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Inspection on 12/07/07 for Appleby Lodge

Also see our care home review for Appleby Lodge for more information

This inspection was carried out on 12th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Appleby Lodge is a very pleasant homely home which is commented on by the people who live there. A number of the people have lived locally in the area prior to admission to the home and some have known the staff already from their delivery of meals to them in the community prior to admission or from attendance at the home for day care. The home plans all potential admissions well. The manager is always on duty and thought and consideration is put into the process to include a welcome card and flowers in the bedroom on arrival. The positive comments about the standard of care being delivered at the home is a credit to the registered manager and her team of staff. Positive comments were also given about the good standard of the meals at the home. Recruitment procedures are used infrequently due to the stability of the staff team which is regarded by the people in the home for the continuity of care that they receive.

What has improved since the last inspection?

Staff have now received fire drill training by an external professional and good detailed fire risk assessments are completed and held on the premises. The manager has been supported by the responsible individual in achieving this task by the employment of a specialist. Staff supervision is now being evidenced as taking place. This is a large task as the manager is undertaking all the supervision at the home. Considerable progress has been made with the adult protection training to staff since the inspection of the 24th May 2006. All staff except three (who are booked to attend) have now received adult protection training.

What the care home could do better:

The registered manager works extremely hard to deliver a good standard of care at Appleby Lodge. She is appreciated and valued by the people in the home. The inspection report of the 24th May 2006 comments that she must concentrate on obtaining her registered managers qualification. These comments are included again in this inspection report. It is also appropriate for more attention to be given to ensuring that documentation is correct for example the adult protection and complaints policy and procedure and that recruitment procedures are followed at all times. To allow the manager time to complete her studies it is appropriate for the responsible individual to assist in some of these tasks.All staff who have medication administration responsibilities should be provided with medication training to allow them to undertake their responsibilities safely.

