Inspection on 12/12/05 for Apthorp Lodge

This inspection was carried out on 12th December 2005.

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

Apthorp Lodge 09/03/10

Apthorp Lodge 21/01/10

Apthorp Lodge 03/11/09

Apthorp Lodge 17/08/09

Apthorp Lodge 19/06/09

Apthorp Lodge 11/06/08

Apthorp Lodge 04/12/07

Apthorp Lodge 22/05/07

Apthorp Lodge 14/08/06

Apthorp Lodge 09/08/05

Apthorp Lodge 13/01/05

Apthorp Lodge 22/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Henry Nihill House

Birchwood

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

The Infirmary

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

CARE HOMES FOR OLDER PEOPLE Apthorp Lodge Nurserymans Road off Brunswick Park Road London N11 1EQ Lead Inspector Anthony Lewis Unannounced Inspection 12th December 2005 09:00 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 Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 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. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Apthorp Lodge Address Nurserymans Road off Brunswick Park Road London N11 1EQ 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) 01296 393 055 0208 211 4109 Manager.winglodge@fremantletrust.org The Fremantle Trust Mrs Irene S Rondell Care Home 108 Category(ies) of Dementia - over 65 years of age (37), Learning registration, with number disability over 65 years of age (6), Old age, not of places falling within any other category (65) Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Consideration must be made in respect of the demography of the building. Staffing levels must meet the needs of the service users at all times of the day and night. 9th August 2005, 21 September 2005 & 10 October 2005 Dates of last inspections Brief Description of the Service: Apthorp Lodge is a care home, which was first registered in August 2003 to provide personal care for 54 people, some of whom may have dementia and a learning disability. Following the closure of two other homes, which were also managed by Fremantle Trust, a further 54 places were commissioned in October 2004, bringing the total capacity of the home to 108 residents. The home is a large detached three-storey building. It is purpose built and organised on three levels, with lift access to all floors. It is divided into ten units or flats. Each unit has its own staff team, with a unit leader in charge. There is a kitchen, lounge and dining room in each unit. All bedrooms are single with en-suite facilities. There is also an additional assisted bathroom in each unit. hree units are dedicated to residents who have dementia and one unit to service users who have learning disabilities. The remaining six units are for mainstream services for older people. There is a registered manager in overall charge of the service, supported by two assistant managers, one of whom is responsible for specialist services on the ground floor. The home also has a small licensed bar available for residents. There is a car park to the side of the building and gardens to the side and rear, which are partly paved and accessible to the residents. The home is situated off Brunswick Park Road. It is well served with community services and facilities located along Russell Lane and East Barnet Road. The home has a day centre, which provides services to twenty-six service users specifically from the outside community. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on Monday 12th December 2005 at 9am and was completed at 2.30pm. The registered manager and deputy manager were available throughout the inspection and were very helpful and accommodating. The Commission’s pharmacist inspector, Marilyn MacKenzie also carried out an unannounced inspection of the home’s medication policies and procedures from 10am to 2pm on the same day and her findings are entered in this report in the relevant section. Five residents and six staff were spoken to at length informally throughout the day. The personal files of ten residents and seven staff were viewed, along with a number of other files, documents and safety certificates. A tour of the home was conducted with the deputy manager. Since the previous inspection, the staff team have worked hard to ensure that all of the previous requirements have been met. There were ten requirements made at the previous inspection, of these, this inspection has revealed that all but two of the requirements have been met. All of the core standards have been inspected at this and the previous inspection. The residents are being well cared for by a dedicated staff team, who have worked hard to ensure that all parts of the home, is made as comfortable and accessible as possible. Many of the staff have worked in the home for many years and have a good understanding of the residents’ needs. The management structure and division of the home into units, with a unit leader, has worked well in ensuring that the needs of residents are broken down into manageable groups, while still retaining a sense of community within the home. The home exudes a picture of harmony and co-operation from both the residents and staff, without staff losing sight of their roles and responsibilities to the residents. Two requirements made at the last inspection have not yet been met and have been restated in this report, with a new timescale for compliance. Further information about unmet requirements can be found in the relevant standard. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Two requirements made at the last inspection have not yet been met and have been restated in this report, with a new timescale of compliance. Six requirements have been made at this inspection of these two are restated. One recommendation was made. All residents must have a copy of their contract setting out the services and facilities provided. Medication received into the home must be checked and signed for on service users’ administration sheet to ensure that they are receiving all prescribed medication. Staff must continue to work with the service users’ GPs to ensure that all medication is prescribed, ordered and checked into the home with sufficient time for a service user’s medication to be available when required. To ensure that residents live in a safe and comfortable home and the appearance of the home is maintained, the broken toilet seat and curtain hooks must be fixed or replaced. Staff must receive adequate training to continue to meet the changing needs of residents, (repeated requirement). All staff must receive regular recorded supervision at least six times a year to ensure that their personal development is being monitored and that they are being supported and are meeting the needs of service users, (repeated requirement). Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 Page 7 It is recommended that there is always a signed record of all medication returned to respite service users when they are leaving the home. 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. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 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 Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 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): 1, 2 and 3. Staff are not ensuring that all residents are completely aware of all of the services and facilities provided in the home, which may result in residents misunderstanding of their rights. The staff team are ensuring that comprehensive assessments are being carried out in order to best meet the needs of the residents. EVIDENCE: The statement of purpose and service users guide was viewed and has been updated, to include the Commission’s correct name and residents’ correct spending allowance in the service users guide, which was a requirement at the previous inspection. The personal files of ten residents were viewed and although some contained a copy of their contract, with adequate information of their terms and conditions of residency, five residents did not have a copy of their contract on file. A requirement is made that all resident have a contract setting out the services and facilities provided. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 Page 10 The registered manager stated that a full assessment is carried out on all potential residents by a senior member of the staff team prior to the person moving into the home. The assessments of the ten most recent admissions to the home were viewed and all contained essential information such as health care needs, daily requirements and a brief summary of their overall care needs. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9. The staff team are ensuring that all residents’ care needs are appropriately documented in their care plans and are working according to the plans to best meet the needs of residents. The staff team are not ensuring that medication administration record sheets are fully checked to ensure that residents receive all of their required medication. EVIDENCE: The care plans of ten residents were viewed. Each contained a comprehensive care plan, covering areas such as health and medical care needs, cultural needs, psychological and emotional care needs and hobbies and interests. A support worker was spoken to privately about a resident that she was observed talking to in “Jamaican patois”, she stated that the resident understands and responds better when spoken to in patois. When the resident’s care plan was viewed, their was evidence to substantial this. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 Page 12 Significant improvement has been made by the staff team to ensure that medication administration requirements from the previous inspection have been met and that policies and procedures are adhered to. All flats were visited at this inspection and the receipt and administration records for service users were examined. No gaps were found on the medication administration sheets. The receipt of one service user’s medication had not been signed in on the medication administration record sheet. The assistant manager stated that this was an oversight, as it had been received late at night. A requirement is made that all residents’ medication is signed in on their medication administration record sheet. Medication times for residents had been reviewed and medication is now being given at a more suitable time for them; this included nighttime medication. All the documentation had been completed for service users wishing to administer their own medication. The manager had the completed list of all the staff who had received training and were therefore authorised to administer medication. There were still a few members of staff who still needed to receive the medication training currently being undertaken by Boots Pharmacists. The manager stated that the staff who failed the test at the end of the training session had repeated the training. All the records showed that the temperature of trolleys are being maintained at 25 oc or below. The home is going to undertake a feasibility study with a view to introducing cool room/s for the storage of medication. The coding on the administration sheets showed that during the month two service users had run out of their medication for more than twelve hours. A requirement is made that the registered persons continue to work with the service users’ GPs to ensure that all medication is prescribed, ordered and checked into the home with sufficient time for a service user’s medication to be available when required. They were not on the standard monthly cycle as they had been away or had only recently been admitted to the home. The new supplying pharmacist had ensured with the staff that there was a smooth transfer of the dispensing of medication for the home. The new sheets for use by respite service users do not have a section where medication returned to service users on leaving the home can be signed for by the service user or their relatives. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15. Residents are confident that the home will provide appropriate social activities and that meals will be in accordance to their preferred choice and dietary needs. EVIDENCE: Ten residents’ files were viewed and each contained information on their hobbies and interests and their social and domestic needs, such as going shopping, bingo and watching television. Throughout the home there was information on the notice boards in the hallways with a variety of Christmas entertainment, such as a trip to see the Christmas lights, a Christmas party for family and friends and St Stephen’s Day entertainment with a buffet afterwards. In addition, five residents were spoken to about their views on the social activities that the home provides. Three residents said that they liked doing the exercises that the home provides, another resident said that she likes doing crocheting and another said that she likes travelling. The head chef was spoken to at length about the menu and the preparation of meals. He had a good understanding of the dietary needs of all of the residents and ensures that records are kept of residents personal dietary needs, likes and dislikes. Three residents spoken to said that they enjoy all of the meals and look forward to meal times. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 Page 14 Four care plans viewed contained information on residents’ dietary needs and food likes and dislikes. The list of resident’s dietary needs and their likes and dislikes was viewed in the kitchen. Lunch was taken with residents in one of the units. Staff were observed supporting residents to eat in a patient and unrushed manner. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17. The staff team are ensuring that they respect residents’ rights and support them where necessary to continue to exercise their rights. EVIDENCE: The home has a policy and procedure on residents’ right to vote in local and general elections. The deputy manager said that staff support residents to vote in local and general elections and that most residents vote by post. She went on to say that registration cards are returned for those residents who do not have the capacity to vote. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21 and 23. The dedication of the staff team ensures that residents generally live in a safe and comfortable home, although some parts of the home require minor repairs to ensure that the homely appearance is maintained. EVIDENCE: While touring the home with the deputy manager seven residents were spoken to informally. All said that they were happy and comfortable. One resident said that she was looking forward to Christmas and another said that he was content and did not want anyone fussing over him. A letter was seen from the contractors who have been assigned to ensure that the attic door near flat 9 is more easily assessable. The rope dangling from the attic door has also been removed. This requirement is therefore met. In some units, Christmas carols were playing on either the radio or compact disc player. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 Page 17 While looking at bathrooms and toilets, a toilet seat was broken and propped up next to the toilet in one of the units and a curtains in one of the lounges was hanging off due to some broken curtain hooks. A requirement is made that the registered manager ensures that the broken toilet seat and curtain hooks are fixed or replaced. The home’s gardener/handyperson has ensured that the communal garden is well tended, safe and welcoming. All parts of the garden was clean, tidy and shrubs, plants and the grass has been pruned and the footpath and garden furniture creates an inviting and bright effect. Inside that home, the cleaners have ensured that all parts of the home, especially communal areas are clean and tidy. While touring the home, the damaged lino, which was made a requirement at the previous inspection, has been met, the lino has been replaced. All bedrooms have been decorated to a good standard and residents personal items, such as pictures, ornaments and furniture gives the rooms a comfortable feel. Two residents were spoken to briefly in their bedroom. One said, “I am very comfortable here and enjoy spending time in my bedroom”. The other resident was keen to show pictures of her family. She said, “I am very happy here, staff look after me well”. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30. Staff are ensuring that residents are protected by the home’s recruitment policies and procedures. However, residents are being put at risk due to some staff not receiving sufficient training. EVIDENCE: The files of seven staff were viewed and all contained relevant documents such as two references, a job description detailing the staff’s roles and responsibilities and an application form. A requirement was made at the previous inspection that all staffs’ Criminal Records Bureau (CRB) certificates are retained in the home has been met. Although the original certificates were not available, the registered manager is given a letter from head office whenever a (CRB) certificate has been received. The letter also includes the (CRB) number, date and clearance. Throughout the inspection staff were spoken to, some at length and other briefly. All had a good understanding of their roles and responsibilities and the care needs of the residents. The deputy manager said that she is responsible for staff training. The home’s mandatory training matrix was viewed and although staff are receiving regular mandatory training, which was a requirement at the previous inspection, some staff are yet to complete important training such as dementia and Protection of Vulnerable Adults (POVA) training. The deputy manager said that she is in the process of arranging dates for their training in the New Year. This requirement is revised and restated in that the registered persons must ensure that all staff receive sufficient training to meet the changing needs of the residents. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 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): 34, 35 and 36. Robust financial accounting procedures ensure that residents’ interests are safeguarded and the business is financially viable. Staff are not being appropriately supervised to ensure that they can sufficiently meet the needs of residents. EVIDENCE: The office administrator was spoken to at length regarding the home’s accounting and financial procedures. Records of transactions such as petty cash accounting and the business statements were viewed and all transactions are being recorded adequately. The home’s business insurance cover was seen and is adequate for the home and in date. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 Page 20 The receipts and record keeping was discussed and the financial arrangements for residents’ finances was discussed. A random sample of residents’ finances and valuable possessions, which is kept in the home’s safe, was viewed and records were up to date and in order. Although staff are receiving supervision, they are not conducted on a regular basis for some staff. A requirement was made at the previous inspection that all staff receive regular recorded supervision. The supervision records for seven staff were viewed and one member of staff had not received supervision since February 2005 and two staff had not received supervision since the summer of 2005. This requirement is restated. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 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 3 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 x 2 3 3 X 3 X X X STAFFING Standard No Score 27 X 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 3 2 X X Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 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 OP2 Regulation 5(1)(b)(c) Requirement The registered persons must ensure that all resident have a contract setting out the services and facilities provided. The registered persons must ensure that all medication received into the home is checked and signed for on the service user’s medication administration record sheet. The registered persons must ensure that they continue to work with the service users’ GPs to ensure that all medication is prescribed, ordered and checked into the home with sufficient time for a service user’s medication to be available when required. The registered persons must ensure that the broken toilet seat and curtain hooks are fixed or replaced. The registered persons must ensure that all staff receive sufficient training to meet the changing needs of the residents. (Timescale of 28/10/05 not met) This requirement is restated. DS0000051441.V265319.R01.S.doc Timescale for action 17/02/06 2. OP9 13(2) 27/01/06 3. OP9 13(2) 27/01/06 4. OP19 23(2) (bcd) 18(1)(c) (i) 27/01/06 5. OP30 24/03/06 Apthorp Lodge Version 5.0 Page 23 6. OP36 18 (2) The registered persons must ensure that all staff receive regular recorded supervision at least six times a year. (Timescale of 28/10/05 not met) This requirement is restated. 24/03/06 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 The registered persons should continue to ensure that there is a signed record of all medication returned to respite service users on leaving the home. Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Apthorp Lodge DS0000051441.V265319.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!