Inspection on 28/09/05 for Beechwood Lodge

This inspection was carried out on 28th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Beechwood Lodge 29/10/09

Beechwood Lodge 03/11/08

Beechwood Lodge 30/06/08

Beechwood Lodge 14/01/08

Beechwood Lodge 29/06/07

Beechwood Lodge 26/04/06

Beechwood Lodge 11/04/05

Beechwood Lodge 30/12/04

Beechwood Lodge 13/08/04

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

CARE HOMES FOR OLDER PEOPLE Beechwood Lodge 148 Barnhorn Road Bexhill-on-Sea East Sussex TN39 4QL Lead Inspector Kevin Whatley Announced Inspection 28th September 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beechwood Lodge DS0000021046.V249175.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. Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Beechwood Lodge Address 148 Barnhorn Road Bexhill-on-Sea East Sussex TN39 4QL 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) 01424 844989 Beechwood Lodge Limited Mr Robert Jempson Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of residents to be accommodated is twenty (20) 11th April 2005 Date of last inspection Brief Description of the Service: Beechwood Lodge is a care home registered to accommodate a maximum of 20 older people. The home is owned and managed by Mr Robert Jempson. The premises are situated in a residential area of East Sussex near to Little Common and just over a mile from Bexhill-on-sea. The home is close to local shops and amenities and the coast is less than a mile away. Bedroom accommodation is situated on two floors, with a shaft lift to enable resident’s ease of access to each floor. The home has considerable communal space including a large garden. Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Beechwood Lodge will be referred to as ‘residents’. The announced inspection took place on a weekday in September and lasted approximately 6 hours. Eleven residents were accommodated at the home at the time of the inspection. The inspection included a tour of the premises and it’s facilities, with many residents also consenting for their bedrooms to be viewed. Approximately three residents were spoken with individually, whilst several others commented on their care during the course of the inspection. The proprietor/manager, the deputy manager, and two members of care staff, were spoken with during the visit; whilst a visiting relative also commented on the services being provided at the home. Relevant records, files and policies and procedures were viewed at various stages throughout the inspection. What the service does well: What has improved since the last inspection? The homes statement of purpose, residents guide and complaints policy and procedures have been developed to include all necessary information and now offers residents and staff alike concise and relevant information and guidance. A new format of care planning has recently been introduced that allows care staff the opportunity to plan and review packages of care against assessed Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 6 needs in a more concise manner. The programme of installing a majority of the required radiator guards has almost be completed and the home was found to be free from unnecessary hazards. Criminal Records Bureau (CRB) checks have now been completed for all but one member of staff and new staff files have been purchased. 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. Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 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 Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 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): 1, 2 and 5. The home provides prospective residents and their relatives, carers and friends with an adequate level of information concerning the services offered at the home. Residents are protected by suitable terms and conditions of residence. EVIDENCE: Since the last inspection the home have reviewed and assessed it’s Statement of Purpose and Resident’s Guide and have subsequently developed documentation that now contains more comprehensive information regarding the home and the services it offers. Both documents were viewed and were seen to outline the care principles of Beechwood Lodge, the level of services to be provided and the manner in which such care will be given. The information includes concise details of what services are included in the cost of residing at the home and those services that are not included in monthly fees. Basic fees include newspapers and magazines, chiropody, manicure and hand massage and hairdressing. A number of residents files were viewed, these confirmed that the home have developed suitable service contracts which residents sign on admission. The contracts include appropriate terms and conditions of residency including Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 9 details of the exact nature of the services being paid for and those not being included in the basic fee, whilst the homes complaints procedure and contact details of the Commission for Social Care Inspection (CSCI) are clearly noted. The services policy on admission to the home state that resident’s move in initially on a four week trial basis to assess whether the service meets their expectations and whether the home can meet the assessed need of the resident. One resident confirmed that they were visited at their own home prior to moving into Beechwood Lodge and stated that they were made aware that they moved in on a trial basis to see if ‘they liked it first’. Beechwood Lodge DS0000021046.V249175.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 and 9. The assessed care needs of resident’s are incorporated into appropriate plans of care. The specific health care needs of residents are met by the home. The home have a suitable medicine storage and administration process, though they must ensure that these are adhered to at all times. EVIDENCE: Since the last inspection the home have started to implement a new format for the care planning of residents. The new system utilises a more concise documentation process that outlines all relevant aspects of care such as mobility, nutrition and social needs and incorporates them into a plan of how such needs will be met by care staff. Such care plans had obviously been devised sensitively and identified individual likes, dislikes and preferences of how residents wish to be cared for and supported. Care plans also confirmed that the health care needs of residents are assessed prior to admission and reviewed as the placement progresses. All care plans highlighted physical health care issues and how these needs are to be met. There was evidence of the home liaising appropriately with other care professionals such a District Nurse and a Parkinson Nurse, whilst care staff displayed considerable knowledge and understanding of health care issues and Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 11 the role they have in ensuring the home can meet this specific area of resident’s needs. The homes medicine storage and administration system was viewed and this confirmed that there are adequate and appropriate lockable storage facilities for resident’s medication. However the cupboard containing homely remedies was found to have a faulty lock and could not therefore be locked. The home utilise a ‘blister pack’ administration system for issuing residents with their prescribed medication in line with a suitable medicine administration recording format. All records were found to be accurate, up to date and complete. Beechwood Lodge DS0000021046.V249175.