September 2005 Brief Description of the Service: The Salvation Army Bridge Programme Detox Unit is registered by The Commission for Social Care Inspection to provide detoxification treatment for up to four service users (male or female ) aged 18- 64 years who are addicted to alcohol or drugs. The management team are committed to provide temporary accomodation and a medical based detoxification treatment for homeless people with an alcohol and/or drug addiction. As a Christian Organisation, The Salvation Army believes in an approach which covers every aspect of a persons life including physical, social, emotional and spiritual needs. The Community Detoxification Unit offers a 8 to 12 day treatment depending on assessed needs. There is a designated Doctor attached to the unit. The service users are expected to participate in therapeutic groups as well as activities groups and life skills groups. The service is staffed by qualified nurses during the day and there are unqualified care assisstants who provide support at night. The unit is located in The Salvation Army Hostel which is situated close to the City Centre and major transport routes. The Salvation Army Bridge Programme is an addiction service for homeless people in Bristol and also offers Outreach support, Stage 1 Preparation, and Stage 3 Rehabilitation, none of which are registered services. The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place mid week between 10.30am and 4.00pm.It generally focussed on the care of adults who are undergoing treatment for drug or alcohol addiction. At the time of the inspection there were only three service users receiving treatment in the four-bedded unit. The manager, two members of staff and a student nurse were spoken to and a wide range of documents was examined including care and medication records, complaints log, accident and health and safety records. It is to be noted that the current registration of this unit is in the process of being reviewed by The Commission for Social Care Inspection What the service does well: What has improved since the last inspection? The management of the Salvation Army Bridge Detoxification Unit is currently undergoing a major change. Improvements to the monitoring process organised by the senior management team has taken place since the last inspection which ensures that service users continue to benefit from a well run home. The management of health and safety records has improved since the last inspection, which ensures that the health and safety of service users and staff is promoted. [Please see below] The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 6 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 Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The information about the Salvation Army Detox Unit provided to service users and their representatives is in the process of being up dated. This information now ensures that a person can make an informed decision about whether the unit can meet their individual care needs. EVIDENCE: The Statement of purpose and service users’ guide were examined. It was noted that they were in the process of being revised following the last inspection with details of the new manager, the complaints procedure and details of the Commission for Social Care Inspection. The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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 assessed during this inspection. They were all assessed at the last inspection conducted on 21st September 2005 and found to be met. EVIDENCE: The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 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 assessed during this inspection. They were all met at the last unannounced inspection conducted on the 25th September 2005 EVIDENCE: The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Service users’ physical care and emotional health needs contiue to be fully met and support and treatment is delivered in a way that meets individuals’ assessed needs. The medication administration system in place has improved since the last inspection. However it is still not satisfactyory .Further improvement is required to ensure that there are safeguards in place to protect service users and staff at all time. EVIDENCE: The unit continues to provide a medical based detoxification programme, which offers spiritual, emotional and psychological support. This was confirmed by three service users seen during the inspection who all said that they were not religious but felt supported by all members of staff including the volunteer. They individually said, “the Salvation Army have good values. They do not push religion on you. You are never forced .It is your own personal choice ”. All service users confirmed that they felt well supported by all of the staff. The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 12 Service users are expected to participate fully in all programme activities and medical treatment (after admission by the detox unit’s doctor, unless a medical exemption has been gained). This was confirmed by the residents seen at the time of the inspection who discussed the different groups that they were involved in. It was noted that the detoxification process for all service users includes mandatory urine testing and/or breathalysing throughout the stay and an agreement to abstain from all drugs, alcohol and medication that has not been agreed by the unit Doctor. All medications/herbal extracts that the service user brought with them are handed to the registered nurse on duty at admission. This information is explained to the residents in the service users guide. The unit does not provide nursing care, but service users do have access to a doctor 24 hours/day either on site or contactable by telephone in an emergency. A District Nurse is also available if the need is identified. The inspector saw evidence of access to Optician, Dentist and a GP. The admission process includes registration with a local GP and the unit also has a consultant psychiatrist who comes in to see service users twice a week. There is qualified staff on duty during the day. This includes the