Inspection on 28/02/06 for Thornebury Nursing Home

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 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Thornebury Nursing Home 08/11/07

Thornebury Nursing Home 25/01/07

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Thornebury Nursing Home 5,7 &9 Langthorne Road Leytonstone London E11 4HL Lead Inspector Sheelagh Doherty Unannounced Inspection 28th February 2006 10:00 Thornebury Nursing Home DS0000065852.V284246.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 Thornebury Nursing Home DS0000065852.V284246.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. Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Thornebury Nursing Home Address 5,7 &9 Langthorne Road Leytonstone London E11 4HL 020 8539 9443 020 8539 9443 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) Outlook Care Mr Olaposi Olalowo Folaju Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th September 2005 Brief Description of the Service: Thornebury Nursing Home is registered to provide care for up to 16 service users of either sex who have enduring mental health problems. The aim of the home is to provide rehabilitation and to enable service users to move to more independent living facilities. For the majority of residents this is a long-term aim. The building is comprised of three two-storey buildings which have been adapted and converted to provide single rooms and communal areas for service users and office space for staff. The home is situated in a residential area of Leytonstone with easy access to local facilities and public transport. The home is adapted for wheelchair users and those with limited mobility, including four of the bedrooms. Thornebury Nursing Home DS0000065852.V284246.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 on a weekday morning and carried on until mid afternoon. The main purpose of the inspection was to review the home’s progress in implementing the requirements and recommendations of the last inspection and to assess the home against key National Minimum Standards. There were 14 service users in residence and the home had two vacancies. The inspector spoke with a number of residents and staff and undertook a tour of the building. A number of records were examined. Most of the requirements and one of the recommendations had been met and the inspector found that the service was generally operating in line with National Minimum Standards. However, there is an ‘institutional’ rather than a ‘homely’ feel to the home which needs to be addressed in order to provide a more normal living environment and foster the rehabilitative aim of the service. The requirements not yet met centre on repair and refurbishment of the kitchen. The inspector was informed that this work was due to start in the near future. If this does not happen the registered person must inform the Commission of the reason for the delay. Thanks are extended to the residents, the staff and the acting deputy manager who assisted with the inspection. What the service does well: What has improved since the last inspection? All documentation now reflects the correct information about the organisation which operates the service. Medication handling and recording has improved and reconciliation of medication was satisfactory. Some minor repairs have been carried out. Thornebury Nursing Home DS0000065852.V284246.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. Thornebury Nursing Home DS0000065852.V284246.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 Thornebury Nursing Home DS0000065852.V284246.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, 2, 4 Prospective service users are fully involved in the pre-admission assessment process and the decision to live in the home. Appropriate assessment takes place prior to admission. However, insufficient information was available about the prospective service user [in the home at the time of the inspection] to enable staff to provide care. EVIDENCE: Both a Statement of Purpose and a Service User Guide are provided for prospective service users. These include details of the home, the staff and the service provided. Although no service users have been admitted since the last inspection the deputy manager was able to give a clear outline of the process of assessment and admission of a new service user. This includes close liaison with the prospective resident and their family [if appropriate] and the mental health professionals currently delivering services. Prospective service users are able to visit the home on a number of occasions, including for overnight stays and meals with current residents, prior to the final decision being made. The assessment process takes about 6-8 weeks. At the time of the inspection one prospective service user was visiting the home as part of the pre-admission process. Staff at the home keep a daily record of how each visit goes and use this as part of their assessment process. However, there was no other information about the prospective service user Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 9 available to staff. Whilst it is acknowledged that a member of staff from the current place of residency accompanied the prospective resident the inspector would expect there to be at least outline information about the person, their history and their care needs available at the home. Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 10 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): 6, 7, 8, 9 and 10 Despite detailed individual care plans there are some aspects about the way the care planning system is used which are, in the judgement of the inspector, institutionalised, e.g. records being kept centrally instead of with individual plans. More needs to be done to ensure that care plans reflect the current needs and changing goals of residents and to ensure that risk assessments are comprehensive and not contradictory. EVIDENCE: All service users have an individual plan of care which is developed with input from the service user and signed by them. Care plans contain detailed information about the needs of the service user and how these are to be met. Those seen covered a number of aspects of care including medication, physical and mental health, mobility, cultural and social needs and independent living skills. Each resident has a daily log, separate from the care file and there was no evidence that the daily log was used to evaluate the effectiveness of care plans. Care plans are generally reviewed on a three monthly basis and evidence of this was seen on file. However, evaluations of care plans relating to independent living skills do not indicate whether or not any progress is being Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 11 made / goals being achieved and there was no evidence that evaluations were undertaken with input from the service user. All residents have risk assessments in place which cover such things as shopping, using kitchen equipment and cooking. In relation to one service user there was a risk assessment which covered independent access to the community – two different assessments were in place which said contradictory things – one that the resident was allowed out alone for a set period of time and the other that the resident