Inspection on 23/10/07 for Laetus Lodge

This is the latest available inspection report for this service, carried out on 23rd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

CARE HOME ADULTS 18-65 Laetus Lodge 171a Tooting High Street London SW17 0SZ Lead Inspector Davina McLaverty Unannounced Inspection 23 October & 5 November 2007 10:00 rd th Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 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 Laetus Lodge DS0000066295.V350934.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 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. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laetus Lodge Address 171a Tooting High Street London SW17 0SZ 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) 01737 551612 01737 555150 Mr Mark Anthony Peake Mr Eamonn Dominic Doherty Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5TH October 2006 Brief Description of the Service: Laetus Lodge was registered in May 2006 and provides accommodation for a maximum of eight adults with learning disabilities. Staff support is provided 24 hours a day. The home is situated in Tooting convenient for local shops and leisure facilities. Bus, train and tube services are close by. It provides spacious accommodation over three floors. Information about Laetus Lodge is available in the Statement of Purpose and Service User Guide. Current fees start at £893 per week. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days and a total of eight and a half hours was spent on the premises. A number of records were examined, which included staff records, individual’s care plans, medication records, health and safety records, as well as team and residents meetings minutes and the record of complaints. Four people who live in the home were spoken to individually as well as four staff members. The inspector was made welcome and wishes to thank residents and staff for their help. Prior to this inspection taking place the Manager completed an Annual Quality Assurance Assessment (AQQA), and evidence from this was used to help form some of the judgements in this report. Survey forms were also sent direct to the home for the manager to forward to all the individuals residing there, to staff, involved relatives and health care professionals. A good response was received from all sources, in that three relatives, four health care professionals, all five people who live in the home and five staff members returned their survey. Nearly all responses were positive, the surveys have also been used to support the judgements made in this report. What the service does well: What has improved since the last inspection? Care plans and risk assessments are signed and dated by the residents and their key workers. Relatives are also kept informed and their input sought. The premises are more homely with plants, pictures and some furnishings, which have been chosen by the people living there. All staff have undertaken medication training. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 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 summary of this inspection report can be made available in other formats on request. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 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 Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4 People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. There is clear information about the home, which will help potential people and their relatives/ advocates understand what the service provides. Assessments are completed before people move into the home, in order to make sure that their individual needs can be met. EVIDENCE: The home’s Statement of Purpose and Service User Guide had both been updated and now give accurate information about the service. This helps people who are thinking of living there have a better understanding of what it is like. Also, interested people are invited to the home to view the premises and to meet the other people who live there. There is a comprehensive assessment procedure in place, which includes several visits to the home for the prospective person and their representative. From discussion with the people living in the home they confirmed that they had all visited prior to admission. People also stated that they had been given sufficient information to help them make the decision to live at Laetus Lodge. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 Page 9 Three people spoke of a new person who had moved into the home and how the person had come to tea, had an overnight stay and how staff had asked them how they felt about this person moving in before any decision was made. One person told the inspector that they really liked this, as it made them feel part of the process in deciding who lived in the home. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 & 9 People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Good care plans are in place and staff work with individuals to identify goals that are important to them, however, these must be clearly recorded in the care plans. People are encouraged to make decisions and take risks, risk assessments were in place. EVIDENCE: All individuals have a care plan, that is person centred and provides information about how people’s needs are to be met. Care plans are signed and dated by both the staff member and the person who the plan is about. People spoken with are aware of their care plans and contribute to its content in the reviews. However, the plans should clearly detail involved activities, as well as individual’s short term and long-term goals how they are going to be achieved. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 Page 11 Risk assessments are in place and include appropriate responses to minimise risks without denying the person the activity they wish to participate in. Risk assessments were dated and signed by the individual and their key worker. People spoken with clearly are involved in making decisions about how they live their lives. This is carried out through individual chats with staff and through the monthly meetings. