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Inspection on 18/12/07 for Throckley Nursing & Residential Home

Also see our care home review for Throckley Nursing & Residential Home for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The standard of physical care provided in the home is very good. Staff are knowledgeable and pay close attention to physical care needs. Care plans are of a good standard. Staff personnel records contain the required information to make sure residents remain safe. The home is clean and well maintained, making it homely and comfortable.A good variety of activities are available for residents to be involved in if they wish. Staff were highly praised during the visit by relatives for the care they provided to a terminally ill resident and her family. Most residents say they feel well cared for.

What has improved since the last inspection?

A number of areas in the home have been redecorated and carpets replaced since the last inspection. Safeguarding adults training has been updated. This means that staff know how to recognise adult protection issues and act on them appropriately. The activity programme continues to develop. Bathroom areas are more homely.

What the care home could do better:

Staff continue to demonstrate some institutionalised practices which highlight a poor understanding of person centred care, and the potential negative effects on residents. Some residents felt staff are busy at times, especially at weekends. Some training would be beneficial in helping staff to promote independence while maintaining safety.

CARE HOMES FOR OLDER PEOPLE Throckley Nursing & Residential Home Ponteland Road Throckley Newcastle Upon Tyne Tyne & Wear NE15 9EP Lead Inspector Aileen Beatty Key Unannounced Inspection 18th December 2007 & 28th January 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Throckley Nursing & Residential Home Address Ponteland Road Throckley Newcastle Upon Tyne Tyne & Wear NE15 9EP 0191 267 5655 0191 229 1119 throckleygrange@highfield-care.com 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) Southern Cross Home Properties Limited Mrs Elizabeth Ann Brennan Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th December 2006 Brief Description of the Service: The home is purpose built and located in the centre of Throckley. It is close to all local amenities and is on a local bus route. The home caters for up to 50 older people and has a maximum of 35 nursing care beds. There are spacious communal areas, dining rooms and a separate smoking lounge. A passenger lift services all areas. The home has 44 single bedrooms, some with en-suite facilities. Externally there are accessible gardens, patio areas and car parking is available. The home has access to a shared mini bus for outings. Fees range from £388.47 to £409.25 per week. The home provides information about the service through the service user guide and statement of purpose. A copy of the last inspection report from The Commission for Social Care Inspection is available in the entrance to the home. Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Before the visit: We looked at: • Information we have received since the last visit on 4th December 2006. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 18th December 2007 During the visit we: • Talked with people who use the service, relatives, staff, the manager & visitors. • Looked at information about the people who use the service & how well their needs are met, • Looked at other records which must be kept, • Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, • Looked around the building/parts of the building to make sure it was clean, safe & comfortable. We told the deputy manager what we found. What the service does well: The standard of physical care provided in the home is very good. Staff are knowledgeable and pay close attention to physical care needs. Care plans are of a good standard. Staff personnel records contain the required information to make sure residents remain safe. The home is clean and well maintained, making it homely and comfortable. Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 6 A good variety of activities are available for residents to be involved in if they wish. Staff were highly praised during the visit by relatives for the care they provided to a terminally ill resident and her family. Most residents say they feel well cared for. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are fully assessed before they enter the home. Prospective residents are given good information to show that they can be cared for before they move in. EVIDENCE: There has been no change to the admission procedure since the last inspection. A comprehensive assessment is provided by social services before residents move into the home. This contains information about the type of help they need and information about their past medical and social history. The manager also visits residents to tell them what they may expect when they move into the home and to make sure that they are the most appropriate place to care for them. Care records read during the inspection contained Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 9 completed assessments and show ongoing review of the information gathered from admission. New residents may visit the home to meet other residents and staff. This may be a short visit and then a longer one to perhaps stay for a meal. There is a six week formal trial period. An up to date statement of purpose and service user guide is available in the home. Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are of a high standard and physical care provided is good. Terminal care is very good. The dignity of residents is sometimes compromised inadvertently by staff. EVIDENCE: The care files of four residents were read. They all contained detailed information about the care needs of residents. Physical assessments are carried out, and care is reviewed formally on a regular basis. The deputy manager on duty demonstrated up to date and in depth knowledge of the health needs of individual residents. A complication of an existing condition (in a new resident) was quickly picked up by the deputy. Prompt Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 11 medical attention was sought and the problem was diagnosed and treated due to the vigilance of staff. While physical care needs of residents appear to be being met, there was a concern expressed by a resident that she must wait to go to the toilet at times when staff are busy (see standard 27). As it was confirmed there are sufficient staff on duty at all