Inspection on 29/11/05 for Astral Lodge

This inspection was carried out on 29th November 2005.

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

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

Other inspections for this house

Astral Lodge 11/12/07

Astral Lodge 01/02/07

Astral Lodge 01/09/05

Astral Lodge 13/12/04

Astral Lodge 10/09/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Astral Lodge Astral Lodge 2 Cumnor Road Sutton Surrey SM2 5DW Lead Inspector David Pennells Unannounced Inspection 29th November 2005 11:15 Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 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 Astral Lodge DS0000019072.V269711.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 Adults 18-65. 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. Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Astral Lodge Address Astral Lodge 2 Cumnor Road Sutton Surrey SM2 5DW 020 8642 1884 020 8661 7974 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) Astral Lodge Limited Mr Bennie Darkey Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow two specified service users over the age of 65 to be accommodated for as long as the service can adequately meet their needs. 1st September 2005 Date of last inspection Brief Description of the Service: Astral Lodge is a care home providing mental health nursing care to up to a maximum of seventeen adults (two of whom would share a room) who have enduring mental health problems. The home currently has a variation to provide care to two named service users who are over 65 years of age. The home provides 24-hour mental health nursing support to all service users, with care staff support provided under the nursing staffs supervision. The ethos of the establishment – established since June 1996 - is self-help within the understanding / context of the psychological and other social and physical needs of each individual. Accommodation is extensive and provided over two floors; a large lounge, a dining room and separate smoking room are provided. There are fifteen single and one double bedroom (currently singly occupied) situated over both floors of the home. Two toilets are situated on each floor, a bathroom is on the first floor and a shower room is situated on the ground floor. The home has a relatively small but pleasant garden, through which is a route to the external laundry facility. There is car parking for three on the hardstanding at the front of the house, with more spaces available at the side of the building. The home is very close to Sutton town centre (five minute walk away), with its associated excellent transport links and all shopping and leisure amenities. Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit was conducted at the home over a period of approximately three hours from late morning to early afternoon on a weekday. During the visit, the inspector was able to meet with many of the service users at the home, with staff members and the deputy manager, who was ‘on duty’. During the time spent at the home, the requirements and recommendations form the previous inspection visit were reviewed with the deputy manager, as well as essential documentation being checked. The premises were walked – both with staff and the inspector touring the building on his own. Service users were engaged with, and some invited the inspector to view their rooms. Private ‘chats’ were undertaken with four service users in this way. The inspector is grateful to service users, staff and the deputy manager for their attention and assistance, and for the hospitality shown to him on the day of his visit. What the service does well: Astral Lodge is an unassuming property that seeks to ensure that service users enjoy the best of living within a supported environment set well within the local community. There is a sense of supportive community, and certainly service users seen and spoken to at the home were very content with their lifestyles and spoke highly of staff support at all levels, and clearly relate well to the management. A number of service users have been resident at the home for lengthy periods of time; two for eight years, three for seven, one for six years and five for five years. This ‘stability’ for service users is mirrored by the permanence, in general, of the staff team; the resultant way of life at the home is, therefore, familiar, reassuring and comfortable. Many service users being supported in this, a care home with nursing – are clearly in the category of ‘chronic mental health’ – possibly meaning that a move is unlikely (and a triumph if such ‘rehabilitation’ is successful). Astral Lodge therefore seeks to provide as individual and personal an environment whilst still understanding the need for collective, long-term, support at the home. Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None were inspected at this visit. Prospective service users can expect to find out adequate detail to make an informed choice when try to decide whether to reside at the home, this supplemented by the opportunity to visit and find out about the home before confirming their stay. The home ensures the appropriate service is provided to each individual based on both their own and other professional’s assessments. EVIDENCE: No service users have been discharged since the last inspection – when four of the above standards were inspected and found ‘met’, resulting in the above judgement statements being made. They are reiterated here for the reader’s information. Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None were formally inspected at this visit. Service users can be confident that the home will provide a care plan, based on current assessment, and reflecting a service user’s rights to exercise choice and autonomy both inside and away from the home, within a risk-assessed context. EVIDENCE: The above judgement statement is quoted from the last inspection visit report – where four – including all the ‘core’ standards – were inspected and all found to be ‘met’. An older service user commented: “it’s a very nice place here – it’s very quiet most of the time” – this reflecting a contentment with the general ambience of the home – especially since the last ‘noisy’ service user left about a year ago. There is certainly a distinct feeling of care, community and belonging here. Another service user interviewed was well aware of his care plan; he was clear that the house staff members were ‘there’ if he needed someone to talk to; “They understand,” he continued: “they’re always there – and knowing that fact is important.” Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None were inspected at this visit. Service users at the home can be assured that they will be encouraged to participate in the life of the home and beyond - as an individual, being encouraged to participate in in-house and community-based opportunities and leisure activities. Relatives and friends of service users can be assured of a positive welcome at the home; their participation in the life of the home being welcomed to broaden horizons and maintain family / friendship links. Meals at the home are provided in good quantity - with a nutritious and attractive menu being provided. EVIDENCE: The above judgement statements are quoted from the last inspection visit report – where all the standards were inspected and all found to be ‘met’. The inspector found – or heard of - nothing to contradict the impression he formulated at the last inspection visit. Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 & 21. Service users can expect to be encouraged to maintain their personal and physical and mental health as much as possible, whilst the staff will provide such assistance as is appropriate / needed (including assistance with medication) to ensure their health and general wellbeing. Service users can be certain of appropriate support and assistance at the end of life, in consultation with relatives leading to a more personalised service. EVIDENCE: The above first judgement statement is quoted from the last inspection visit report – where the first three standards were inspected and all found to be ‘met’. Again, nothing seen during this present visit contradicted the opinions formulated by the inspector on the last inspection. The inspector checked the medication records and storage and observed medication being handed out. All was done within the context of best nursing practice. Since the last inspection visit, a policy on pressure areas / relief has been put in place (essential for those older service users and younger ones who chose to stay in their beds or have repetitive habits). Also the proprietor has devised a simple unthreatening form for service users or their relatives /carers to complete regarding steps to be taken if they were suddenly found to be seriously ill or pass away. Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Neither were re-inspected at this visit. Service users are confident that the management will handle comments and complaints swiftly and appropriately. Service users can be assured that they will be protected from the possibility of physical, financial or any sort of abuse. EVIDENCE: The two standards above were both found ‘met’ at the previous inspection; on conversation with the deputy, it was clear that procedures had not changed. There is a clear and comprehensive complaints procedure for the home. The home’s Adult Abuse and Protection procedure has been recently revised to back up the local authority procedure folder, which was also in evidence. Safe keeping of cash service user’s valuables was previously examined with the proprietor. Records for each service user are kept separately. Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25 & 30. The home provides a warm, safe and comfortable environment for service users to feel ‘at home’ which can meet their individual needs and promote their independence. Such an environment would be enhanced for all, by the use of an extractor fan to take the effect of smoke out of the general atmosphere. Service users would benefit - both corporately and individually - if the home’s laundry facilities were enhanced. EVIDENCE: The first judgement statement above is an adaptation of that stated following the last inspection visit. Two principal areas were drawn to the inspector’s attention during this visit - and ‘laundry’ and ‘ventilation’ were clearly issues for both staff and service users. The two domestic style washing machines provided at the home (both starting to look ‘the worst for wear’ – one of which was not working at the time of the visit) - must be upgraded alongside the single tumble dryer (1 only). Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 14 Both service users and staff commented on this ‘failing’ facility – which hinders their best progress. The facility should be enhanced to, at least, one semiindustrial machine of each type (suited to the house washing) – and possibly a robust ‘domestic’ type of each as well - appropriate to service users’ individual use. This provision really is needed to provide adequate facilities to enable both service users and staff to undertake the laundry satisfactorily. Admittedly this may well require more robust supervision of service users – but once a routine is established with staff supervising, this will be to the ultimate benefit of all. A recommendation that the home should review the provision of fluorescent lighting throughout the house, as this is not always - according to some research - the most appropriate for their wellbeing, is reiterated as only one bedroom has currently received ‘ordinary’ incandescent lighting fittings as yet – thanks to a flood through the ceiling and the loss of the previous light fitting. A further requirement set this time – related to cleanliness and the health of service users - is that of ventilation. It was noted that the smoking room was very cold – due to open windows and the lack of extraction of air / smoke from the room. A good extractor fan must be provided - taking smoke and stale air from within the house to the outside and avoiding the issue of massive heat loss during the winter due to windows being left open. Such a facility would keep this room relatively warm - rather than it being an ‘ice box’ - as it was on the day of the inspection. Although the contemporary attitude towards smoking anywhere, almost, is negative – it must be acknowledged that service users do have the right to smoke in some form of reasonably comfortable but separate environment – and this is a reality in most mental health establishments. Of course, such seeming ‘encouragement’ should be tempered by education and support to understand the risks, to join cessation classes or to adopt other approaches to ‘kicking’ the habit. Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 & 36 The home provides a stable and competent staff team - which provides a suitably appropriate service to the community of residents at the home. Senior staff members are appropriately trained to run the home - with care staff now still needing to undertake more mental-health focused training to work knowledgeably alongside the nursing staff. The further development of care staff’s expertise in understanding mental health issues will benefit the service users – especially when they are ‘in crisis’. The home implements a full recruitment process, thus ensuring the safety, protection and wellbeing of service users. The implementation of a full Induction process – on line with the new ‘Skills for Care’ format – would benefit all at the home, both current and new staff. Support to members of staff, both through the holding of regular staff support meetings - and providing individual staff supervision - would improve the service provided, through enhancing communication between staff in general and by encouraging their training and self-development. EVIDENCE: Service users commented on the helpfulness, kindness and conscientiousness of the staff members at the home: “They’re really considerate”, one said. Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 16 The judgement statements are a composition of the previous inspection’s statements – much is in place at the home – whilst still acknowledging the outstanding requirements with regard to staff training, induction and formal 1:1 supervision. The registered person is still required to develop a staff training & development programme that should include specific training for care staff in mental health. It was believed by the Deputy that the manager was looking into courses provided by the London Borough of Sutton’s training department. Induction and Foundation Training (now known as Common Induction Standards for Adult Social Care) to Skills for Care specification - must be introduced to ensure that all staff members have a core underpinning knowledge base. As far as the Deputy was aware nothing had been undertaken in this regard as yet; fortunately there was little turnover of staff during this period. The registered person must also ensure that all staff members employed at the care home receive formal supervision, which must be recorded. This 1:1 process should occur at least six times per year. Individual meetings were yet to be arranged on a consistent basis. Staff meetings are currently held - and minuted - every four months. It is strongly recommended that the frequency of such meetings is increased to a minimum of six a year. Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 & 43. Service users can be confident that the home is well run – with their views and comments being taken on board in regard to the quality of the service provided. The safety of service users is generally well protected, though the number of staff trained in First Aid should be increased to ensure round-the-clock cover. The house is maintained and run in a safe and appropriate way – though the regularisation of observing and recording hot water temperatures is again to be improved - to ensure that all safety measures are being regularly monitored, to avoid the risk of scalding. The home is effective in its service and has evidenced its financially viability and long-term prospects through the production of a development plan, which has been made available to the Commission. Evidence of such long-term viability can instil confidence in the service user group that the home is a stable and secure environment on which they can rely. Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 18 EVIDENCE: The proprietor, who also manages the home, is a Registered Mental Health Nurse; he has in the past completed the Certificate in Management Studies. He has extensive experience of managing care establishments; having both managed this home for six years and possessing ten year’s previous management experience in other mental health settings. On the health and safety standards, more staff training must be provided to ensure that a member of staff trained in First Aid covers the house on a continuous ‘24/7’ basis. Checks on fire alarms, the fire extinguishers, emergency lighting and other such safety / maintenance issues were generally well maintained. It was all the more disappointing, therefore, to find a deficit in the checks of the hot water outflow temperatures – which checks should be undertaken and recorded on a regular weekly basis (to ensure that all taps with valves can be monitored and observed for variance / failure) - especially in areas of high risk - such as bathrooms and showers. Attention to this requirement set at the last visit had lapsed back to inactivity since 17/10/05 - so the requirement is reiterated. The proprietor has provided a full Business & Financial Plan – a copy of which was ‘promised’ to the Commission at the last inspection in December 2004 – this was obtained by the Proprietor from his Accountant immediately after the inspection visit day and submitted to the Commission. It is now held on file. Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X 1 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X 1 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Astral Lodge Score X X 3 3 Standard No 37 38 39 40 41 42 43 Score X X X X X 1 3 DS0000019072.V269711.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? 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 YA30 Regulation Requirement Timescale for action 28/02/06 16(2)(e) (f) A new requirement: The domestic style washing machines and dryers provided at the home must be upgraded to at least one semi-industrial machine of each - in order to provide adequate provision to enable both service users and staff to undertake the laundry adequately. 23(2)(p) A new requirement: A robust extractor fan must be installed in the smoking room to ensure that smoke is taken out of the house for all service users’ benefits and to ensure that service users do not suffer from the cold in the winter months through having to open windows. The registered person must develop a staff training and development programme that should include specific training for care staff in mental health. (Timescale of 30.11.04 & 30.10.05 not met.) 2. YA30 31/01/06 3. YA35 18(1)(c) 31/01/06 Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 21 4. YA35 18(1)(c) Induction and Foundation Training (now to be known as Common Induction Standards for Adult Social Care) to Skills for Care specification - must be introduced to ensure that all staff members have a core underpinning knowledge base. (Timescale of 15.04.05 & 30.10.05 not met.) The registered person must ensure that all staff members employed at the care home are offered formal supervision, which must be recorded. This 1:1 process should occur at least six times per year (36). (Timescales of 30.11.04 & 30.10.05 not met.) Staff training must be provided to ensure that the house is covered by a member of staff currently trained in First Aid. (Timescale of 30.10.05 not met.) 31/01/06 5. YA36 18(2) 31/01/06 6. YA42 13(4) 31/01/06 7. YA42 13(4) Hot water outflow checks must 29/11/05 be undertaken and recorded on a regular weekly basis - to ensure that all taps with valves can be monitored and observed for variance / failure. Special attention must be paid to areas of high risk - such as bathrooms and showers. (Attention to this requirement (timescale 01/09/05) had lapsed back to inactivity since 17/10/05, so requirement is reiterated.) Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 22 RECOMMENDATION 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 YA25 Good Practice Recommendations That the home should review the provision of fluorescent lighting throughout the house, as this is not always according to some research - the most appropriate for their wellbeing. (A previous recommendation.) Staff meetings should be increased to a minimum of at least six per year – if not more. 2. YA33 Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Astral Lodge DS0000019072.V269711.R01.S.doc Version 5.0 Page 24 - 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. 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