must be escorted when leaving the unit. Both of the assessments had been developed in 2004 and one had been recently updated [09/02/06]. This indicates that reviews are undertaken in a way which is not person centred and which does not look at the care planning and risk assessment process holistically. Risk assessments are kept in a central file for ease of reference by staff rather than in the individual files of service users. This, along with the separate daily log, contributes to the judgement of the inspector that some aspects of the care planning system contribute to the institutional feel of the home. Through observation and discussion it was evident that residents are able to decide how to spend their day and there was evidence that they are consulted to some degree about the daily running of the home through weekly meetings chaired and minuted by residents. However, from those minutes seen it was evident that this is not an effective method of consulting with residents or recording decisions made by or with them. There is a confidentiality policy in place. Staff spoken with were aware of this and the circumstances in which they would need to share information with a more senior member of staff. Records are stored in the office which is locked when a member of staff is not present. Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 12 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): 11, 13, 15, 16, 17 Service users are given opportunities for personal development and are supported to make choices about how and where to spend their time both on a daily basis and in relation to long-term goals. EVIDENCE: The inspector was informed that the occupational therapist post had been vacant for some time and that a member of staff had just been appointed to work as activity co-ordinator on a part time basis. In discussion with this member of staff the inspector was satisfied that the range of activities would improve and that there would be both one-to-one and group activities undertaken which would support development of independent living skills and provide more leisure opportunities for residents. Residents have free access to the local community, with risk assessments in place if necessary. They also have free access to the house, the communal areas and to their bedroom. The staff office has a keypad access and the inspector observed that even when staff were in the office this door was kept locked and residents had to knock to gain access. This does not reflect a Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 13 respect for the rights and responsibilities of service users and adds to the feeling of institutionalisation already mentioned. There were no visitors in the home during the inspection but there was evidence on file that family members are involved in the lives of residents and that residents are assisted to maintain relationships with family and friends. From discussion with staff and observation there was evidence that service users are offered a varied and nutritious diet with three meals a day being served and snacks and drinks available as required. Input has been sought from the community dietician regarding provision of healthy meals and although residents were invited to participate in this discussion there was very little interest. From discussion the inspector was satisfied that the cook will continue to encourage residents to choose healthy alternatives. Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 14 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, 20, 21 Residents receive support according to their needs and wishes to ensure that their physical and emotional needs are met. Some aspects of medication systems need to be improved. EVIDENCE: Most service users are able to manage their own care with such support and assistance as is required recorded in care plans. All service users are registered with a local general practitioner and are supported to attend appointments and to have an annual health check. Access to other health professionals such as dentist, chiropodist etc is facilitated. Records examined confirmed this. There is a policy and procedure in place for all aspects of medication handling and all medications are administered by registered nurses except for one service user who is responsible for their own medication. There was no record of an assessment having been completed about this resident’s ability to manage their medication safely and the risk assessment in place was not comprehensive. Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 15 There were records of medications received into and leaving the home and medication administration records appeared accurate and up to date. Reconciliation of one medicine was accurate. Information about resident’s wishes re: ageing, illness and death were not evidenced in care plans. Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 16 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): 23 The home has taken some action to ensure protection of residents. However, appropriate training must be provided to staff. EVIDENCE: Staff had available on the notice board a brief outline of action to take in the event of actual or suspected abuse having taken place. This included informing appropriate agencies including the Commission. However, the telephone number given was for the Ilford office and not the Stratford office. The registered nurses employed in the home receive guidance from their professional body in the nature of a booklet specifically dealing with this issue. A member of staff informed the inspector that there had been no training on adult protection issues for at least two years and this was supported by examination of the training provided in 2005 which did not include adult protection. The previous inspection in September 2005 also highlighted this issue but there was no evidence that this had been addressed in the intervening time. The organisation must ensure that all staff receive training in the near future. Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 17 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): 24, 25, 26, 27, 28, 30 The home meets the needs of the current client group. Some issues around repair and refurbishment need to be addressed. In the inspector’s judgement, the atmosphere of the home is institutional. EVIDENCE: The home consists of three houses which have been converted and adapted to provide accommodation in three different but adjoining units. Each unit has personal space and communal space, including lounges and dining areas. There is a main kitchen for all three units. One unit has a kitchen which is used by residents developing independent living skills. The size and layout of the home is sufficient to meet the needs of the service users. However as previously stated, some aspects of the environment are institutional in feel. Although the home is bright an airy and in good decorative order there are few homely touches and, in the inspectors view, more could be done to provide a more comfortable and homely environment. At the previous inspection the lack of window coverings in the upstairs bathrooms was highlighted and this inspector was informed that residents had discussed this and decided not to have coverings. This was said to have been minuted in the weekly meeting but no evidence of this record could be found. Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 18 All residents have their own room and those seen were comfortable and showed evidence that the residents were able to make them their own by arranging them as they wished and bringing / buying personal possessions with them. All communal areas were of a satisfactory standard of hygiene. There remain outstanding requirements from the last inspection for work to be done in the kitchen. The cook said that there are plans to renovate the kitchen. The organisation must provide the Commission with a timescale for this to be carried out in the near future or attend to the remaining outstanding requirements in the interim. Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 19 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): 32, 35, 36 The staff team is appropriately qualified and experienced. A training programme is in place. Training in adult protection issues needs to take place. Appropriate supervision takes place. EVIDENCE: There is at least one qualified mental health nurse on duty 24 hours a day with a manager on-call at all times and a senior manager available in the event of an emergency occurring. Support workers and ancillary staff complete the staff team. The staff rota showed that staff are employed in sufficient numbers to meet the needs of the residents and the staff rota accurately reflected the staff on duty at the time of the inspection. Throughout the inspection staff were observed to interact with and support service users in a professional and competent manner. Staff were aware of individual residents needs and their roles and responsibilities in meeting these. Staff stated that supervision sessions take place on a regular basis and that these are effective in providing support to staff and enabling them to fulfil their responsibilities. Since the last inspection a senior member of staff is acting up as deputy manager and will be interviewed for that post soon. Responsibility for supervision of staff is shared between the manager and the acting deputy. Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 20 There is a rolling programme for provision of training. The training record for 2005 was examined and showed that staff receive a range of general and service–specific training including the following: person-centred planning, challenging behaviour, breakaway techniques, drug and addiction behaviour, supervision and appraisal, health and safety, basic food hygiene, fire safety and first aid. See also standard 23 re: adult protection training. Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 21 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): 40, 41, 42 There are effective management systems in place within the home. There is suitably qualified and experienced manager in post. Systems are in place to promote and protect the health and safety of residents though risk assessments showed that these are not always adhered to. EVIDENCE: The registered manager was off sick on the day of inspection. This had not led to any staffing or managerial problems as the acting deputy was on duty and was dealing with matters as they arose. For instance the boiler in one of the houses was not working and there was no heating in that unit. An emergency service/ repair request had been made and contingency plans implemented to ensure that the ambient temperature remained satisfactory and that residents were not cold. All residents spoken with were happy with the arrangements in both communal areas and their bedrooms and on a tour of the building no areas were found to be below a satisfactory temperature. A regulation 37 notification was made to the Commission about this matter whilst the inspection was in progress. Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 22 The atmosphere of the home was relaxed and friendly and interactions between residents and staff and between staff members were appropriate. Staff informed the inspector that the current management of the home was satisfactory and said that they were able to approach the manager to discuss issues as they arose. They were also aware of the management structure in the organisation and of whom to speak to if they wished to raise issues with a more senior manager. There are a number of policies and procedures in place for management of health and safety issues and from discussion, observation and examination of records the inspector was satisfied that these were generally being adhered to but see also standard 9 re: risk assessments in place for residents. Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 23 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 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 2 3 LIFESTYLES Standard No Score 11 3 12 X 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 2 2 X X X 3 3 2 X Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement Care plans must be developed in line with the philosophy of person-centred care and reflect the current needs of the service user. The daily log be used in the evaluation of care plans. Effective systems for consulting with residents about the day-today operation of the home must be in place with records available to show those decisions taken by residents. Risk assessments must be comprehensive, up to date and not contain contradictory information. The routines of the home must respect the rights and responsibilities of the residents by becoming less institutional. For example, by allowing them free access to staff in the office unless there is good reason not to do this. Residents who retain control of their own medication must be formally assessed as to their ability to manage this safely. Risk assessments in relation to this must be comprehensive. DS0000065852.V284246.R01.S.doc Timescale for action 30/06/06 2 YA8 12 30/06/06 3 YA9 13 30/06/06 4 YA16 12 30/06/06 5 YA20 13 30/06/06 Thornebury Nursing Home Version 5.1 Page 25 6 YA21 15 7 8 YA23 YA24 13 23 9 YA24 23 Information about the resident’s wishes in relation to ageing, illness and death must be recorded in the plan of care. All staff must receive training in recognition, prevention and management of abuse. The timescale for renovation of the kitchen must be provided to the Commission. If renovation is not planned to happen in the near future the repairs required in the last inspection report must be made. In consultation with residents more soft furnishings and homely touches to be added to offset the institutional feel to the home. 31/07/06 30/09/06 15/06/06 30/07/06 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 YA3 Good Practice Recommendations Information about a prospective service user’s history and care needs should be available to staff when the prospective service user is going through the preadmission assessment process and spending time in the home. As far as possible evaluation of care plans should take place with input from the service user. 2 YA6 Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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 Thornebury Nursing Home DS0000065852.V284246.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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