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 and 14. The homes routines match the needs of residents, whilst opportunities for group and individual activities and interests are provided. Residents are supported to make decisions about their lives and encouraged to maintain contact with others outside of the home. EVIDENCE: Several residents stated that they can ‘choose what they want to do’, whether that be watching television or listening to music in their rooms or joining other residents in the lounge or going on a shopping trip. The times of meals appear appropriate and no resident commented negatively on any aspect of the homes routines. Residents have the option of eating in the dining room or in their own rooms. The home do not have a comprehensive activities programme in place, although a singing group visit the home monthly. Most residents stated that they do not want ‘bingo or bridge’ and are ‘happy to ask for events’ as and when they want them. A majority of the residents at Beechwood lodge are active and often go out on visits to the local shops or events in the local community on their own or with another resident. Religious services are held at the home bi-monthly. Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 13 It was clear from talking to residents and staff that the home places a high importance on respecting the individual choices of those living at Beechwood Lodge. As previously noted many of the residents currently residing at the home do not require a high level of personal care support and are therefore able to participate in an active lifestyle. One resident commented that they can ‘do what they wish to do’ in an environment that is ‘like a very caring hotel’. Beechwood Lodge has an open and relaxed visitors policy and the visitors book confirmed that many residents receive regular visits from family and friends. During the inspection a number of guests were seen to visit. The manner in which staff interacted with the visitors indicated that anyone visiting the home are made to feel very welcome. One relative noted that they can visit ‘whenever they wish within reason’ and stated that they were always ‘welcomed and encouraged to visit’. Beechwood Lodge DS0000021046.V249175.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. Residents concerns and complaints are addressed via a robust complaints policy and procedure. Residents are protected from the risk of harm by the homes adult protection policies and procedures, however the home must ensure that care staff receive adequate training in these areas. EVIDENCE: Since the last inspection the home have updated their complaints policy and procedures. This was viewed and was found to be concise and relevant outlining all relevant aspects of the homes responsibility to deal with matters of concern or complaint and included the contact details for CSCI and timescales for the completion of any investigation into any such complaint. A copy of this is now displayed in a communal area of the home. The homes complaints book was viewed and this confirmed that no complaints had been recorded since the last inspection. CSCI have not received any complaints regarding the home since the last inspection. The home have suitable adult protection polices and procedures in place that includes clear guidance on ‘whistle blowing’. Care staff spoken with displayed a clear understanding of adult protection issues. The last inspection report made a requirement that the home must ensure that all care staff must receive adult protection training, at the time of the inspection this was still outstanding, however it was confirmed during the inspection that this will be provided by an outside agency within the next few weeks. Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 15 Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25 and 26. Beechwood Lodge offers residents adequate facilities within a spacious and homely environment. The home must continue to improve the surroundings to ensure that residents are safe at all times. EVIDENCE: Beechwood Lodge continues to be maintained in a generally good structural order both inside and out with a decor that is both homely and relaxed. A number of residents agreed for their rooms to be viewed and these were seen to be in good order having been personalised with photographs, pictures and ornaments. All of the bedrooms have en-suite toilets whilst four of these also have showers; there are adequate numbers of communal toilets and bathrooms on both levels of the home. The home has considerable communal area space including two lounges, both with TV’s and stereo’s, and a large dining area; whilst there is a large well maintained garden to the side and rear of the property with easy access for all residents. The home was found to be clean, tidy, hygienic and free from any odours or smells. Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 17 The last inspection report made a requirement that all radiators must have guards fitted. Since this inspection all but one bedroom has now had guards fitted to their radiators. The proprietor/manager stated that the outstanding radiator covers will be fitted in the next two months. A tour of the premises confirmed that there are several areas in need of attention including the radiators situated in communal areas that have yet to have their guards fitted, windows that need retainers and one area of the upstairs, that is not being currently being used for accommodation, that needs to be cordoned off. Records viewed confirmed that the premises underwent a health and safety risk assessment carried out by a certified contractor earlier this year that included every residents rooms; a review of this risk assessment is now due. Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30. The assessed needs of resident’s are met by the numbers and skills of care staff deployed at the home. The home must continue to develop it’s care staff training programme. Beechwood Lodge must adhere to all legislative requirements in relation to the recruitment of staff. EVIDENCE: The home currently deploys two members of care staff to work during the daytime, often being assisted by the proprietor/manager, whilst one member of care staff is on ‘waking night’ duty after 9pm with the proprietor/manager, who lives 500 yards away, on call throughout this period. The home also employ a domestic carer and cook. Both care staff and the proprietor/manager stated that the levels of staffing meets the current needs of residents, though acknowledgement was made of the need to review the situation should the numbers of residents or their assessed needs increase. Residents commented that staff ‘were always around’ to ‘care and look after them’. Records seen including the ‘night time’ log book indicated that sufficient checks are made by care staff on residents throughout the day and recorded accordingly in daily logs. Care staff were seen to be competent, knowledgeable and caring and carried out their tasks with obvious enthusiasm and respect for the residents living at the home. Care staff spoken to displayed considerable insight into the individual needs of residents and it was clear that staff are committed to providing a high level of care support. Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 19 The last inspection report highlighted the homes poor approach toward the recruitment of staff and the lack of staff records including ensuring that all staff have written confirmation of all the necessary checks having been completed prior to commencing employment. Since the last inspection a majority of staff have had new Criminal Records Bureau (CRB) checks confirmed, although no references have been kept. The home have now purchased a suitable system for storing staff information in individual files, however these have yet to be compiled. It is of concern that the most recently appointed member of care staff has started working at the home without confirmation of their CRB check or evidence of references. The previous inspection made a requirement that an appropriate programme of induction and training that is approved by the Training Organisation for Personal Social Services (TOPSS) must be implemented for care staff. At the time of this inspection there was no clear evidence of such a programme having yet been implemented. The proprietor/manager stated that he is currently in negotiations with an outside agency to develop and implement an induction and training programme for the home. Five members of care staff are currently undertaking National Vocational Qualification (NVQ) level 2 in Care. Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 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, 36 and 38. The home is managed with the best interests of residents in mind, however the future management structure of Beechwood Lodge must be addressed. The management supports care staff to carry out their tasks though the home must implement a suitable format of formal supervision. The management must continue to implement health and safety improvements. EVIDENCE: The home has been owned by the same family for a considerable number of years and the current proprietor/manager has acted in his role for several years since taking on the sole running of the business. It was clear from this and previous inspections that in most respects the proprietor/manager fulfils the role of registered manager, however he has no formal qualifications in care or care management and stated he has no intention of gaining any. The proprietor/manager noted that it is his wish to utilise his qualifications and return to the legal profession. However he wished to stress that despite this he is not intending to sell the business but rather wishes to install a registered Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 21 manager and acknowledged that to conform with the requirements of registration that consideration for a suitable person needs to occur in the very near future. As with the previous inspection residents commented that they felt ‘looked after’ and ‘comfortable’ in their environment and able to speak to the proprietor/manager should they have any concerns or complaints. Beechwood Lodge continues to be a relaxed and homely environment, which is run for the contentment of it’s residents. The previous inspection recommended that the proprietor/manager should introduce a formal staff supervision programme. However no action has been taken to address this issue and subsequently staff do not receive any formal supervision at the home. Care staff commented that despite having no formal supervision that they felt supported by the proprietor/manager. The proprietor/manager accepted that this requirement must be met as a matter of priority, though stated that the relatively small staff team allows ‘on-going’ informal supervision to occur on a daily basis. A number of records were viewed including the accident book. In general all records maintained for the health and safety of staff and residents were found to be up to date, accurate and relevant. However an incident involving a resident falling and subsequently requiring hospital treatment, despite being recorded in their care plan, was not recorded in the homes accident book. Fire records confirmed that regular alarm testing takes place, whilst fire fighting equipment is maintained by a certified contractor. There was also clear evidence of staff receiving regular fire safety training. Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 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 3 3 x 4 X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 1 X 2 Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP9 OP18 Regulation 13(2) 13(6) Requirement That all medicines within the home must be stored securely. That all care staff must undertake adult protection training (outstanding from previous inspections). That the CSCI must be contacted to confirm the programme of installing radiator covers, window retainers and the blocking off of the unused area of the home has been completed. The home must adhere to all legislative requirements in respect of the recruitment of staff (outstanding from previous inspections). The home must implement a suitable induction and training programme for care staff (outstanding from previous inspections). The proprietor/manager must address installing a registered manager. The home must implement a system of formal supervision (outstanding from previous DS0000021046.V249175.R01.S.doc Timescale for action 28/09/05 28/04/06 3 OP19 & OP38 13(4)(c) 28/04/06 4 OP29 17(2) 28/09/05 5 OP30 18(1)(a) & (c) 28/04/06 6 7 OP31 OP36 9(1)(2) 18(2) 28/04/06 26/04/06 Beechwood Lodge Version 5.0 Page 24 inspections). 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 The home should include information regarding it’s service provision for ‘respite care’ and details of the services it does not offer, within the statement of purpose and residents guide. The home should also consider including residents comments regarding the level of service offered at Beechwood Lodge. The home should introduce residents meetings to gain feedback on the services provided at the home, including a consensus of opinion regarding implementing programmes of activities and events. That the home should have a residents ‘falls book’ that could be kept to assess a chronology of incidents and inform care plan reviews. 3 OP12 3 OP38 Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Beechwood Lodge DS0000021046.V249175.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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