Inspection on 23/08/06 for Alphington Lodge Residential Home

This inspection was carried out on 23rd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 but made no statutory requirements on the home.

Other inspections for this house

Alphington Lodge Residential Home 10/03/09

Alphington Lodge Residential Home 12/03/08

Alphington Lodge Residential Home 22/11/05

Alphington Lodge Residential Home 08/04/05

Alphington Lodge Residential Home 02/11/04

Alphington Lodge Residential Home 02/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Alphington Lodge Residential Home 1 St Michaels Close Alphington Exeter Devon EX2 8XH Lead Inspector Stephen Spratling Key Unannounced Inspection 23rd August 2006 08:45 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 Alphington Lodge Residential Home DS0000037791.V301718.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. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alphington Lodge Residential Home Address 1 St Michaels Close Alphington Exeter Devon EX2 8XH 01392 216352 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) Nicola Hitchcott Anna Hitchcott Mrs Susan Reynolds Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2005 Brief Description of the Service: Alphington Lodge is a period property with large level gardens and an enclosed courtyard. It is situated in the centre of Alphington within short walking distance of local shops, church, pubs and health centre. The home is registered to provide accommodation and personal care to up to 28 older people. The accommodation comprises the main building, which has three floors, all served by passenger lift and a cottage annexe with two ground floor rooms. All rooms provide single accommodation, 14 are ensuite. The home has three pleasant lounge/dining areas. Current fees are £380 per week. The inspection report is available in the home’s entrance hall. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the inspection site visit the inspector sent out a total of 33 questionnaires, seeking people’s views about the service. Completed or partially completed questionnaires from seven service users, five from health & social care professionals and four from staff were returned. The inspection site visit was made unannounced on the 23rd August 2006, starting at 8:45 am and ending and 4:30 pm. During the course of the inspection the inspector spoke with 11 residents, four members of care staff, the home cleaner and the home manager. He looked closely (case tracked) at the care of three residents and looked at other documents/records e.g. policies & procedures and recruitment records. What the service does well: People thinking of moving to this home are provided with useful information about the service they can expect and the homes good assessment practices help to make sure they are only admitted if the service can care for them properly. Residents are treated kindly and their choices are respected. Good attention is paid to ensuring their personal and health care needs are attended to properly. Some activities are available and some residents particularly value the opportunity to go on outings to local places of interest. Residents speak highly of care staff describing them as “very very good” and “attentive”. Staff are encouraged to attend training, which helps to ensure they are suitably skilled and good at their jobs. Staff are on duty in sufficient numbers to ensure they have time to care for residents properly. The building is kept clean, safe, well maintained and provides a homely and comfortable place for residents to live. Good meals are provided. The home has a clear complaints procedure and residents can be confident that if they have concerns they would be listened to and acted upon. This home is well managed. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 6 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. Alphington Lodge Residential Home DS0000037791.V301718.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 Alphington Lodge Residential Home DS0000037791.V301718.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and prospective residents can be confident that the home’s good assessment and admissions practice will help to ensure that their needs can be met. This home does not offer an intermediate care service. EVIDENCE: The three residents’ care records read contained useful assessments describing the residents’ needs prior to admission. They all also contained information gathered from other health and social care professionals. Staff confirmed that prospective residents are welcome to visit the home before moving in and two residents were able to confirm that they had visited before deciding to move in. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 9 All seven residents who returned Commission questionnaires confirmed that they received enough information before moving in to help them decide if it was the right place for them. Alphington Lodge Residential Home DS0000037791.V301718.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that they will be treated with respect and that they receive the personal care and health care they need. Though some changes are recommended, systems are in place help to ensure that residents receive the medications they need safely. EVIDENCE: The three care plans read were much improved since the last inspection. All reflected the individual residents’ needs as had been identified at assessment and showed evidence of regular review. They contained useful descriptive detail to help staff provide care consistently to residents in the best way for that individual. For example one provided clear guidance on how staff should support a resident to manage their anxiety and another provided clear basic guidance on how to communicate with a resident who has significant sensory deficits. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 11 Asked “do you receive the medical support your need?” all seven residents who returned Commission questionnaires confirmed that they “always” do. All five health care professionals who returned Commission questionnaires confirmed that they believe their advice is incorporated into service users’ care plans and that the staff take appropriate action when they can no longer manage the care needs of service users. One wrote that they think Alphington Lodge is an “excellent care home”. All the residents spoken with confirmed that staff are polite and kind. Those asked specifically confirmed that their privacy is respected and one resident commented that they always see staff treating other residents well. The inspector viewed the medications held on the lower ground floor. They are securely stored, with receipt of medications and management of controlled drugs properly recorded. The inspector was told by staff and the manager confirmed that sometimes night staff administer medications into labelled pots and then day staff pass these medications out to residents with their breakfast tray. The manager said that to help staff to do this more safely each resident has been risk assessed and a traffic light system introduced to guide staff as to how much help/supervision each resident needs with medication. This practice does not follow guidance issued by the Royal Pharmaceutical Society and increases the risk of errors being made in medication administration. Two residents currently manage their own medications. The manager said that only staff who have had training to administer medications do so; of six of these staff sampled, the manager was able to produce evidence that five of them had received training from a local pharmacist and the sixth had done one session of the two session course. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities available meet the expectations of most residents and their visitors are welcomed. Residents’ choices are respected and supported by staff. Residents receive good food that meets their dietary needs. EVIDENCE: Two people responding to Commission questionnaires indicated concern that some residents are made to get up earlier than they would choose to. One resident of 11 who met the inspector said that they would like to get up later but did not think this was allowed. This person’s care records indicated that they like to get up early and the manager agreed to review this with the resident and staff. All other residents able to, confirmed that they get up and go to bed when they choose and that they spend time where they choose. Some residents met had clearly chosen to sit in shared areas and others confirmed that they choose to remain mostly in their rooms. Staff confirmed that visitors are welcome at any time and residents confirmed that their visitors are made to feel welcome. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 13 Some residents told the inspector about recent trips out, one to Exmouth and another to a country house; they had clearly enjoyed these outings and were looking forward to others planned. Residents also mentioned some other inhouse activities such as bingo, visiting entertainers and religious services. One resident spoke about how they are supported to maintain contact with their church and friends in the community. Two residents spoken with said they would like more to do, but others said that they are happy with the level of activity available. Residents completing Commission questionnaires were asked “do you like the meals at the home?” One said always, five said usually and one said sometimes. Residents spoken with confirmed that they can have a drink when they want, that fruit is readily available and described the food as generally good or very good, confirming that alternatives are offered where they do not like the main meal of the day on offer. Two residents commented that they get tired of sandwiches at tea time and would like more choice. Another said they would prefer their hot meal in the evening but did not believe this was possible. Since the inspection the owners of the home have told the inspector that a choice of food is available at teatime including hot dishes. Residents were seen taking meals in private according to their preference. Others were seen eating together around small tables in the shared areas making lunch time a pleasant and sociable event. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that concerns and complaints will be listened to and acted upon. They can also be confident that staff would act to protect residents if they were being mistreated, but can not be fully assured that staff would respond in line with best practice guidance and locally agreed procedures. EVIDENCE: The home’s complaints procedure is clear, includes contact details for the commission and is posted up in the home’s entrance hall. Six of seven residents completing a commission questionnaire said that they know who to talk to if they are not happy. On a pre-inspection questionnaire the manager reported receiving no formal complaints in the previous 12 months. The commission has not received any formal complaints about this service since the last inspection. One of the three staff members asked said they had received some training about recognising and reporting abuse. Of the three this one person was fairly clear about what they should do if they were concerned a person in their care was being abused the other two showed common sense but were not aware of the correct procedures to follow. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a well-maintained, clean, homely and comfortable environment for residents. EVIDENCE: The inspector saw that the front of the building has recently been decorated and a pool in the grounds has been guarded by a fence to make it safer. The gardens are accessible to residents and well maintained. The building can be accessed via a ramp up to the main entrance and all three floors of the home are serviced by a shaft lift. The inspector walked around all the shared areas of the home and looked in 14 private rooms; all areas were clean and no unpleasant odours were present. Many of the private bedrooms were personalised with residents’ pictures and soft furnishings. The bedrooms in the older part of the house have, since the Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 16 last inspection, been fitted with secondary glazing. All the radiators seen have now been suitably guarded and all the fire doors seen now shut properly. The temperature of water in one bathroom was checked and was within acceptable limits. Residents confirmed that they find the home comfortable and that they are happy that the home is kept clean and is well maintained. The inspector spoke with the home cleaner who confirmed that she has the time and equipment she needs to do her job effectively. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Kind, suitably skilled care staff, employed in sufficient numbers ensure that residents are treated with respect and get the care they want and need. Recruitment procedures are in place but are still not sufficiently robust to maximise protection of residents. EVIDENCE: Residents who completed Commission questionnaires were asked “are staff available when you need them?”; three answered always and four responded usually. All the residents who spoke to the inspector were very positive about staff, confirming that they always get help in good time, that staff are polite and kind and that staff know their jobs. One resident said that “senior staff are very very good”, another residents described staff as “attentive” and another said that every one at the home was “exceedingly nice”. All five health and social care professionals who returned Commission questionnaires confirmed that they believe “staff demonstrate a clear understanding of the care needs of service users”. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 18 Three of the four staff returning Commission questionnaires confirmed that they received induction training when first working at the home; the fourth did not answer this question. The inspector was shown the induction pack which new staff now work through, this pack covered all the recommended topics. An overview of staff training was seen; this indicated that most staff have received a variety of training on subjects such as first aid, safe moving and handling, food hygiene and some on medication handling. Using this overview the manager is now more easily able to identify staff who are due particular training. Staff spoken with confirmed that they have received training on the subjects noted above. The manager said that many staff have now been enrolled on NVQ courses which start in September and some staff spoken with confirmed this. The inspector looked at the recruitment files for four members of the care staff; two contained the required pre-employment checks. One contained the required checks but the Criminal Records Bureau check was dated as having been issued two months after this person had started work. The fourth staff file did not contain a CRB check at all, though there was evidence that one had been applied for. Protection of Vulnerable Adults First Checks for these staff members had not been received. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is well managed and has a systematic approach to health and safety, which helps to protect residents from harm. Though some systems are in place to monitor the service that residents receive, more could be done to ensure that improvements that could be made are identified and acted upon. EVIDENCE: Sue Reynolds has managed this home since 2002 and she has worked at the home in a care capacity since 1986. She completed the Registered manager’s award in 2005. A new post of home deputy manager has recently been established to support the management and administration of the home. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 20 Three of four staff completing Commission questionnaires indicated that they feel well supported by the management, confirming that they receive formal and informal supervision; one person indicated that they thought communication and support could be better. Care staff spoken with all confirmed that they like working at the home, indicating they felt well supported and able to raise concerns; three of them said that the good staff team was one of the best things about working at the home. As reported earlier all residents spoken with and all professionals completing Commission questionnaires indicated an overall satisfaction with the service provided at the home. The inspector was shown the outcome from a recent resident survey inviting comment on the service; responses were all very positive. This home is owned by and registered to a partnership who are not in day to day control of the home, the manager confirmed that their representative visits regularly; the inspector requested copy of monthly (regulation 26) unannounced inspection reports; these were not available. Information provided by the manager on a questionnaire completed before the inspection indicated that 10 residents died at the home in the preceding 12 months, all of which the Commission should have been informed of. The Commission have been informed about only three of these deaths. The inspector looked at and checked the money held by the home for two residents. The records of deposits and withdrawals were clear and the totals recorded reflected the money held. Money is kept in a suitably secure place. A current insurance certificate for the home was on display in the home’s entrance hall. Several upper floor windows were checked and had suitably restricted opening. A fire extinguisher on the first floor was seen to have been serviced within the past year and as noted earlier (see environment) work to protect residents from burns and to maintain fire doors has been carried out since the last inspection. Records confirming that the lift and patient handling equipment had been serviced within the past 12 months were seen. Certificates confirming the safety of the home’s “electrical installations” (dated 15/03/05) were also seen. The home’s fire risk assessment was dated as having been reviewed and updated in January 2006. No unmanaged threats to health or safety of residents were seen by the inspector. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X 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 2 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 22 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 OP18 Regulation 13 (6) Requirement The registered person must make arrangements, by training or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person must not employ a person to work in the care home unless.. he has obtained in respect of that person all the information and documents specified in paragraphs 1 to 7 of schedule 2 (Criminal Records Bureau checks must be received before staff start work where exceptions are made Department of Health Guidance must be followed) This requirement was also made following the two previous inspections of this service. Timescales given have been exceeded. Timescale for action 22/12/06 2 OP29 19 (1) 22/09/06 Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 23 3 OP37 26 4 OP37 37 Where the registered provider is a partnership, the care home must be visited either by one of the partners or by an employee of the partnership who is not directly concerned with the conduct of the care home. Visits must take place at least once a month and should be unannounced. The person carrying out the visit must interview, with their consent and in private, such of the service users and their representatives and persons working at the care home as appears necessary in order to form an opinion of the standard of the care provided in the care home, inspect the premises of the care home, its records of events and records of any complaints and prepare a written report on the conduct of the care home. A copy of this report must be supplied to each of the partners and the home manager. The registered person must give notice to the commission without delay of the occurrence of (a) the death of a service user 22/10/06 22/09/06 Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Medicines in the care home should be managed in line with Royal Pharmaceutical Society Guidelines… Secondary dispensing (putting medications into pots for another to person to give out) should not happen and the staff member administering medications should see that they are taken by the person they are intended for. Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Alphington Lodge Residential Home DS0000037791.V301718.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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