Inspection on 26/09/06 for Appleton Lodge

This inspection was carried out on 26th September 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

Appleton Lodge 18/07/07

Appleton Lodge 21/10/05

Appleton Lodge 04/05/05

Appleton Lodge 22/09/04

Appleton Lodge 14/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Appleton Lodge Lingard Lane Bredbury Stockport Cheshire SK6 2QT Lead Inspector Sylvia Brown Unannounced Inspection 26th September 2006 07:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Appleton Lodge DS0000008536.V312978.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. Appleton Lodge DS0000008536.V312978.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appleton Lodge Address Lingard Lane Bredbury Stockport Cheshire SK6 2QT 0161-430 6479 0161 406 6812 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) www.schealthcare.co.uk Southern Cross Healthcare Services Limited Dawn Haughton-Tarmey Care Home 30 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (10) Appleton Lodge DS0000008536.V312978.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Maximum number registered - 30. Services users to include up to 30 (OP), up to 3 (DE)(E) and up to 10 PD(E). 21st October 2005 Date of last inspection Brief Description of the Service: Appleton Lodge is one of the care homes owned and run by Southern Cross Healthcare. The home is located in a semi-industrial and residential area. Public transport is convenient and enables visitors and more able residents to travel to local shopping areas. Appleton Lodge is purpose built and stands in its own grounds, along with another home owned by the company. Appleton Lodge offers residents single bedroom accommodation, all with en-suite facilities. Accommodation is provided on two floors. Residents have the opportunity of sitting in various communal seating areas, one of which is designated for residents who prefer to smoke. The home has wide corridors and is able to support residents who use manual and electric wheelchairs. The home has a variable fee structure which starts at a base rate of £362 per week paid by local authorities. In addition, a top-up fee of £68 per week is charged to the service user. The maximum fee charged is currently £516. Appleton Lodge DS0000008536.V312978.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection site visit to Appleton Lodge was conducted as part of the overall inspection process of the home. It commenced at 7:30am and was completed in one day. Time was spent with night staff as they completed their night duty and day time care staff as they went about their day to day routines and supported service users. The inspector sat and shared mealtimes with service users and spent considerable time talking with them about the care and support they received. A number of records were looked at, including service users’ files, health and safety records and staff files. The inspector and manager walked around to home and assessed it comfortable, safe and pleasant for service users to live in. Time was also spent talking with the acting manager about how he has managed the home in the absence of the registered manager, who is on maternity leave. Comment cards were provided to service users, relatives, professional visitors and staff. Information received at the time of the inspection and through the returned comment cards has been included within the report where relevant and applicable. Feedback was provided to the manager at the end of the site visit about the findings. What the service does well: The home continues to maintain a fairly good standard of service. Though service users felt staff’s attitude and non-verbal communication affected them, they all spoke positively about the actual care they received. One newly admitted service user spoke glowingly about the care and support she has received since moving in. Longer-term service users stated that the home ensured that their care needs were met and that they felt, in the main, well cared for and satisfied with the services. Appleton Lodge DS0000008536.V312978.R01.S.doc Version 5.2 Page 6 Service users are supported to make decisions and choices for themselves. Service users preferring to rise early were served early morning drinks and had breakfast when they wished. Service users were observed rising throughout the morning, as they wanted. Bathing routines are flexible and service users can have baths as often as they want. Though parts of the home need upgrading, service users are supported to make their room their own. They are able to bring in small items from their own homes and can personalise them as they desire. Service users also spoke positively of the meals they received and confirmed that they could order different choices, however there were some comments made which indicated that there is room for improvement regarding how service users are supported to make meals choices and be aware of what is actually on offer at meal times. What has improved since the last inspection? What they could do better: The home could be maintained to a better standard. Day to day repairs and larger maintenance issues remain outstanding, with parts of the home looking shabby and uncared for. Service users and relatives all made comments about the state of the home, with one relative saying “I would like to see the recent redecoration of the downstairs extended to the upstairs. Lounge chairs badly need changing and the carpets are worn and tired, all could do with a face lift”. Staffing