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 & 17 People who use the service receive excellent quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who live at the home are given lots of opportunities to take part in a wide range of activities at the home and in the community. People are supported to stay in contact with friends. Individuals rights are respected in their daily lives be they cultural or religious, routines in the home are flexible. EVIDENCE: On both days of the inspection individuals were carrying on with their daily lives at their own pace and with the support of staff on duty. Individuals were in and out of the home participating in activities of their choice. One person spoken with said that staff supported them regularly at the local gym and to go to the library. This person also said that they attend Share Day centre where they were involved in Maths and English classes. Another person spoke of their involvement with the Baked Bean Theatre group. Another person spoke of their Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 Page 13 trips out to see their partner. Staff reported that two people attend social education centres five days a week, but this was their choice. Daily routines of the people who live at Laetus lodge are fluid, in that they could also change at short notice if that’s what the person wanted. One person spoke of their involvement with their family and the places they went together. Another person also spoke of their contact with their family, although it was not that regular, but contact by telephone was. All staff spoken with stated that they supported family contact if this is what the person wanted. People’s wishes were paramount in determining the frequency of contact. A family member has used the guest room in the home on occasions. Three relatives surveys were received, all of which were positive about all aspects of the home with the following comments being made: “ the staff are very polite and welcoming”, “ staff at the home have been very helpful and good and have been communicating with me at all times”, “ the home provides good quality care to the clients, as it is their welfare that is the staff interest, and encouraging each individual to lead a reasonable life style out in the community where reasonable and possible”; and “ the staff are great and they support my relatives needs very appropriately”. Four of the people living there were positive about the food and the choices offered. One person stated they could more or less do what they like and can eat the food they enjoy. During the inspection people were observed to go about the home at will and were able to get a drink or snack when they wished. Records of menus are kept and these showed that a suitable range of food is available for people to enjoy. Three of the four people spoken with stated how much they liked living at Laetus Lodge. One person stated that they wanted to move elsewhere now and was in the process of talking to their care manager. All four social care professionals’ surveys confirmed that the home worked in partnership with them. One person stated: “the home is very collaborative in their working, seeks support where needed. Very client focussed”; another survey stated that “the home works very closely with the Assessment and Intervention Team and are able to carry out recommendations /advice to their service user on-going”. In respect of culture and diversity, one survey stated the “following the appointment of a manager, he has recruited a culturally appropriate staff team, who take responsibility for developing the service uses cultural heritage and involves the clients families”. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 People who use the service receive excellent quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home receives a very good level of support from external agencies to help meet people’s health needs. An appropriate medication system is now in place. EVIDENCE: Staff were observed to treat people in the home with respect. People are able to make choices about how they prefer to live and receive support, for example, how they have their rooms and what time to get up and go to bed. The staff team reflects the cultural background of people who live there. All people are registered with a local GP, opticians and dentist and are supported as required to attend appointments. As already stated, the home has input from Wandsworth Community and Assessment team and work very much in partnership with various professionals to best meet the assessed needs of the people living in the home, some of whom have quite complex needs. One health care professional survey stated: “ the manager manages to focus staff and professional attention on the wishes and feelings of clients Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 Page 15 when matters”, All four surveys responded positively to the question: “ Do you feel that the person’s health and social care needs are being met by the home? One stated “ the home responded quickly to my clients infected toes recently”, and another “excellent individually centred care provision, respects residents cultural needs and values”. All staff have now received training in the administration of medication. An appropriate medication policy and procedure is in place. Medication is stored appropriately in a locked cabinet. Administration records showed no gaps in recording and people were seen to have a medication profile in place, that detailed the medication being taken, and any possible side effects. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Staff are well informed about adult abuse issues, which helps to protect people living in the home. People’s views are listened to by staff. EVIDENCE: An appropriate complaints procedure is in place. People confirmed verbally and in their surveys that they have a copy and that they knew how to complain if they needed to. Four of the six people living at the service reported that they felt generally well treated by staff and that they felt listened to. The complaints book was examined and four complaints were recorded. All four had been appropriately investigated with the complainant being informed of the outcome. There are suitable policies and procedures in place for the protection of vulnerable adults. A copy of the Local Authorities inter-agencies procedures was available in the home. Staff spoken to were knowledgeable of the procedure, however, from the records examined, not all staff have received formal training in the Protection of Vulnerable Adults. The manager stated that he is aware of this and training is being organised. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,28 & 30 People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People residing in the home benefit from a clean and comfortable environment which they see as “home” and which the are able to personalise. EVIDENCE: Laetus Lodge is situated in Tooting, very close to local facilities and convenient for buses, tubes and trains. The home is laid out over three floors and all areas were seen to be well maintained. A number of communal areas are available for people to make use of, including a lounge, quiet room, dining area and modern kitchen. Communal rooms are well furnished and comfortable with people being involved in personalising these areas. On the ground floor there is access to a rear patio area with tables and chairs. Part of this area has been covered and is the designated smoking area. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 Page 18 Bedrooms seen were suitably furnished and personalised with pictures ornaments and personal belongings e.g. television, DVDs, posters/photographs etc. The décor is of a good standard. Each person has their own key and can lock their bedrooms if they wish. All parts of the house were found to be clean and hygienic. People living there with staff support are responsible for the upkeep of the home, which they share. They have individual responsibilities for their bedrooms, but can be supported by staff if need be. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 35 & 36 People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who reside in this home are well supported by a small, consistent staff team. EVIDENCE: There is a small staff team, which provides twenty-four hour cover that includes a sleep at night staff. All four staff spoken with were knowledgeable regarding individuals needs and had a positive relationship with them. Comments from staff regarding the people residing there included: “ they are individuals with individual needs”, “ residents opinions are valued and respected”, and everything we do is designed around the needs of the people in our care. We ensure that the number of staff on duty and the shifts they work are consistently adjusted to enable us to provide the support the residents need”. This was evidenced in the roster, which is written weekly to allow for people living there being flexible and not having to plan way in advance what they wish to do, it also allows for special events e.g. Bonfire night, when more staff can be rostered on shift at short notice if need be. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 Page 20 People spoken to stated that they felt listened to with their wishes being carried out. Since the last inspection, no new staff has started work. However, the manager said that recruitment had recently taken place, as the home is wanting to increase the number of people living there. The owner wants to open a second service in the New Year. References and the Enhanced Criminal Bureau checks have been sought. Three current staff files were sampled and appropriate checks were seen to be in place. Evidence of regular supervision sessions was also seen, as well as regular staff meetings. Two staff survey forms returned stated that the staff members would like more training to be put in place. In discussion with staff and the manager, training varied from staff to staff members. The manager stated that he is in the process of reviewing training and is discussing with staff during supervision their training needs. A comprehensive training plan is to be introduced with appropriate records being maintained to evidence exactly what training each staff member has undertaken. All staff spoken with and in the questionnaires returned stated that they felt well supported by the manager and each other, and all stated how much they enjoyed coming to work. Comments from surveys include: “ I achieve great job satisfaction in my role here. My views and opinions are listened to and respected, and every decision is discussed in a truly democratic and inclusive way”, and “ there is a good team at Laetus Lodge and the inputs from members are taken on board to improve the service offered to service users”. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The manager is committed to providing a person centred service to the people who live there and with the staff team, has worked hard to ensure that people receive a safe and effective service. EVIDENCE: The manager was registered when the home opened in May 2006. He is very experienced in the area of learning disability and mental heath. He has a good understanding of the needs of the people residing in the home and is committed to ensuring that the people living in the home live their lives as they want and with the staff team, supports them in all aspects of their lives. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 Page 22 Many comments were received from staff, health care professionals and people regarding the manager’s professionalism and management style. Observations and discussions with the people in the home and staff during the inspection were positive, indicating that the manager is respected and well liked by those living and working at the home. The manager must, however, undertake the Registered Managers Award. The manager and staff said that they are well supported by the provider of the service who is very aware of the people who live in the home and staff needs. Monthly Regulation 26 visits are carried out with copies being sent to the Commission. However, because the provider does not have a background in care, the manager should have access to an experienced professional consultant on a regular basis to provide peer support. Observation on the day and feedback from individuals confirmed that their views are taken into account, however, a quality assurance system, which formally seeks the views of the people living there, their relatives, advocates, professionals and stakeholders. During the inspection the manager was able to show the proposed questionnaire to the inspector that he wants to use. There are good systems in place for making sure health and safety checks are up to date. The Control of Substances Hazardous to Health Regulations (COSHH), assessments was seen to be in place. Gas safety and electrical installation certificates are up to date. Hot water temperatures are also recorded weekly. Fridge and freezer temperatures are taken daily. The fire alarm system is tested weekly. Staff must ensure that when a new person moves in that a fire drill is carried out to ensure that the person is clear what to do in the eventuality of a fire. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 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 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 4 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 3 2 X X 3 X Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 Page 24 No 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 YA6 YA23 YA35 Regulation 12(1), 15 18(1) (c) 18(1) (c) Requirement Care plans must detail individual’s long and short-term goals. All staff must receive training in the Protection of Vulnerable Adults. Mandatory training e.g. food hygiene, health and safety, first aid, and fire awareness must be in place for all staff. Refresher training must also be evidenced The manager must undertake the Registered Managers Award. A Quality Assurance scheme must be developed which includes the views of residents, relatives/advocates and stakeholders. Timescale for action 30/01/08 30/01/08 30/03/08 4 5 YA37 YA39 9(2) (b) (i) 24(1) 30/08/08 30/04/08 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. Refer to Standard YA37 Good Practice Recommendations The registered person should ensure that the manager has DS0000066295.V350934.R01.S.doc Version 5.2 Page 25 Laetus Lodge access to an experienced consultant to provide peer support and supervision. 2 YA42 A fire drill should be carried out when new people move into the home to ensure that the person will know what to do in the eventuality of a fire starting. Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Laetus Lodge DS0000066295.V350934.R01.S.doc Version 5.2 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. 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. 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