CARE HOMES FOR OLDER PEOPLE Appleby Lodge 157 Launceston Road Kelly Bray Callington Cornwall PL17 8DU Lead Inspector Elaine Bruce Key Unannounced Inspection 12th July 2007 09:20 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 Appleby Lodge DS0000008945.V345286.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. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appleby Lodge Address 157 Launceston Road Kelly Bray Callington Cornwall PL17 8DU 01579 383979 01579 383108 nanpalmer@hotmail.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) Appleby Rest Homes Limited Mrs Janice Rider Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th May 2006 Brief Description of the Service: Appleby Lodge offers accommodation and personal care for up to eighteen older people. The single storey, purpose built home is situated in Kelly Bray, one mile away from the town of Callington. It is reached via a driveway that leads off from the main road. Car parking is available at the end of the driveway. A public house, post office, shop and Methodist Chapel are all within easy reach. The accommodation comprises of 18 single bedrooms, 2 bathrooms, 5 separate WCs, an office, a well-equipped kitchen, an outside laundry area and a lounge/dining room with access to the patio and large well-kept garden via French doors. The garden is wheelchair accessible. The home has a no smoking policy. A variety of activities are offered to the service users and visitors are encouraged with no restrictions on visiting times. Appleby Lodge is fully wheelchair accessible. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection at Appleby Lodge took place on the 12th July 2007 over 6 hours. The registered manager was on duty and the responsible individual for the Company attended the home on the afternoon of the inspection. This visit had been planned at the request of the manager to discuss the annual quality assurance assessment that the home had received from the Commission for Social Care Inspection. During the course of the day the premises were inspected, staff files and care records were inspected, medication was audited, the standard of meals assessed and people in the home and staff spoken to. Case tracking took place with four people. All the people spoken to during the course of the day expressed very positive comments on the standard of care that they are receiving at the home to include the following: “It is lovely here, the staff are very kind and the recent trip out was lovely”. “It is lovely here, this home brought me back to life” The home is able to offer a respite care service as well as longer term care. They also provide a number of meals to people locally in the community and a number of clients attend the home for a day care service. The weekly cost of fees for care ranges from £300.58 to £319.30 What the service does well: Appleby Lodge is a very pleasant homely home which is commented on by the people who live there. A number of the people have lived locally in the area prior to admission to the home and some have known the staff already from their delivery of meals to them in the community prior to admission or from attendance at the home for day care. The home plans all potential admissions well. The manager is always on duty and thought and consideration is put into the process to include a welcome card and flowers in the bedroom on arrival. The positive comments about the standard of care being delivered at the home is a credit to the registered manager and her team of staff. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 6 Positive comments were also given about the good standard of the meals at the home. Recruitment procedures are used infrequently due to the stability of the staff team which is regarded by the people in the home for the continuity of care that they receive. What has improved since the last inspection? What they could do better: The registered manager works extremely hard to deliver a good standard of care at Appleby Lodge. She is appreciated and valued by the people in the home. The inspection report of the 24th May 2006 comments that she must concentrate on obtaining her registered managers qualification. These comments are included again in this inspection report. It is also appropriate for more attention to be given to ensuring that documentation is correct for example the adult protection and complaints policy and procedure and that recruitment procedures are followed at all times. To allow the manager time to complete her studies it is appropriate for the responsible individual to assist in some of these tasks. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 7 All staff who have medication administration responsibilities should be provided with medication training to allow them to undertake their responsibilities safely. 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. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 8 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 Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 9 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): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive procedures are in place prior to admission to ensure that the people being admitted to Appleby Lodge can be confident that their needs will be met. EVIDENCE: The home has a statement of purpose document in place that meets all the requirements of The Care Homes Regulations (2001). The statement of purpose document is available in the home. A service user guide has been distributed to all existing people in the home and all potential admissions also receive this documentation. Some small amendments are required to this documentation to ensure that people have the correct information on how to contact the Commission for Social Care Inspection. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 10 The registered manager assesses all people prior to admission to the home to ensure that their care needs can be met and that they are older persons (OP) not falling outside the category of registration for the home. No admissions take place when the manager is off duty. Documentation is in place to evidence that pre admission assessments are taking place. The home also receives (where funding arrangements are in place) a copy of the assessment of need by the funding authority. The home provides meals to the local community and a small number of clients attend the home for a day care service. This allows these people to be familiar with the home prior to admission. If a person does not know the home they are encouraged and welcomed to visit prior to admission. All admissions are handled with consideration by including a “welcome” card and flowers in the bedroom. This was observed on the day of the inspection when a new admission was taking place. The home has an admission policy and procedure in place to guide staff on good practice. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People at Appleby Lodge can be confident that they will be treated with respect and that their personal and health care needs will be met. EVIDENCE: Individual plans of care are in place for each person at Appleby Lodge. People in the home and their representatives are encouraged to be involved in the care planning process and evidence is in place of regular monthly reviews taking place. Separate good daily records support the care plans. These records are though being unnecessarily duplicated by the care staff. Although the records are generally good the time to operate two systems is unnecessary and should be reviewed. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 12 The community nursing service are regular visitors to the home. Pressure relieving equipment is provided along with aids and adaptations as required. Care planning documentation evidences health care professional involvement to include opticians and chiropodists. Medication administration records were found to be completed appropriately as was the storage and administration of the medication. A medication policy and procedure is in place to guide staff on safe practice. Senior staff have medication administration responsibilities and more staff require medication training to ensure that they have the knowledge and skills to administer safely. Staff were observed at all times to treat the people at Appleby Lodge with respect and dignity and comments from the people in the home confirmed these observations. Appleby Lodge DS0000008945.V345286.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines of the home are relaxed, relatives and friends can be confident that they are welcomed and social activities are arranged. The dietary needs of the people in the home are well catered for with a balanced and varied selection of food that meets peoples’ tastes and choices. EVIDENCE: The people in Appleby Lodge are able to chose how they wish to spend their day at the home and this starts with the time that they wish to get up. Information is included in care planning on the personal history of the individual and how they wish to spend their social/leisure time. The home is very homely and informal with staff and people interacting and enjoying their time together. On the day of the inspection a carer was painting the nails of a number of people and conversations were taking place. Staff write their care records in the communal areas and they also have their meals and coffee there with the people in the home. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 14 Some formal activities are arranged to include music and reminiscence sessions. Monthly visits to the home occur from the Church of England and the Methodist Minister. A clothes shop visits the home twice a year for people to buy any items that they may require. Nine people with eight staff went on a trip out from the home the week before the inspection. This was fully funded by the home and appears to have been a very enjoyable occasion. A number of people are independently mobile and enjoy spending time in the gardens and having a daily walk. Visitors are welcomed to the home and are encouraged to sign into the home on arrival. The daily records evidence when visitors have been received. The spacious communal areas allow people to interact with their visitors there or if they require more privacy in their bedroom. Information is available in the home on advocacy services should this be required for a person without a representative. The menu for the meals at the home is prepared one month in advance and takes into account the individuals’ choices and preferences. The main meal of the day on the day of the inspection was steak and kidney pie with parsnips, cabbage and creamed potatoes. This was to be followed by blamange and topping. An alternative choice is always provided to all the meals. Wine is offered to the people in the home on a Sunday and the bar in the home is used when required. Local produce is used for cooking to include meat and vegetables. In addition to cooking meals for the home the cooks provide meals that are then delivered into the local community. On the day of the inspection work was being carried out to meet the requirements of legislation from the District Council Environmental Health Department. The home is keeping records to meet the Better food Safety Awareness documentation. All the staff employed at the home have received training in basic food hygiene awareness. All of the people spoken to during the course of the day in the home expressed very positive comments on the standard of the meals. Appleby Lodge DS0000008945.V345286.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 adequate. This judgement has been made using available evidence including a visit to this service. The people at Appleby Lodge can be confident that any concerns or complaints are treated seriously and that they will be protected from abuse. EVIDENCE: People spoken to during the course of the day expressed very positive comments that they would be able to speak to the manager if they had a complaint. It is appropriate that the documentation displayed in the entrance of the home is up to date and clear with correct information on the Commission for Social Care Inspection as well as the policy and procedure provided to the people in the home. The home has in place an adult protection policy and procedure. The policy has information on the definitions of abuse but requires updating with the correct details of the Commission for Social Care Inspection. The staff are on a rolling programme to attend the adult protection training presently being provided by the Adult Social Care Department of Cornwall County Council. All the staff except three (who are booked to attend the training) have received adult protection training. Appleby Lodge DS0000008945.V345286.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 people at Appleby Lodge live in a pleasant, well-maintained home that is comfortable, warm and clean. EVIDENCE: Appleby Lodge is a single storey building with level access throughout and the front entrance has a ramp for wheel chair use. The home has a spacious central lounge and dining area which is comfortable and homely. The bedroom accommodation is accessed by corridors that run either side of the communal areas. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 17 The home was found to be very clean on the day of the inspection. The cleaner said that she worked Monday to Friday and at the week end the care staff undertook cleaning responsibilities. The property has a pleasant, level back garden which people can access and there is a pathway which allows people to walk around the grounds should they so wish. The laundry is outside the home with suitable facilities but the staff do have to access this facility in all weathers. Attention should be given to filling in some of the pot holes in the entrance road to the home. Appleby Lodge DS0000008945.V345286.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. The people at Appleby Lodge are cared for by knowledgeable, capable and caring staff in sufficient numbers to meet the needs of those currently living in the home. EVIDENCE: Two cares (at a minimum) are on duty at Appleby Lodge at all times with three cares on duty during the morning peak activity period. In addition to the care staff there is a cook, kitchen assistant, domestic assistant and the manager. There is one waking and one sleeping member on duty at night. Recruitment procedures are used infrequently as the staff team are very stable with no vacancies generally being the norm. On the day of the inspection a new cook had been recruited and a criminal records bureau check was not in place. This was discussed and the manager advised that this would never have taken place for a care staff member, but she understood that even for the cook this is not correct recruitment procedures. It is also recommended that the older criminal records bureau checks at the home are updated. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 19 Staff are encouraged to undertake and complete an NVQ qualification. Copies of certificates are kept in the home and displayed in the entrance hall. Statutory training to include first aid, moving and handling, fire drill and health and safety training is up to date. There are plans for dementia and eye care training to take place later in the year. During the course of the day the people in the home commented on the kindness of the staff: “I am very happy at the home, the staff are so kind and caring”. Two senior care staff members were spoken to during the course of the inspection. They explained about all the training that has recently been taking place in the home and how they value the college coming to the home to provide the training. Appleby Lodge DS0000008945.V345286.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): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and staff team at Appleby Lodge are striving very hard to provide a well managed home. The home is safe, rights are upheld and people are respected but further progress now needs to be made in dealing with some of the administration tasks at the home. EVIDENCE: The registered manager is qualified at NVQ level 3 and has six years experience as manager of the home. She is on call at all times when not working in the home. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 21 As commented in the inspection report of the 24th May 2006 the manager is still undertaking her studies to obtain the registered managers award qualification. It is recommended that priority should be given to completing this qualification as soon as is possible. It is noted that she has also had to undertake studies to obtain her NVQ 4 qualification first. The manager has undertaken first aid training this year. The manager is very much a hands on manager directly involved in the delivery of care. Documentation is now in place that she is undertaking regular supervision of the staff at the home. Since the inspection of the 24th May 2006 a questionnaire has been sent to the people/representatives in the home to establish an audit /quality monitoring to ensure that the home is being run in the best interests of the people. Comments on the returned questionnaires indicate that the answer to this is yes, but an analysis of the results is yet to take place. It is anticipated that the responsible individual will undertake this task as well as some of the updating information required for documentation. The people at Appleby Lodge are encouraged to manage their own finances and if they are not able this is done on their behalf by relatives and solicitors. Any records of personal spending and money held by the home on behalf of the people are appropriately maintained. The manager has made considerable progress in meeting the requirements of supervision evidence. She has full responsibility for staff supervision and this is now taking place every other month. A number of staff have recently attended a health and safety training course with more staff planned to attend this training. The health and safety training has included training on infection control. A discussion took place with the responsible individual during the course of the afternoon on responsibilities and duties to meet requirements of legislation. Appleby Lodge DS0000008945.V345286.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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 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 2 17 x 18 2 3 x x x x x x 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 2 x 3 x 3 3 x 3 Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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. 3. 4. 5. 6. Refer to Standard OP1 OP7 OP9 OP16 OP18 OP29 Good Practice Recommendations To ensure that correct information is provided in the service user guide/statement of purpose on the Commission for Social Care Inspection. To review the daily recording system and bring together as one recording system rather than two. To provide medication training to all staff who have medication administration responsibilities. For the complaints policy and procedure to be provided with the correct information on the Commission for Social Care Inspection. To update the adult protection policy and procedure with the correct information for contacting the Commission for Social Care Inspection. To ensure that criminal records bureau checks are in place at all times and renewed as appropriate. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 24 7. OP31 For the manager to obtain her registered managers qualification as soon as is possible. Appleby Lodge DS0000008945.V345286.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Appleby Lodge DS0000008945.V345286.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. 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!