levels were not sufficient to meet the day-to-day and more complex needs of service users appropriately. When spoken to, staff felt under pressure and that there were not enough staff to meet the needs of and support service users in a timely manner. Appleton Lodge DS0000008536.V312978.R01.S.doc Version 5.2 Page 7 Service users made comment about being left waiting for support with personal care whilst staff are busy elsewhere. One service user stated “its very bad at times, sometimes they leave you waiting when you want to go to the toilet”. Service users were also dissatisfied with the routines at breakfast, as one staff is expected to serve breakfast, she also completing personal care and rising routines with others. They felt this practice left them alone too long and was unhygienic. Service users also made negative comments about their observations of some staff. One service user said “everything is very nice but it is dependant on who is on”; “you can tell what day you are going to have as soon as you see the staff’s face”. Another stated “we hear staff grumbling, so then we don’t want to ring or bother them”. Other service users agreed with such comments, though they confirmed that they were still cared for well when they received assistance. 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. Appleton Lodge DS0000008536.V312978.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 Appleton Lodge DS0000008536.V312978.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 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. Service users have pre-placement assessments which are kept under review after admission. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Inspection of service users’ records identified that they were assessed by the home’s manager prior to being accommodated and that the home received assessments completed by the placing authorities prior to admission. Assessments were kept under review and were monitored monthly. Records also identified consultation processes with service users where their needs were discussed and how they were to be met. The home does not admit service users for intermediate care. Appleton Lodge DS0000008536.V312978.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 Quality in this outcome area is good. Service users have their health care needs met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Service users have detailed care plans in place. Comments received from both service users and relatives identified that they were consulted and kept informed. The care plans recorded all the required aspects of care and how they should be met. The records demonstrated that service users were treated as individuals and reflected their individual preferences for care support. Observations were that care records were completed appropriately and contained enough detail to tell the reader what support was given. Appleton Lodge DS0000008536.V312978.R01.S.doc Version 5.2 Page 11 Professional health care visitors and support services were recorded on the service users’ files. Two comment cards were received from health care centres, both of which stated that the home maintained a good standard of care. One wrote “The care provided by care staff is of a very high standard. They are very caring and knowledgeable and any changes we recommend are always implemented”. All comment cards received from service users stated that they always received the medical support they required. One stated “Appleton are excellent and have called the GP when required”. Medication administration records were, in the main, maintained correctly. There was evidence that seniors or management monitored the records and investigated when errors were noticed. Appleton Lodge DS0000008536.V312978.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. Service users are able to make choices and decisions for themselves. The home does not provide sufficient opportunities for social stimulation or promote alternative food options. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Service users’ care plans detail their preferred day to day routine and social preference. Throughout the inspection it was clearly evident that service users choose where they wish to spend their day. Some chose the company of others, whilst some preferred their own rooms. Service users stated they visited with each other in their rooms and were able to have private times when they wished. Service users confirmed that were able to see their visitors in private and that some were taken out by friends and family to visit places of interest within the community. Appleton Lodge DS0000008536.V312978.R01.S.doc Version 5.2 Page 13 The home employs an activities co-ordinator, whose responsibility it is to devise the home’s social programme. When asked if service users had enough daytime occupation and socialisation, views varied. Of the eight comment cards received, three stated that sometimes, there were enough activities arranged and two stated there were always enough activities organised. The remaining three were not satisfied. One said “There is occasional bingo downstairs”. Others stated there were never enough activities. One relative commented there are not enough activities upstairs, they do not seem to take place even though they are listed on the notice board”. Another stated “the activities offered are not suitable for my mother. She needs more conversation and stimulation.” Service users’ individual records failed to