Inspection on 12/06/07 for Athorpe Lodge

This inspection was carried out on 12th June 2007.

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 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

Athorpe Lodge 12/03/09

Athorpe Lodge 23/11/05

Athorpe Lodge 24/08/05

Athorpe Lodge 24/03/05

Athorpe Lodge 11/10/04

Athorpe Lodge 26/02/04

Athorpe Lodge 27/05/03

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

CARE HOMES FOR OLDER PEOPLE Athorpe Lodge Off Falcon Way Dinnington Sheffield South Yorkshire S25 2NY Lead Inspector Stephen French Key Unannounced Inspection 09:00 12th June 2007 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 Athorpe Lodge DS0000003072.V312151.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. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Athorpe Lodge Address Off Falcon Way Dinnington Sheffield South Yorkshire S25 2NY 01909 568307 01909 563880 NONE 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) Athorpe Health Care Limited Karen Radford Care Home 89 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (77), Physical disability (77) of places Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. A separate unit is maintained for those users in the DE(E) category. To allow a named service user under the age of 65 years to be admitted who requires nursing care; on variation dated 24th October 2005 To allow a named service user under the age of 65 years to be admitted who requires nursing care; on variation dated 29th March 2006 To allow a named service user under the age of 65 to be admitted who requires nursing care; on variation dated 21st April 2006. 23rd November 2005 Date of last inspection Brief Description of the Service: Athorpe Lodge is situated in the grounds of Dinnington Hall in the village of Dinnington. Athorpe Lodge is a purpose built home providing for 89 elderly people in need of care due to infirmity or dementia. The home provides personal and nursing care in five units with a separate unit for people who have dementia. All bedrooms are for single occupancy with ensuite facilities. The home is constructed at ground and first floor levels; with a shaft lifts for ease of access for people. The home has its own garden; separated from Dinnington Hall by wooden fencing and gates and nearby car park. Local facilities are within easy access from the home. The fees in June 2007 are £343.00 - £497.00 per week. Information about the home and the Commission for Social care Inspection is made available to people within the home’s Service User Guide, copies of which are given to prospective and current people and can be obtained, on request, from the home. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit carried out on the 12th June 2007. The inspector arrived at the home at 09.00 am and left 15:00pm. During this visit the inspector spoke to some of the people living there, some of the staff and the home’s management. The inspector read some care records, checked a sample of medication, reviewed staff recruitment and training records and brief looked round the home. Prior to the visit 5 questionnaires were sent to the home to obtain peoples views about living at the home. When this report was being written none had been returned, although some people in the home are very frail and would not be able to complete a questionnaire. Relatives and other professionals questionnaires were also sent out, and one questionnaire was received back from a visiting professional who said that she was happy with the care that she felt people received. Other information used in the inspection process included notifications from the provider to the Commission for Social Care Inspection about deaths, illnesses, accidents and incidents at the home, copies of the monthly visit reports; produced by the provider, and information completed before the visit by the manager. What the service does well: The home provides a safe comfortable friendly environment for people. Their needs are assessed before they enter the home and people are given the information they need to choose whether to live at Athorpe Lodge. Each person has a care plan that tells staff what to do to make sure people get the care they need to maintain good health. There are a range of social activities on offer which people can join in if they wish, and people spoken to said the meals were very nice People are asked their views, each year, about the quality of the care they get, and in regular meetings people are encouraged to discuss any changes they would like; or to raise any problems they may have encountered. There are sufficient numbers of trained competent staff on duty to meet the health and social needs of the people. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 6 People spoken to during the visit said the staff were very kind and always willing to help. Relatives spoken to said that they were very happy with the care that was provided by the home. During the visit the inspector observed staff responding to people in a friendly appropriate manner. 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. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 7 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 Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People’s needs are assessed prior to them entering the home to make sure that Athorp Lodge can provide the care people need. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 9 EVIDENCE: The manager said that the funding authority always provide a copy of the persons core assessment and care plan prior to admission to the home. These were seen for those care files examined. The manager went on to describe the process she undertakes when a new person wishes to be admitted to the home. Within this process an assessment from the local authority is obtained and the manager or her deputy visits people enquiring about admission; either in their own home or in hospital and a pre admission assessment is completed. This assessment determines the level of care the person will require and a decision is then made to decide if the home can meet the person’s health care needs. The manager said that she then would telephone the person to confirm that, following the assessment, the home were able to meet their needs. Pre admission assessments were seen for a person who had recently been admitted to the home confirming that the home is following their admission policies and procedures. And, one person spoken to said that the manager had visited him at home prior to him moving in. The manager said the home does not offer Intermediate Care. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service The health care needs of the people living at the home are being met and medication checked was administered safely. EVIDENCE: The manager said that each person has a care plan, which informs the staff of the actions they are to take to ensure that the persons health, personal and social care needs are met. She also said that the home is currently renewing the documentation in the care files to ensure that information regarding people’s needs is recorded in more detail As part of this visit six peoples care files were examined, one file from each unit. These contained information, which had been obtained from the pre admission assessment and from discussions with the person and their relatives. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 11 A notification to the commission at the beginning of 2007 included the need to review actions needed to prevent pressure sores. At this visit it was found that risk assessments were completed for such things as nutrition, moving and handling and skin integrity. These risk assessments alert the staff to the possibility of the person requiring further support or medical intervention in order to prevent further deterioration in their condition. Where an assessment had identified a risk e.g. limited mobility, a detailed care plan was in place. Risk assessment and care plans were reviewed monthly to ensure the care that was being given was meeting the health care needs of the person. However, it was seen that one person had returned from hospital the previous day and their health care needs had changed, but these were not recorded onto the care plan. This meant the person may not get the care from staff; this was discussed with the manager who said this would be rectified immediately. Staff make a daily entry in each persons care file outlining what care they have received that day. On looking at these records it was found that the persons social and psychological wellbeing was rarely mentioned and staff had focused on tasks they had performed. These entries therefore currently do not give a holistic view of how the person has spent their day. Care plans seen showed that the healthcare needs of the people living at the home are met through the home’s own practices and with the assistance of other healthcare professionals such as district nurses, GP’s and members of the mental health care team. Two people spoken to said that they were aware of their care plans and that staff had discussed changes with them. The manager said that qualified nursing staff and senior care staff are responsible for the administration of medication. She also said that should a person wish to self medicate then a risk assessment would be completed and staff would give appropriate assistance to the person in taking their medication. Medication seen on the day of inspection was stored correctly. Policies and procedures are in place to ensure the ordering, storage, administration and disposal of medication is done safely. The stock balances of five peoples medication was examined, it was difficult to balance the medication against the medication administration records, as the balance of the previous months medication had not been recorded. This was discussed with the manager who said she would ensure balances would now be recorded. Medication administration records examined confirmed that people receive their prescribed medication safely and on time. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People’s recreational needs are met and the food is good. EVIDENCE: The manager said that the home employs three activities coordinators, one full time and two part-time. The activity coordinators are responsible for organising and supervising all organised activities within the home. The manager said people are informed on a daily basis of what activities are taking place. When looking round the home it was seen that activities were displayed on the notice boards in each unit. Records of activities offered, and who has joined in, was recorded in the persons care file seen. Activities include, bowling, trips out to the local pub and theatre and shops. Five people spoken to during the visit said that they were happy with the activities on offer. The manager said that the activities organiser spends time on a one to one basis with people who live on the unit for people with enduring mental health problems, to make sure they get the activities they would like to take part in. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 13 The manager said that visitors are welcome to visit the home at any time of the day and evening, and people spoken to confirm this. People said that they were able to choose what they did during the day and this included what time they rise and retire and where they sat during the day. The home has a four-week menu, which has two choices of main meal for lunch. Meals can be taken in either the dining room or in the person’s own room if they wish. The manager said that recently the meal times have been changed and the main meal is now taken at teatime. She said that this has resulted in many of the people who did not appear to eat much at lunchtime, having put on weight as they have a better appetite. On the day of the visit the lunch consisted of homemade soup or sausages and potato croquets. People spoken to said that the meals were very nice and that there was always a choice available. The manager said that each unit now keep a stock of snacks so that if a person is hungry they are able to have something to eat at anytime of the day or night. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People know how to raise complaints and are safeguarded by staff having received appropriate training. EVIDENCE: The home has a complaints policy, which was seen displayed in the reception area of the home. The manager said that people are given a copy of this policy when they are admitted to the home, and people spoken with confirmed that they were aware of the homes complaints policy. The manager said that she is responsible for investigating complaints made to the home, and that she would inform the complainant of the outcome of any investigation undertaken. The manager also said that should she be unable to investigate the complaint then it would be referred to the regional manager. All complaints are recorded in the homes complaints log, and this was examined and the last complaint received by the home was 10/5/07 which was dealt with in a timely manner. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 15 The manager said that staff receive training in adult safeguarding as part of their induction training as well as periodically to ensure they are aware of their responsibilities in identifying and reporting incidents should these arise. Staff training records, and three staff spoken to, confirmed that this training has taken place. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,25,26 People who use the service experience Adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. The planned redecoration and replacement of some furniture needs to occur to improve the quality of the environment for people, although the home is safe and comfortable. EVIDENCE: As part of this visit a number of people’s bedrooms, communal lounges, dining room, bathrooms and toilets were seen. There are six units within the home, each having its own dining/lounge area, and most of these had recently had new furniture and carpets laid. There are also small kitchenettes where relatives and people who live in the home can make drinks and snacks, and these were domestic in style. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 17 People’s bedrooms seen were personalised with their own belongings such as ornaments, pictures and small pieces of furniture. Bedroom doors are lockable and the manager said people are given the option to hold the key if they wish. It was seen, that a number of bedrooms were in need of redecoration, this would improve the person’s environment, and the manager said that this had already been identified and plans were in place for a redecoration programme to commence. Bathrooms and toilets were seen to be in close proximity to people’s bedrooms and communal areas. Bathrooms contained specialist baths to enable the staff to assist those people with mobility problems to bath safely; there are also shower rooms for people who prefer to shower. All of the bathrooms seen were in need of redecoration and the manager said that she was hoping to make these more personalised by hanging pictures and choosing a relaxing colour for the walls. The manager said that the unit for people who have a dementia type illness is due for redecoration and each persons bedroom door will been painted and door furniture such as a letterbox, doorknocker and room number will be added to help the person identify their own room. She also said that she was looking at providing tactile pictures for the walls so people can touch them to stimulate their interest. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People are cared for by a competent, trained staff team in sufficient numbers to meet the needs of the people living in the home EVIDENCE: The staff duty rota was examined for the months of April and May 2007 and confirmed the total staffing numbers for the home, in 6 units, to be: AM…………….. Two qualified nurses and Twelve care staff PM…………….. Two qualified nurses and Twelve care staff Night duty... Two qualified nurses and Seven care staff All of the people spoken to said that there are enough staff available to attend to their needs, although one relative spoken to said they thought that there did not appear to be enough staff on duty. A sample of five staff recruitment records were examined and these were found to hold the correct information and evidence that checks had been made which helps to make sure only staff suitable to work with vulnerable people are employed Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 19 The manager said that new staff complete a five day induction programme to ensure they have the information and skills to be able to care for the people living in the home. Induction records examined for recently employed staff confirmed that induction training was taking place. Staff spoken to during this visit informed the inspector that their skills and knowledge are updated regularly by attending various training courses such as health and safety, moving and handling and by completing a National Vocational Qualification (NVQ) in care. The home currently has 77 of their care staff who have an NVQ level 2 or above in care and are commended for this. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 People who use the service experience excellent quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. The home is well managed and the views of people are sought and any shortfalls are addressed. Systems are in place to protect the health and safety of the people and staff EVIDENCE: The manager of the home has been in post for the past eighteen months. She is a qualified nurse with many years of experience in caring for this particular group of people. She has completed her N.V.Q level 4 qualification in management. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 21 The home should be commended on its comprehensive quality-monitoring tool, which is completed on a monthly basis. Evidence was seen that audits have been completed in areas of care such as pre admission procedures, care planning, medication, privacy and dignity and the internal environment. If there are any shortfalls then action plans are drawn up and acted upon, e.g. a planned redecoration programme is to occur. The home also seeks the views of the people and relatives about the care that they receive by sending out questionnaires annually; the results of which are sent out to people and relatives. The results of last questionnaire sent out in 2006 was seen by the inspector and 100 of the respondents said that they were happy with the care that was provided. People are also able to air their views on the way the home is run through meetings, which are held regularly. The inspector saw the minutes of the last meeting held in December 06, and evidence that the next meeting is to be held in June 07. The manager said that the format of this meeting was going to change to try and get more people to attend. She said that the June 07 meeting will include a social event with wine and cheese. People are able to keep small amounts of personal monies within the homes safekeeping. This enables them to be able to purchase small items such as sweets, newspapers and pay for hairdressing. Three amounts of people’s personal monies were checked and the balances tallied with the records held by the home. Staff have received training in health and safety and the manager is aware of her responsibilities surrounding this. Staff have received training in fire prevention and moving and handling. Accidents to people and staff are recorded. Contracts are in place for such things as waste disposal, servicing of hoists and electrical equipment, which should ensure that the equipment people use is safe. Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 3 X 3 Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations The home should write to the person following an assessment to inform them that the home can meet their needs and also identify the room in which they will be living, so people can have a record of this. Daily entries in the care notes should describe the persons social and psychological well being, to enable staff to meet peoples needs The balance of medication carried forward from the previous month should be recorded this will ensure that a clear audit trail can be carried out to confirm that people receive their medication as prescribed. To improve the environment in which people live the communal areas mentioned in the report and planned should be redecorated and consideration given to having a maintenance plan setting out issues to address; including action needed and timescale, e.g. in replacing some of the furniture. 2 3 OP7 OP9 4 OP19 Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Athorpe Lodge DS0000003072.V312151.R01.S.doc Version 5.2 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!