part time doctor attached to the unit who monitors levels of alcohol and drug use and service users general condition, plus trained nurses that have qualifications in mental health. It is the role of the qualified nurses to assess and monitor services users during the detox programme, administer medication and offer support During the last inspection it was noted that there were a couple of errors in the recording of medication administered and following the inspection there had been a couple of errors in the medication administered. Consequently, it was organised for the CSCI Inspector to conduct a follow up inspection. This took place on the 5th and 15th Of December 2005. It was noted that all recommendations made by the CSCI pharmacist had been followed up. However, it was noted during this visit that an agency nurse who had been on duty over a weekend and had not been able to access the controlled medication prescribed for one service user so she had used two other residents prescribed medication over the weekend so that this service user could continue with his detox programme. The manager said that the medication in question was found at the back of the medication cupboard on the Monday morning. This is not acceptable practice. It was also noted that The Commission for Social Care Inspection was not informed of the incident until it was raised during the inspection. The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 13 The inspector also noted that staff access the same homely remedy of paracetamol as services users and a record is held. It was advised that seperate supplies should be maintained to reduce the risk of error in recording. The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The complaints procedure has been improved since the last inspection. However further improvement is needed to ensure that service users feel their views are fully listened to and acted upon. Arrangements for protecting service users are partially satisfactory but staff recruitment procedures are not satisfactory and must be urgently improved to protect services users from harm. EVIDENCE: Three service users confirmed that there is a complaints procedure is in place that that they were familiar with the procedure, as a copy is supplied to all service users on admission. It was noted that the complaints procedure has been up dated since the last inspection. It now includes a response time and full details of The Commission for Social Care Inspection. Service users attend a meeting every morning where they are encouraged to raise any concerns. A service users feedback book is also in use since the last inspection. It was noted that this book had details of The National Care Standards Commission, which was the former inspection organisation before The Commission for Social care inspection. The NCSC no longer exists and may be misleading for service users. The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 15 The service users feedback book was examined and it was noted that three services users had raised the issue of the detox unit not being cleaned properly. This had been reported to the manager on the 20th of February but no record was made of what the manager action the manager took and what the outcome was. Another complaint about a service user not receiving the food he ordered was seen and there was also no information about what action was take. The manager informed the inspector that she had immediately told the manager responsible for the cleaning agency about the complaint and was waiting to hear the outcome. This s complaint will be discussed in the section of the environment. There is an adult protection policy and procedure in place and the home hold a copy of ‘No Secrets in Bristol’. The staff team have experience and knowledge of adult abuse and what guidelines are in place to protect a service user from harm. Service users’ valuables are held securely in The Salvation Army Hostel facilities and not in the unit. It was noted that the Protection of Vulnerable Adults list check is not accessed prior to a new member of staff starting employment. This will be discussed further in the section on staffing. The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The comfort of The Salvation Army Detox Unit home has improved since the last inspection. However, the cleanliness of The Salvation Army Detox Unit has deteriorated since the last inspection. This needs to be reviewed to ensure that the unit is kept safe and clean at all times. EVIDENCE: The Salvation Army detoxification unit is housed in a new building, which has been designed with specific reference to the National Minimum Standards. There is wheelchair access to all areas, it is secure and there are CCTV cameras in the hostel, although not in the unit. It was noted that scaffolding is still in place as the refurbishment of the whole building is still in the process of being completed. All four rooms are en suite and well furnished; due to the short stay element of the unit service users do not bring their own furniture. It was noted that they were tastefully furnished, comfortable and warm. They all contain equipment as outlined in the National minimum standards. This was confirmed by all three service users who said that “the facilities were very good and they were warm enough”. The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 17 However during the discussion with the service users they told the inspector that when they had moved into their rooms that they had not been fully prepared for them. They said the bedding was clean but the floors had not been swept and the bathroom was dirty. They said that it had been an on going issue and had reported it to the manager. On the day of the inspection the unit was found to be clean and tidy. The inspector saw evidence of infection control guidelines being observed by staff and noted that the domestic support staff was engaged in cleaning the unit. The unit has a communal area, that which accesses a paved garden. Service users can make snacks and drinks in this communal area. It was noted to be clean, comfortable and homely. It contained DVD/Video TV