identify service users’ participation in activities. In the main, service users have control over their own lives and are able to make informed decisions and choices. However, although service users spoke positively of the care they received, some were not satisfied with how some staff conducted themselves at times. One service user stated “its very bad at times, sometimes they leave you waiting when you want to go to the toilet”. Another two said they have to wait for care and attention at times, as they are both in wheelchairs and need assistance. Meals and mealtimes are pleasant experiences. The menu is varied and offers service users choice. Routines for ensuring service users are aware of choice are not sufficient. On the day of the inspection no service users on the upper floor were served a hot meal option at breakfast. When asked, they stated they were not aware of the hot food option. There was some difficulty receiving hot food items when ordered by the inspector. Service users stated that unless they ordered the day before, they also had difficulties when ordering differing food options. Appleton Lodge DS0000008536.V312978.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. The home has efficient complaint and adult protection procedures in place. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home has written complaints procedures in place. Most service users and relatives consulted with were aware of the complaints system. All stated they had confidence in the system and that when complaints were raised, they have been dealt with appropriately. The records of complaints recorded all the required details of the complaint and the action taken to investigate. Where possible, positive outcomes were sought for the complainant. Adult protection procedures were in place, staff receive appropriate training and are aware of their responsibility to protect service users. All service users stated that they had someone to talk to if they were not happy. All spoke positively of the acting manager and felt confident that he would act on their behalf if they needed him. Appleton Lodge DS0000008536.V312978.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, 20, 21, 23, 24 & 26 Quality in this outcome area is adequate. Service users have their own rooms which they can furnish and arrange to meet their individual preferences. Parts of Appleton Lodge are not appropriately maintained. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Appleton lodge is a purpose built home which provides all service users with single bedroom accommodation, all of which have en-suite facilities. Inspection of the premises confirmed that service users had personalised their rooms, some had brought personal items and possessions from their own home and had arranged their rooms as they liked. The inspection identified that bathing and showering facilities were not kept at the required standard. Exposed shower drains were observed, as were a broken toilet seat, damaged flooring, faulty lighting and damaged paintwork. Appleton Lodge DS0000008536.V312978.R01.S.doc Version 5.2 Page 16 Some en-suites required additional shelving or storage, some bedrooms required brighter lighting to ensure they were sufficiently bright for those with failing eyesight. Some carpets had staining and paintwork throughout the home was badly marked. Comment cards indicated that the home was mainly clean and fresh which was again confirmed by service users at the inspection visit. Appleton Lodge DS0000008536.V312978.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. Staff attitudes affect service users and staffing levels are not sufficient to meet the needs of service users in a timely manner. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Though service users commented favourably on the care they received and were generally satisfied with the home, they felt nervous, anxious and/or disappointed regarding staff’s attitude and non-verbal communication. Service users commented on a number of occasions when they did not call for assistance or were reluctant to because of the staff “face” or because they had heard them “grumbling”. One service user stated, “we need people to speak to us nicely”. As stated within standard 12, staffing issues were a concern to service users. When talking with staff it was clear that they were not satisfied with staffing arrangements. They stated there were insufficient staff to meet the needs of service users and that this affected how they supported them. Staff confirmed that service users were having to wait for care whilst staff assisted others. Appleton Lodge DS0000008536.V312978.R01.S.doc Version 5.2 Page 18 On the top floor six service users required two care staff to support them, however only two staff are designated to the upper floor. The inspector observed service users being left when they wanted assistance whilst staff were busy elsewhere. Staffing levels are further reduced when breaks are taken. When asked, staff confirmed that their breaks were constantly interrupted to either assist service users or complete records. They stated they worked 12 hour shifts and found it difficult to provide a consistent standard of care when they had worked without uninterrupted breaks. Staffing records identified recruitment and selection procedures were appropriately followed. Application forms and interview records were appropriately detailed. References were evident, as were statutory checks. Staff received induction and mandatory training. Staff complete NVQ training at levels 2 and 3 and continue with the home’s ongoing training programme. Appleton Lodge DS0000008536.V312978.