Inspection on 19/12/05 for Avon Lodge

This inspection was carried out on 19th December 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

Avon Lodge 09/10/07

Avon Lodge 30/11/06

Avon Lodge 31/05/06

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

CARE HOMES FOR OLDER PEOPLE Avon Lodge 33 Bridgend Road Enfield Middlesex EN1 4PD Lead Inspector Susan Shamash Unannounced Inspection 19th December 2005 11:00 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 Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Avon Lodge Address 33 Bridgend Road Enfield Middlesex EN1 4PD 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) 019 9271 1693 019 9271 1693 Avon Lodge UK Ltd Mr Rakesh Mathur Care Home 36 Category(ies) of Dementia - over 65 years of age (36) registration, with number of places Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd July 2005 Brief Description of the Service: Avon Lodge is a residential care home for up to 36 older people over the age of 65 who may have a diagnosis of dementia. The property is a detached, two-storey, purpose-built property. All rooms include wash hand basins but they do not include en suite facilities. Rooms are provided on two floors accessed by a shaft lift and stairs. Each floor has two sets of bathrooms equipped with bath hoist facilities or easy access walk in showers. Communal space is provided in separate sitting, dining and recreational areas as well as a designated smoking area. A large garden area is also provided to the rear of the building. The stated aims of the home are to ‘provide a pleasant, comfortable and stimulating environment, conducive to meet the physical, emotional, cultural and religious needs of each resident, and homely surroundings to the best of their abilities. Residents are also encouraged to be independent wherever possible, and involve themselves in the decision-making process, relating to the daily living-arrangements in the home.’ The home is situated not far from shopping facilities and amenities in Enfield. A number of bus routes serve the area. Avon Lodge DS0000062486.V265325.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 lasted approximately seven hours. The inspector was assisted by the registered manager and the area manager for the home, who cooperated fully with the inspection process, and enabled the inspector to move freely about the home. This was the first inspection of the home since it became operational. It was in the process of being refurbished at the previous visit to the home. The inspector spoke to approximately ten residents, six relatives and nine staff members (following their handover meeting). The inspector also had the opportunity to join residents for a meal at the home. Written feedback forms were received from seven relatives, three care managers, three health care professionals and ten service users. A tour of the home was conducted, and staff, residents’ and a range of other records maintained at the home were inspected. What the service does well: The home has recently been decorated and refurbished and is bright and inviting. There is generally a high standard of furnishings, decoration and cleanliness in the home, and the home is well equipped to meet service users’ needs. Detailed assessments are undertaken before residents are admitted to the home and care plans are reviewed regularly to ensure that they are up to date. Residents are encouraged to maintain contacts with their friends and relatives. There is an open atmosphere within the home so that managers and staff are readily available to talk to relatives and service users. A thorough recruitment system is in place to protect residents and staff are generally well qualified, with 50 trained to at least NVQ level 2 in care. Health and safety records are generally maintained to a high standard at the home so that residents are protected appropriately. The home is well managed with clear policies and procedures regarding its operation and clear systems in place to protect residents from abuse. Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 6 The manager is very experienced in working with service users who have dementia and relatives speak highly regarding the support he provides to them, particularly when service users are newly admitted to the home. What has improved since the last inspection? What they could do better: In view of the newness of the home, the inspector was impressed with the systems that had already been set up to ensure the protection of service users. Care plans need to be produced for the remaining service users (a small number) and greater detail should be included in monthly reviews. Further evidence of consultation with service users and relatives is also desirable. The recording of medication administration must be monitored to ensure that there are no gaps in the record and all symbols used are clearly explained. An increase in the variety and number of activities provided to service users is needed and the number of kitchen staff should also be reviewed to ensure adequate meal choices for service users. Disposable hand towels should be provided in the laundry and a shower needs fitting in one downstairs bathroom. Staff must be provided with regular one-to-one supervision sessions and training regarding dementia, adult protection, infection control and fire safety. Regular checks must be undertaken to ensure that accurate records are maintained of service users’ monies stored in the home for safekeeping. Testing of hot water outlets and ‘dorguard’ must be recorded and action must be taken to ensure that the front door can easily be opened from inside in the event of a fire. It is recommended that pictorial formats be produced for the service users guide and menus at the home, and that the home record their own minutes of review meetings with social workers so that any actions can be taken without delay. Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 7 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. Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. (6 is not applicable) Service users and their relatives have the opportunity to visit the home, and their needs are assessed before they move in to ensure that these can be met. Detailed information about the home is available to prospective service users so they can make an informed decision. EVIDENCE: A detailed statement of purpose and service users guide were available for the home as appropriate. It is recommended that an alternative format be considered for the service users guide that may be more accessible to service users who are diagnosed with dementia. Assessments in service user files indicated that a detailed assessment of service users’ needs takes place prior to their admission. This was confirmed by service users, relatives and staff spoken to. Service users and relatives spoken to indicated that there had been opportunities to visit the home prior to admission. Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 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 and 10. Service users’ health, personal and social care needs have been assessed and care plans are in place for the vast majority of service users. These need to be extended to the remaining service users including evidence of their consultation and more detailed review notes to ensure that their needs are being met appropriately. Administration of medicines is generally appropriately recorded however a small number of gaps in the medication administration records may place service users at risk. Service users and their relatives feel that they are treated with respect and consideration by the staff team. EVIDENCE: Five care plans were inspected and these were generally found to be comprehensive with regular monthly reviews as appropriate. Speaking to service users and their relatives, the inspector was told that they were involved in choosing preferred care routines as appropriate. However, there was not always adequate recorded evidence of consultation with service users or their relatives/advocates, regarding their preferences. Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 11 There is also room for improvement in the detail included in monthly reviews of care plans and recording of agreements regarding any limitations placed on service users as a result of risk assessments conducted by the home. It is recommended that staff at the home record their own notes of review meetings taking place with social workers, so that actions can be put in place speedily without needing to wait for the official minutes to be received. Recorded evidence confirmed that service user’s health needs are being met through consultation with a variety of health care professionals, and this was confirmed by written feedback from three health care practitioners. Medication records within the home were generally satisfactory, but a small number of gaps were noted in the medical administration record (MAR) sheets. A requirement is made accordingly. The inspector also noted that, the code ‘F’ was sometimes being used to denote medicines which were not given. The problem with using this symbol is that it is not on the key printed at the bottom of each MAR sheet, and therefore its meaning is unclear. If it is to be used, its meaning in each case should be recorded next to the key on the bottom of each MAR sheet to avoid confusion. Service users and their relatives confirmed that their privacy and dignity were respected and also spoke very positively about the support and accessibility of the home’s management. Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 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 and 15. A number of activities are available to service users with support from staff at the home. However there is room for improvement in this area to ensure that service users receive sufficient stimulation. Service users are encouraged to maintain contact with their family members and friends. Service users are given choices about the way in which their care is provided. Service users are generally satisfied with the quality of food provided at the home, however there is room for improvement in the number of choices available to them and flexibility of kitchen services. EVIDENCE: Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 13 A number of activities are available to service users including board games an exercise group, reminiscence group and occasional trips out to local shops. The manager advised that organised outings were also planned for service users. However a significant number of service users spoken to indicated that there were not always sufficient activities provided for them and that they were frequently bored. It is therefore required that further provision be made with regard to activities for service users at the home. Visitors spoken to at the time of the inspection confirmed they were encouraged to visit the home. In addition to friends and relatives, and health and social care professionals, a mobile library and a hairdresser visit the home and magazines and newspapers can also be ordered by service users at the home. Attempts are also being made to forge links with local churches for service users who are interested in attending religious services. Service users and relatives spoken to indicated that staff offered them choices about their care at the home. The inspector had the opportunity to eat a meal with service users in the dining area. Discussions with service users indicated that, although they were able to choose alternatives if they did not like the main meal provided, this was rarely done. Service users indicated that food served was satisfactory but were not particularly enthusiastic about the meals served at the home. Inspection of the kitchen and discussion with kitchen staff indicated to the inspector that there is insufficient provision of kitchen staff at the home to meet the needs of a speedily growing number of service users. This clearly has ramifications in terms of the quality and choices of meals available to service users. A requirement is made accordingly. It is also recommended that pictorial formats be produced to illustrate the home menus for service users and assist them in making choices for each meal. Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 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 and 18. Service users can be sure that their concerns about the home will be addressed appropriately. An adult protection policy is available for the home but there is a need for further staff training in this area to ensure that the risk of service users being abused is minimised. EVIDENCE: The home’s complaints procedure is appropriate to protect the interests of service users. Feedback from service users and relatives indicated that they felt able to express concerns about the home, and that the management were very receptive to their opinions. One complaint was recorded and this had been addressed appropriately. The home has an appropriate procedure regarding the protection of vulnerable adults, and some staff have undertaken training in this area. However it is required that all staff members undertake adult protection training to ensure the protection of service users. Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26. Service users live in a pleasant environment that is well furnished, clean and hygienic and purpose built to meet their needs. They have access to a range of comfortable communal areas both inside and outside of the home. The management are commended for bringing about a wide range of changes to provide a safe and comfortable environment for service users. EVIDENCE: Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 16 The home is newly decorated and furnished, giving it a bright and inviting appearance. Feedback from service users and relatives indicated that a high standard of housekeeping is provided at the home. Bedrooms and communal areas are comfortable and well furnished. The home has adequate communal areas and a sufficient number of toilets and bathrooms. A shower remains to be fitted on the ground floor and hand towels need to be provided in the laundry area. At the last visit to the home (when the home was not yet operational) a number of undertakings were made by the provider regarding the building. All of these had been fulfilled, and the manager and provider are commended for the improvements that they have brought about to the home environment. Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The home operates safe recruitment practices, and there are generally sufficient staff scheduled to work in the home to meet service users’ needs. Management are aware of staff training needs and plans are in place to address these. Staff need to undertake training in dementia, adult protection, infection control and fire safety to ensure the protection of service users. EVIDENCE: Satisfactory Criminal Record Bureau (CRB) Disclosures were available for staff members working in the home as appropriate. Five staff files were inspected and these were found to contain application forms, two references, proof of identity documents and the other records specified under Schedule 4(6) of the Care Homes Regulations 2001. Training certificates were available for training completed by staff members and the manager indicated that approximately 50 of care staff were trained to at least NVQ level two in care or equivalent. Staff spoken to were knowledgeable about their role and responsibilities within the home. Although some staff have had training in these areas is required that all staff undertake training in dementia, adult protection, infection control and fire safety. Clearly the number of staff working in the home will need to be reviewed as further service users are admitted to the home. Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 18 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 and 38. The home manager is appropriately qualified and experienced. There are clear communication mechanisms within the home providing protection for service users in having their needs met effectively and consistently. Frequent monitoring visits are carried out by the registered provider ensuring that the home is run in the best interest of service users. A staff supervision system must be provided and recording to ensure that service users are provided with appropriate support. There is room for improvement in the recording of service users’ finances kept for safekeeping by the home to ensure their protection from financial abuse. There is generally a high standard of practice in health and safety at the home, but there is room for improvement in a small number of areas. EVIDENCE: Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 19 The manager for the home has been successfully registered with the CSCI and has over thirteen years of experience working with older people including those diagnosed with dementia and has been the registered manager of another care home belonging to the provider for over three years. He has obtained the Registered Managers Award at NVQ level 4 and is an active member of the Alzheimer’s’ Society. Discussions with staff, service users and relatives visiting the home indicated that there are clear communication channels at the home. The manager advised that he has also received significant support from the area manager for the home. Owing to the newness of the home, it is understandable that a clear supervision system is not yet operational in the home. However it is required that all staff receive one-to-one supervision at least six times annually and that these sessions are recorded. Monthly inspections by the area manager for the home are taking place and the manager is aware that a quality assurance audit will need to be undertaken at least annually. The majority of service users manage their own finances with support from their family or solicitors. Where the home is asked to keep service user funds for safekeeping, records are maintained. However inspection of the records for four service users indicated that these records did not always accurately match the actual monies stored for each service user. It is required that regular checks be put in place to ensure that records of monies stored for service users are accurate, and that any inaccuracies are explained. Health and safety checks for the home were generally satisfactory including up to date safety certificates and regular safety checks. However a small number of shortfalls were noted. There is a need for regular recording of hot water temperatures specifying hot water outlets that have been tested on each occasion to ensure that these do not exceed 43°C. The operation of ‘dorguard’ devices must be monitored weekly during alarm call point tests and these must also be recorded. Finally identified action must be taken to ensure that the front door presents an unimpeded escape route in the event of a fire. Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X 4 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 2 X 2 Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? N/A 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 The registered persons must ensure that care plans are available for all service users. Greater detail should be included in monthly reviews of care plans, and there should be evidence of consultation regarding agreements for any limitations placed on service users as a result of risk assessments. 2 OP9 13(2) The registered persons must ensure that there are no gaps in the medical administration record (MAR) sheets. If use of the code ‘F’ is to continue, its meaning in each case should be recorded next to the key on the bottom of each MAR sheet to avoid confusion. The registered persons must ensure that adequate and varied activities are available for all service users. The registered persons must ensure that a review of kitchen staff numbers is undertaken to meet the needs of the steadily growing number of service users DS0000062486.V265325.R01.S.doc Timescale for action 17/03/06 27/01/06 3 OP12 16(2)(m) (n) 16(2)(i) 31/03/06 4 OP15 17/02/06 Avon Lodge Version 5.0 Page 22 5 OP19 16(2)(j) 23(2)(b) 6 OP30 18(1)(ci) 7 OP35 17(2) Scd 4(9) 8 OP36 18(2) 9 OP38 13(4)(a) living at the home, whilst ensuring quality and choices. The registered persons must ensure that the shower is fitted in the identified ground floor bathroom and disposable hand towels are provided in the laundry area. The registered persons must ensure that all staff members undertake training in dementia, adult protection, infection control and fire safety. The registered persons must ensure that regular checks are put in place to ensure that records of monies stored for service users are accurate, and that any inaccuracies are explained. The registered persons must ensure that all staff receive oneto-one supervision at least six times annually and that these sessions are recorded. The registered persons must ensure that hot water temperatures are tested regularly, specifying hot water outlets that have been tested on each occasion to ensure that these do not exceed 43°C. The operation of ‘dorguard’ devices must be monitored weekly during alarm call point tests and these must also be recorded. The registered persons must ensure that identified action is taken to ensure that the front door presents an unimpeded escape route in the event of a fire. 03/02/06 31/03/06 20/01/06 10/03/06 27/01/06 10 OP38 13(4)(a) 20/01/06 Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 23 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 OP1 Good Practice Recommendations It is recommended that an alternative format be considered for the service users guide that may be more accessible to service users who are diagnosed with dementia. It is recommended that staff at the home record their own notes of review meetings taking place with social workers, so that actions can be put in place speedily without needing to wait for the official minutes to be received. It is recommended that pictorial formats be produced to illustrate the home menus for service users and assist them in making choices for each meal. 2 OP7 3 OP15 Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Avon Lodge DS0000062486.V265325.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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