Inspection on 26/09/08 for Ashton Lodge

This inspection was carried out on 26th September 2008.

CSCI found this care home to be providing an Adequate service.

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.

Other inspections for this house

Ashton Lodge 12/02/07

Ashton Lodge 11/05/06

Ashton Lodge 14/09/05

Ashton Lodge 17/05/05

Ashton Lodge 13/01/05

Ashton Lodge 27/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

CARE HOMES FOR OLDER PEOPLE Ashton Lodge Ashton Road Dunstable Bedfordshire LU6 1NP Lead Inspector Angela Dalton Key Unannounced Inspection 26th September 2008 10:00 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 Ashton Lodge DS0000014990.V371857.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. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashton Lodge Address Ashton Road Dunstable Bedfordshire LU6 1NP 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) 01582 673331 F/P 01582 673331 resicarehomesltd@btconnect.com Resicare Homes Limited Care Home 54 Category(ies) of Dementia - over 65 years of age (54), Old age, registration, with number not falling within any other category (54), of places Physical disability over 65 years of age (54) Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th February 2008 Brief Description of the Service: The home is situated in a residential street, close to Dunstable town centre. The home was extended in 2005 and now provides 54 beds in single and double rooms, 4 lounges, and a number of communal toilets and bathrooms. The home was arranged with the bedrooms on all three levels and communal areas on the ground floor. For operational reasons the home was divided into three areas, grouping service users according to their needs, but still respecting freedom of movement throughout the home. A pleasant garden was easily accessible and was well used by the service users in the summer months. The home charges between £457 and £500 per week depending upon the care and support required by people who use the service. This rate was effective from 1st May 2008 and will be reviewed on 1st May 2009. This fee does not cover hairdressing, private chiropody and dry cleaning. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Two inspectors conducted this unannounced site visit on 26th September 2008 between 10:00am and 5.00pm. Two people were case tracked. We followed the care of people who use the service to ensure the care they receive is reflected in the care plan and meets their individual requirements. The case tracking process cross-references all the information gathered to confirm that what Inspectors are being told is actually happening and reflects the Statement of Purpose, which contains the aims and objectives for the service. It included discussion with service users, relatives, staff and the deputy manager and provider. Many of the people who use the service have dementia and our observations of care are recorded, as we could not always obtain their experiences. We were present for lunch and observed several aspects of daily activity. People who use the service are well cared for and staff focus upon individual needs to ensure care delivery is of a high standard. What the service does well: This home provides a clean, comfortable and homely environment for people who use the service. All people who use the service appeared clean, comfortable and well cared for. This was reflected in comments made by relatives who we spoke to and people who use the service. Two of the service users that were picked for case tracking, had been admitted since the last inspection. Both of their files contained detailed pre admission assessments. These had been carried out prior to the admission date, and clearly identified the level of assistance required in all areas of care. Care plans and risk assessments were clearly documented and demonstrated that changing needs were being identified, acknowledged and addressed through regular review. Additional health needs are attended to by visiting professionals. Observations of care practices and discussions with service users indicated that they are treated with respect and dignity. Staffing levels assure that time is available to sit and talk to people who use the service and their relatives. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashton Lodge DS0000014990.V371857.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 Ashton Lodge DS0000014990.V371857.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All people who move into the service have had their needs assessed which ensures that they can be met and appropriate care is delivered. EVIDENCE: Assessments are always completed prior to admission. They are completed by a senior member of staff and provide a basis for the care plan as identified needs and likes and dislikes are recorded. This ensures that the care can be tailored to individual requirements and is personalised. There was evidence to support this in the files of people who use the service. The proprietor stated that if the service felt that they could not meet the needs of an individual then they would not be admitted. During the inspection an admission was taking place. The inspector observed staff prepare paperwork and communicate what the person who used the service required. Family were involved in the process and the choice of three vacant rooms were offered with the suggestion of the newly refurbished room being the most suitable. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 10 There are eight interim beds and this enables people who are admitted for ‘short stay’ care to experience living at Ashton Lodge before they make a commitment to returning home or moving into full time care. Ashton Lodge DS0000014990.V371857.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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improved recording and staff training could better meet the specialist health needs of people who use the service. EVIDENCE: Two people who use the service had their care case tracked – people who use the service have their records cross referenced to confirm that the care that they need is being provided. All records that relate to specific people who use the service are inspected to gain an overview of their experience and quality of care. Care plans were informative and detailed how personal preferences are met. This enables independence to be maintained and for the person who uses the service to retain control over their lives. The high level of care delivery was reflected in the care plans. Some detail needs to be added: although there were nutritional and pressure wound care and prevention care plans there were no assessments. Further detail is also needed to reflect how the specialist needs of people with dementia are met and how activities are tailored to their requirements. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 12 District Nurses visit to administer insulin and staff have access to their care plans. However, this information does not form the overall plan of care and does not reflect the work staff do in their monitoring and management of diabetes. One member of staff has been trained by the district nurse to take blood sugars and this has been cascaded to other staff. All staff need to be directly trained where nursing procedures are carried out in a care home. This training must also be evidenced to ensure staff are competent and up to date and the safety of people who use the service is assured. Staff had not received training about the care of people with diabetes. The inspector spoke to a nurse visiting the service who had no concerns about the care in the home and felt that guidance was always carried out, communication with the staff was good and people were well cared for. The service records the number of falls that occur but the results are not analysed and professional advice is not sought. The proprietor agreed to pursue this in order to identify the potential causes of falls and aim to reduce them. Information relating to people who use the service was on display in a corridor, detailing rising times and bathing schedules. This should not be on view, as the privacy of people who use the service was not observed. The medication was checked: one person who used the service’s tablets did not reconcile – there were three more tablets than there should have been suggesting that three doses had been signed for but not given. Insulin pens were in the drugs fridge but there was no record of them on the Medication Administration Record Sheet (MAR). It was recorded that none had been received. Insulin pens were being kept in the district nurses room which did not reflect safe practice, as the room was not temperature controlled. This was rectified during the inspection and insulin pens will now be kept in the correct conditions. The home has five medication trollies but only one of them is stored in a room where the temperature is recorded. Without keeping temperature records of each trolley there is no assurance that medication is being stored at the correct temperature. People who use the service were extremely complimentary about the care that they receive. Staff were observed to be genial and good humoured. They were patient and gentle and spent time talking to individuals. There are several lounges around the home and those with higher needs have staff with them all of the time. Apart from one person, everybody chooses to spend their time downstairs. The person in their bedroom is checked half hourly and staff were observed to knock before entering. They stated ‘staff are all nice. I’d like to say much more than thank you, they’ve done so much.’ They had been extremely ill in hospital but had made an unexpected recovery, which they credited to the care received. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 13 A relative told inspectors that staff were always this kind and it was not as a result of their presence in the home. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are the focus of the way in which the service is operated. Care staff are sensitive to individual needs and offer choice where possible. EVIDENCE: Lunch was observed to be a social occasion and the fish and chips most people chose to eat was reported to be hot and tasty. Staff assistance was given discreetly and in an unhurried and gentle manner and the adequate level of staffing ensures this is achieved. Menu choices are written on a board in each lounge. The owner is exploring alternatives to better meet the needs of those with dementia or whose first language is not English such as pictoral menus. The cook takes great pride in home cooked food and is able to offer a number of options at each meal. She knows personal preferences and dietary requirements and care staff work closely with her to ensure needs are met. Drinks were available throughout the day and observed to be easily accessible. The kitchen was clean and well kept. All records were in order. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 15 There is currently no activities co-ordinator employed but the owner plans to fill the vacancy. This will ensure a programme of events. Staff are organising activities and keeping a record. No evidence was available for tailored activities for those who have a diagnosis of dementia. People who use the service are able to go shopping or attend community events with staff support. Some go out independently. One person who uses the service had recently seen a production at the local theatre. The proprietor is investigating the option of a small ‘shop’ to enable necessities to be available ‘in house’. An organ player was providing entertainment during the inspection. Relatives were complimentary about the service and stated that people who use the service were well presented and had plenty to eat and drink. We observed that that people who use the service were well kempt: jewellery was being worn and make up and nail varnish had been applied, clothes were smart and gents were clean shaven. People who use the service who were getting up early had this recorded in their care plan. Staff stated that if somebody did not wish to get up then they would get up later. This was observed when we arrived at 10 am. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 16 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are protected from abuse. People who use the service are listened to and their views are acted upon. EVIDENCE: People who use the service confirmed that if they were not happy with an aspect of their lives and care they knew how to complain and who to speak to. Some had raised issues which had been dealt with and resolved e.g. requested a hot drink at a particular time before going to sleep. We had previously had concerns raised about issues in the service, primarily care delivery and offensive odours. The proprietor had investigated the concerns and reported the outcome to the Commission for Social Care Inspection (CSCI). We did not find any foundation to the issues raised during our visit. The proprietor is updating the complaints procedure to reflect the changes to CSCI’s address. All care staff have received Safeguarding of Vulnerable Adults training (SOVA) but domestic staff had not been trained. All staff should be equipped to deal with a disclosure of abuse to ensure that the individual is protected. The service does not deal with any finances for people who use the service. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 17 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, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was clean and comfortable and provided a safe and homely environment for the service users. EVIDENCE: The service was clean, tidy and odour free. When we arrived personal care was being delivered and this can be a time of day when unpleasant smells are present: odours are clearly well managed. A recent concern complaint received by us and forwarded to the service to investigate raised the issue of bad odours. It was unfounded on the day of inspection. The home has a maintenance programme and some bedrooms have recently been painted and recarpeted. Bedrooms are personalised and reflect the personality of the occupant. Housekeeping staff were ensuring soap dispensers were filled during the inspection. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 18 There are plans to decorate the communal areas later in the year and a maintenance review is in progress to ensure all bedrooms have locks in working order. The service is equipped with appropriate aids to help service users maximise their independence, including raised toilet seats, grab rails and alarm call buttons. People who use the service who spend time in their own room had easy access to the call bell and confirmed staff responded quickly to its use. Aids and adaptations that require maintenance checks have them conducted when necessary and records were inspected. The main entrance to the building was only accessible by ringing the doorbell and being granted access by staff. There is visitors book in place, which all visitors are expected to sign on entry. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 19 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels and recruitment processes meet the needs of people who use the service. EVIDENCE: Staffing levels are adequate and enable staff to spend quality time with individuals. Inspectors observed staff taking the time to sit and chat with people who use the service. This demonstrates that staff are aware of the importance of talking to people who use the service to ensure that care does not become task focused. People who use the service were complimentary about the staff and stated that they were kind and listened to any concerns that they had. Records reflected that staff received training to enable them to do their job. The service plans to offer training on equality and diversity and the Mental Capacity Act in the coming year. Several staff are waiting to commence NVQ (National Vocational Qualification) training. Records reflected that staff completed an induction programme before working independently. This ensures that they are aware of how the service operates and what the needs of people who use the service are. The proprietor is planning to record that new staff are met with after their first shift to reflect that they are receiving support during their induction. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 20 Recruitment files were inspected and reflected that all required checks had been conducted to ensure the safety of people who use the service. Interview notes were kept but in a haphazard fashion. Better recording of the interview process would reflect the service’s observation of equal opportunities to show each employee is asked the same questions. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 21 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): 31,33,35,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is not registered with the Commission for Social Care Inspection. The Annual Quality Assurance Assessment (AQQA) has not been completed to reflect changes and improvements that have taken place within the service. EVIDENCE: The manager of the service is not currently registered with the Commission of Social Care Inspection (CSCI) and a requirement has been made for this to occur. Staff we spoke to told us that the manager was approachable and they felt that they could make suggestions. People who use the service knew who the manager was and also felt that they were approachable and would deal with any concerns. The manager was away on holiday on the day of the Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 22 inspection but the deputy manager was well briefed and competent. The provider was also present for parts of the inspection. We observed the deputy manager deal with a difficult ‘phonecall in a calm and sensitive manner. They delegated effectively and staff were able to seek support when necessary. The acting manager ensures that CSCI is notified of any incidents that occur and we were able to confirm that appropriate action had been taken by examining records e.g. falls had been reported and recorded in the accident book and care plan. Records reflected that the necessary health and safety checks were being conducted and were up to date. Fire records are being updated to ensure that the time of fire drills is recorded to reflect that all staff are familiar with how to safely respond in the event of a fire. The service does not deal with any finances for people who use the service but an itinerary of personal possessions is recorded and updated. Views of people who use the service and their relatives and friends are sought via an annual questionnaire. The proprietor is exploring how to best publicize the findings that are currently collated in a report. The Annual Quality Assurance Assessment (AQAA) issued by CSCI for the service to demonstrate what changes and improvements have been made has been partially completed. The provider is aware that this must be fully completed to meet legal requirements. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 24 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. 1 Standard OP7 Regulation 15 Requirement Timescale for action 31/10/08 2 OP8 13 3 OP8 18(1)(a) (c)(i) 4 OP9 13(2) Care plans must reflect how the needs of those people who use the service with dementia are met to enable staff to delivery appropriate care. Appropriate interventions must 31/10/08 be implemented for those identified at risk of falling to reduce potential injury and identify common risk factors. This includes falls analysis and seeking professional advice. Staff must not carry out nursing 31/10/08 procedures unless they have received certificated training and competence has been assessed to ensure the protection of people who use the service. Staff must receive diabetes training. Amounts of medication must 31/10/08 reconcile to monitor that correct amounts and dosage have been given. Medication must be kept at the correct temperature to ensure it is fit for consumption. Medication must be secured safely and securely to reduce risk to people who use the service. DS0000014990.V371857.R01.S.doc Version 5.2 Ashton Lodge Page 25 5 OP31 8 6 OP33 24(2) The manager must be registered with the Commission for Social Care Inspection to demonstrate their fitness to practise. The Annual Quality Assurance Assessment must be completed and returned to CSCI to reflect that the service reviews the quality of care delivered. 31/10/08 31/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP7 OP8 OP10 OP12 OP18 OP29 Good Practice Recommendations Information kept in District Nurses’ care plans should be incorporated into general care plans to reflect care delivery. Assessments should be in place for nutritional screening and prevention of pressure sores to support the existing care plans. Personal information relating to people who use the service should not be publicly displayed. Activities should reflect the needs of those people who use the service with dementia. All staff should receive Safeguarding of Vulnerable Adults Training (SOVA) to ensure that people who use the service are protected. A record of interview questions and answers should be kept to reflect equal opportunities. Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Ashton Lodge DS0000014990.V371857.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!