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 & 38 Quality in this outcome area is adequate. The home has an appropriate manager and is, in the main, run in the best interest of service users, even though they are not asked about their satisfaction with service provision. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home’s registered manager was on maternity leave at the time of the inspection visit. The organisation has deployed a unit leader to act as manager in her absence, who has experience of management and has completed a management induction programme whilst being at the home. Appleton Lodge DS0000008536.V312978.R01.S.doc Version 5.2 Page 20 Service users spoke fondly of the current manager and felt confident in his abilities to act on their behalf and look after them. Observations were that he was knowledgeable about the needs of service users and had formed positive relationships with them during his time at the home. The manager stated that he had continued to supervise staff and has completed spot checks at the home, both at weekends and at night-time. The home has not completed quality assurance procedures for some time. There have been no service user meetings or formal systems to find out if service users and others are satisfied with service provision. One relative said that they would like to see more relatives’ meetings so they could ‘catch-up’ they also stated that, to their knowledge, “there have not been any meetings for at least 18 months”. Service users’ finances are mainly dealt with by themselves or their family. Where additional support is required, Social Services may support them. If required, advocacy and legal service can be secured to assist and safeguard service users’ finances. Accounts are maintained of service users’ small balances and receipts are in place for all expenditure. Health and safety records were looked at and found to be in order. Accidents are recorded and evaluated on a monthly basis. The home provides the CSCI with a record of all accidents and notifications when required. Though testing of fire safety equipment is completed, it is not done within the correct time frequency. Electrical equipment has been serviced and a fire safety inspection was undertaken by fire safety officers in May 2006. The manager confirmed issues arising have been dealt with. The manager has completed his own monthly audit of the home, however there have been no Regulation 26 visits completed. Appleton Lodge DS0000008536.V312978.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 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 x 3 3 x 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 3 Appleton Lodge DS0000008536.V312978.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 OP19 Regulation 23(2)(b) (d) Requirement The registered person must make suitable arrangements to upgrade parts of the home that are worn, shabby and faulty. Arrangements should also be in place to maintain it appropriately for the comfort, safety and enjoyment of service users. The registered person must ensure that systems are in place to complete small repairs and undertake day to day maintenance tasks within the home. (Timescale of 01/12/05 not met). The registered person must ensure staffing levels are sufficient to meet the needs of service users at all times. Service users should receive support in a timely manner. Timescale for action 05/01/07 2 OP24 23(2)(b) 05/01/07 3 OP27 18 05/01/07 Appleton Lodge DS0000008536.V312978.R01.S.doc Version 5.2 Page 23 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. 4 Standard OP33 Regulation 26 & 35 Requirement The registered person must complete quality assurance procedures to ensure service users’ satisfaction. Such procedures should include consultation with users of the service. Regulation 26 visits should also be completed, as required. Timescale for action 05/01/07 Appleton Lodge DS0000008536.V312978.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 OP12 Good Practice Recommendations The registered person should review the home’s social activities programme and ensure that service users have sufficient meaningful daytime activities and opportunities to socialise as they individually desire. Activities must be suitable to their needs and completed as detailed within the home’s activities programme. The registered person should ensure that service users are informed of the hot food choices at breakfast time and be supported to order them in the morning. The registered person should ensure that the highest hygiene standards and safety are maintained. Staff deployed to serve and support service users at meal-times should not, unless in cases of emergency, complete personal care support The registered person should ensure that staff follow professional codes of conduct and ensure that their dissatisfaction with their employment does directly impact on service users. The registered person should ensure that residents and relatives are consulted about the service offered at the home. The registered person should ensure that fire safety monitoring is conducted at the required frequency. 2 3 OP15 OP27 4 OP30 5 6 OP33 OP38 Appleton Lodge DS0000008536.V312978.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Appleton Lodge DS0000008536.V312978.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!