and music facilities. The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,34,36 The staffing situation has slightly improved following the last inspection. However further attention is required to ensure that service users benefit from an experienced, effective staff team at all times The staff recruitment procedure is not safe. It must be urgently improved to ensure that all service users are protected at all times. EVIDENCE: The new manager was present during the inspection. This manager who is a qualified registered mental health nurse and is in the process of being registered by The Commission for Social Care Inspection. There is one other qualified nurse and a new nurse has recently been appointed but is waiting for her pin number to come through. There is also a volunteer who is now employed to support service users in the detox unit either through group work or supporting them to go to the shops or get involved in an activity such as going to the cinema, or bowling. The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 19 There is an office administrator who supports the staff team. It was noted that there is currently a student nurse on placement from the University of Plymouth. The unit is not staffed at night, but unqualified staff are available in the Rehabilitation Unit if service users need emotional support or medication. All three service users confirmed this information. There is a telephone facility in the lounge if service users needed to contact staff at night. Both the manager and the other qualified member of staff have experience in the drug and alcohol addiction field. They have both attended the TOPPS foundation course and there was evidence of ongoing training for all staff, relevant to both service user needs and the unit. The manager has supervision provided by Bristol Drug and Alcohol Strategy team. The other qualified nurse is now receiving more regular supervision. The inspector viewed the new staff member’s file and noted that there was no Criminal Record Bureau/ POVA checks in place. There was also no second reference and there was no photograph in place for identification. It was also noted that the manager was not aware if the student nurse had an up to date CRB / POVA check and if the cleaners had also had these checked conducted by the agency check. It was noted that the Protection of Vulnerable Adults register was still not being checked for new members of staff despite a requirement being made at the last inspection. An immediate requirement was made during the inspection and the manager requested that a POVA First check was completed on the new member of staff. This new member of staff was told that she could not work on the unit until this check was returned. The manager explained that further safe guards would be put in place until this member of staff’s CRB check was also returned. The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The management of the Salvation Army Bridge Detoxification Unit is currently undergoing a major change. Improvements to the monitoring process organised by the senior management team has taken place since the last inspection which ensures that service users continue to benefit from a well run home. The management of health and safety records has improved since the last inspection, which ensures that the health and safety of service users and staff is promoted. EVIDENCE: The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 21 The management of the home is currently undergoing a major change following the departure of the registered manager and an internal appointment to the post. This transition has been difficult due to staff shortages. A new member of staff has recently started on the unit as discussed previously and the manager was hopeful that the staffing situation would improve considerably. It was noted that the monthly monitoring visits by the nominated responsible individual were taking place but there was no reference to these management changes or the staff shortages and the effect on the unit. These visits have improved since the last inspection. Individual discussion with service users and staff members now takes place and this is recorded in the report. The information about staff shortages was confirmed by the member of staff on duty and service users seen at the time of inspection. However service users confirmed that they had no complaints about the management of the Unit and said that they “felt safe” and “well looked after by all members of staff.” A sample of records were examined and it was noted that the majority of these were up to date including the fire log. A fire risk assessment and fire procedures were in place and the service users consulted confirmed their s awareness of this procedure and what to do in an emergency. The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 1 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 1 X X X 3 X X 3 X The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 23 yes Are there any outstanding requirements from the last inspection? 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 3 Standard YA20 YA20 YA22 Regulation 13(2) 37 22 Requirement Medication prescribed to one service user must not be given to other service users The A report of all events that affect the well being of a resident must be sent to CSCI Details of The NCSC must be removed from all complaints information. All complaints must be fully recorded and the action and outcome documented The unit must be kept clean and comfortable at all times The staffing situation must be kept under review All staff must have an up to date CRB / POVA check before they commence work All staff must have a photograph in place (personnel files) Two professional references must be provided (One from former employer) Timescale for action 28/02/06 28/02/06 30/04/06 4 5 6 YA24 YA33 YA34 23(2)(d) 18 19 30/04/06 30/04/06 28/02/06 7 YA34 19 30/04/06 The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 The Salvation Army Bristol Bridge Detox Unit DS0000020366.V283611.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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