times, there is no reason for residents to be told there are not enough staff and this must be investigated. Residents all have access to a GP. They may continue to see their own doctor if they wish and it is practical for them to do so. District nurses, chiropodist, dentists, opticians and dietician all visit the home on a regular basis. A policy for the safe handling of medicines is in place in the home. This includes guidelines about the safe storage, receipt and handling of medicines and there are regular medication audits carried out. The inspection of medication procedures found that staff are adhering to this policy and medicines are safely stored and administered. A random check of controlled drugs found the correct quantity. At the last inspection, it was noted that residents were lined up in a row in wheelchairs. It was confirmed that some staff still have a tendency to do this. During this inspection, residents were observed being moved in wheelchairs in an unsatisfactory way by more than one member of staff. On a number of occasions, two residents were brought down in the lift at a time, both in wheelchairs. The first person would be pushed out of the lift, and down the corridor, but with the staff member having let go and allowing them to free wheel some way from the lift. The second person would then be brought out, and they would be pulled from behind the staff member, with the first person being pushed from behind. This was often done in silence. As it was observed being done by more than one member of staff, it must be assumed that this must be accepted practice in the home. It is in fact very poor practice and must not be allowed to happen. In addition to breaching good moving and handling advice, it gives a very poor impression of staff appearing to treat residents as objects. This can be damaging to the self-esteem of residents, and can arise from staff being more focussed on the task in hand than the person. It is important to note, that it is felt by the inspector that the above is due to a lack of training and from allowing habits to become accepted practice. It is not due to any unkindness on the behalf of staff who are in many other ways very caring towards residents. On the day of the inspection, a resident was very ill, and all of her family were with her. The care plan for her terminal care was very good. The family of the resident sought out the inspector to express how “excellent” they felt the care was. They were very happy with the attention to her oral hygiene and pressure area care. They were particularly touched by the kindness staff showed them, Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 12 even when they turned up in the middle of the night and were regularly given refreshments, which were provided on a fully set tray with a cloth, cups and saucers. They said that despite it being a very difficult decision to put their relative in care, they felt very fortunate that the home they had chosen was so good and that this helped them a great deal. Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have good opportunities to take part in a variety of leisure pursuits and interests, which help them to maintain links with the local community and keep and develop social skills. Residents enjoy the meals and are happy with the food provided. EVIDENCE: An activities coordinator is still employed in the home and continues to develop the activity programme. A good range of activities are available, and social history information is gathered to make activities tailored to the interests of residents. There have been a number of recent events, and there continues to be close links with the local community. A Halloween party had been held, and children were invited, which residents enjoyed. Some residents also asked to be dressed up and photographs show people having a good time. Planned events Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 14 are advertised, and displayed on posters in the foyer and lift. It is suggested that these are sometimes too high for wheelchair users and should be displayed at different heights. Residents were enjoying activities during the inspection including a quiz and sing song, and also a “play your cards right” game. Individual records are kept in care files detailing the activities people have been involved in. In most cases this is very full. Visitors spoken to say they are able to visit at any time and are always made to feel welcome. The home still has shared use of a mini bus owned by Southern Cross. Residents were offered choices on a number of occasions. This was most evident at mealtimes – residents were observed at breakfast and lunch time. All residents spoken to said that they enjoy the food, but that they are able to have anything else if they don’t like what is on the menu. Large, easy to read menus are on the tables. On one occasion, a resident in a wheelchair was told he was not allowed to leave the dining room alone. He wanted to make his way to the lift unaided. He was stopped at every attempt. His care records state that he is unable to move independently. He was able to move independently, (in his chair) but staff were concerned he may topple from the wheelchair if he tried to get into the lift alone. In order to preserve the independence of residents as much as possible, it is suggested that priority be given to how this can be maintained safely, without appearing to discourage it. Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are comprehensive policies and procedures and these are followed by the home. EVIDENCE: There have been six complaints since the last inspection and these have been dealt with using the home’s procedure. All have been responded to within 28 days, and a record of action taken by the home is available. Most recent complaints have been regarding the broken down boiler, and a problem with hot water which took some time to resolve. There is detailed information recorded by the manager about the action that was taken and the problems preventing a satisfactory hot water supply. This has now been resolved. The manager has an “open door” policy and encourages people to discuss concerns with her. There have been no safeguarding issues in the last twelve months. Staff have received training in safeguarding adults, and Southern Cross policies and procedures are in place. A whistle blowing policy is also in place, and staff are aware of their responsibility to alert adult protection concerns. Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The building is generally clean and well maintained. EVIDENCE: A number of areas in the home have been redecorated and it is very pleasant and homely. The entrance hall and lounges and dining areas are clean and tidy, and new carpets have been fitted to the upstairs lounge and some bedrooms. Some rooms were identified during the inspection as requiring some attention. The bathroom on the middle floor needs to be repainted, and the walls in an identified bedroom are very scraped and need to be repaired and painted. The bedroom of one resident contained a damaged and unsightly bed table which was removed and replaced immediately following the inspection. The Operations manager confirmed that rooms will be furnished to Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 17 a satisfactory standard when new residents are admitted to the home. The operations manager also confirmed that the areas identified will be decorated as part of the rolling programme of redecoration. There are clear maintenance procedures in place. Water temperatures are taken regularly, and shower heads are cleaned and disinfected. There are checks on the nurse call alarm, door closing devices, and window restrictors. Wheelchairs are also checked regularly to ensure they are in good working order. The wooden panelling outside the home has been replaced and painted, and a new cooker has been installed in the kitchen. The home is clean and tidy, bathrooms and communal areas are clean, with only the table legs in the lounge on the middle floor being noticeably marked. This was pointed out to staff who agreed that they would be cleaned and wiped regularly. The kitchen is clean and tidy. Staff follow the Southern Cross schedule of cleaning and catering checks and food temperatures are recorded when cooking and during serving. The laundry floor has been repaired. The patio and gardens have improved since the last inspection and will be a pleasant place to sit in the summer. New patio plants and containers brighten the area and a dovecote has been bought (unfortunately the doves were too messy and have now gone). Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There may not be sufficient staff on duty at all times to ensure residents’ needs are met. Recruitment procedures protect residents. EVIDENCE: The staffing levels in the home continue to be: 2 qualified nurses 8am to 9pm 1 qualified nurse form 9pm to 8am 7 carers from 8am to 2pm 5 carers from 2pm to 4pm. 6 may be on duty if dependency levels in the home are high. 6 carers from 4pm to 9pm 4 or 5 carers from 9pm to 8am. The administrator vacancy has now been filled. The staff files for two staff were checked. Both contained all of the required information such as criminal records and health checks, and references. Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 19 A training matrix is held and the manager monitors monthly percentages for training undertaken. There are approximately 50 of staff with NVQ level 2 or above. All staff have now received training in the protection of vulnerable adults. One resident said that she felt the home was short staffed at weekends. When asked why, she said that staff tell her that they are busy, and she is afraid to ask to go to the toilet for fear of being a nuisance. She said that she feels she must go when it is convenient to them, and feels sorry for them. This information was passed to the deputy manager who was concerned about this. She felt that this must be investigated as there should be no reason for the home to be staffed differently at the weekends, and that staff must not tell residents they are busy. (See standard 8). Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced manager manages the home in the best interests of residents. Staff are not always supervised on a sufficiently regular basis. EVIDENCE: The manager is a qualified nurse who is experienced in the care of older people, and holds a Registered Managers Award (RMA) qualification. A deputy manager is in post. Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 21 Residents say they are happy with the care provided so the home appears to be run in the best interests of the residents. A new system for managing the finances of residents has been put in place by Southern Cross Healthcare. All residents funds in all Southern Cross homes are now placed in a large pooled account with Barclays. The following explanation of how this account works (in terms of residents receiving their own interest) was provided by the company. “ The account is a pooled account with each of the residents having a virtual account within it. It is totally ring fenced from all the other Southern Cross accounts. The interest is calculated on a daily basis and apportioned to residents on a monthly basis. The calculations will be done within Barclays …so an interest payment will appear automatically on the residents personal allowance record”. Each resident has an account on the computer in the home, which is updated centrally. There is a cash float held in the home, and the administrator is aware of who normally asks for cash on a regular basis and will ensure there is cash on the premises should a resident request access to their money. Staff receive supervision, which is carried out at least six times per year. The manager and Operations Manager carry out regular audits in the home, usually on a monthly basis. These include audits of pressure area care, care files, accidents, vacant hours, and health and safety audits. There were no health and safety concerns identified during this inspection, except the unusual handling of wheelchairs as mentioned. Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 X 3 Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 23 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 OP8 Regulation 12 (1) (a) Requirement Managers must instruct staff not to tell residents they are short staffed or too busy as this causes anxiety and a reluctance to ask for help. Residents must be cared for in a way that demonstrates staff have been trained in person centred care and safe handling. This will prevent the dignity of residents being compromised. Timescale for action 03/04/08 2. OP10 12 (4) (a) 13 (5) 03/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP14 OP12 Good Practice Recommendations Some training in promoting maximum independence whilst keeping residents safe would be beneficial. It is recommended that posters are displayed at a lower level to enable people in wheelchairs to read them more easily. Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Throckley Nursing & Residential Home DS0000040481.V351414.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!