Inspection on 09/12/08 for Bonehill Lodge

This inspection was carried out on 9th December 2008.

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

Bonehill Lodge 30/06/08

Bonehill Lodge 20/09/07

Bonehill Lodge 17/10/06

Bonehill Lodge 25/05/06

Bonehill Lodge 21/02/06

Bonehill Lodge 05/07/04

Bonehill Lodge 29/04/04

Bonehill Lodge 23/10/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Bonehill Lodge 62 Park Lane Fazeley Tamworth Staffordshire B78 3HZ Lead Inspector Mandy Brassington Key Unannounced Inspection 09 December 2008 08:45 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 Bonehill Lodge DS0000004919.V373712.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. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bonehill Lodge Address 62 Park Lane Fazeley Tamworth Staffordshire B78 3HZ 01827 280275 F/P 01827 280275 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) Bonehill Limited Manager post vacant Care Home 26 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (26) of places Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 26 Dementia (DE) 6 The maximum number of service users who can be accommodated is: 26 30/06/08 2. Date of last inspection Brief Description of the Service: Bonehill Lodge is a residential home situated in the suburbs of Tamworth, Staffordshire, having access to local amenities and public transport. The home has a paved area to the rear and a small area of landscaped garden to the front of the home. The home looks out onto rural surroundings, there is limited access to public transport and local shops due to the semi-rural location. The home provides a service for 26 older people and is also registered to care for 6 individuals who have with dementia. The three-storey property provides residential accommodation on both the ground and first floor, en-suite facility is provided within a number of bedrooms. One part of the first floor is accessible via a passenger lift. Bathrooms and toilets are located throughout the home and in close proximity to bedrooms and communal areas. The property has a large lounge, divided into two separate areas, which leads to a dining area equipped with essential furnishings to meet the needs of the service users. There is a conservatory, which leads to a small paved garden. The registered provider is Bonehill Ltd who has overall responsibility for the Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 5 home. The Service User Guide records individual fee levels. The reader may wish to approach the care provider for up to date details of the fees payable. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This visit was an unannounced key inspection and therefore covered the core standards. The inspection took place over 5 hours by one inspector who used the National Minimum Standards for Older Persons as the basis for the inspection. On the day of the inspection, the home was accommodating twenty-two people. We, the commission examined records, carried out indirect observation of seven people who used the service, and five staff on duty. Four plans of care and two new staff records were examined and observation of daily events took place. We looked at five bedrooms, the two communal lounge areas, the dining room, the kitchen and laundry areas and bathing facilities on all floors. We inspected the storage system and medication procedures. What the service does well: People are able to spend time in the home before making a decision to move in and talk to other individuals and staff. As part of the assessment, staff ask people how they want to be supported and write down this information. A care plan is written which describes how to support people who live in the home. There are two main lounge areas and people like to sit with friends. People are able to decide which programme to watch, or what music to listen to. Some people choose to spend time in their room. Family and friends can visit the home whenever they want to, and family members are able to continue to provide care for a relative and spend time in the home. People go out with family and friends, and go on visits or shopping. There are activities arranged and individuals can choose whether to be involved in these. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 7 The planned meals are written on a board and displayed each day, so people can choose an alternative to the main meal being prepared. Food is served to people in their room or in the dining area. Meal times are relaxed and people sit with friends and talk to each other. People dress in their own style and if they need support, staff help individuals to apply make-up or to have a manicure. Staff provide any personal care and people in the home are well-presented and encouraged to take a pride in their appearance. Staff like to develop good relationships with people and will spend time talking and taking an interest in peoples lives and adventures. Staff have a good knowledge of the care needed and what people may want. What has improved since the last inspection? What they could do better: One double bedroom has been changed without thorough consultation with people who use the service. We are concerned that this room does not meet the standards for useable space, and it would be difficult to ensure peoples needs are met safely. This room is to remain vacant until this has been demonstrated to us. The service will need to liaise with our registration department. Flooring to the corridor of one of the new rooms was not completed, and the loose tiles may cause a fall. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 9 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 Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have information about the home and the service provided and can spend time in the home before deciding whether they would like to move in. EVIDENCE: People living in the home have a copy of the Statement of Purpose and Service User Guide, which provides details of the service provided, and the terms and conditions of occupancy. The new manager is aware that this Guide needs to be updated to incorporate the changes in the management arrangements within the home. We examined four records including two people who had recently moved to the home; one person was receiving respite care. Each person had been given a Service User Guide and had a contract with the fees payable. A Care Manager Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 11 had carried out a single assessment identifying support needs and preferred outcomes for people, for people funded through the local authority. Prior to moving in to the home, an assessment is completed with the individual and family members, to determine whether the home is able to meet peoples needs. The assessment includes personal details, a history, personal preferences and interests and support required. People are able to view all vacant rooms and a record of their decision is recorded. Individuals confirmed they were involved in the assessment process and were also able to look around the home. The home does not provide intermediate care. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use service are able to see health care professionals to make sure their health needs are met. EVIDENCE: We examined four plans of care, which demonstrated that people had information recorded about the support they require with personal and health care. Two plans were for people who had lived in the home for a significant period of time, and included information about the support people wanted for bathing, eating and drinking, personal hygiene, mobility and health needs. Individuals and family members had been included in writing the plan where possible. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 13 Two plans examined included a life story written by family members. This included information about family members, previous employment, relationships, interests, holidays and significant life events. All staff spoken to stated this had been of great interest and helped them to understand the person and their life before moving into the home. One staff reported this gave them useful information to discuss with people, especially for people with dementia. The plan included a history of any health concerns and how individuals are able to see and hear. This information means that all staff are aware of how to support people, and risk assessments are completed for any identified concern and mobility. One plan contained information regarding whether a person wished to be resuscitated in the event of their death. A letter from the persons General Practitioner was in place. The manager reported that the person does not have capacity to make this decision. This issue was discussed in detail regarding the persons wishes and an end of life plan. The plan needs to record the assessment process and any decision made, and incorporate the new legislation for the Mental Capacity Act. One plan included detailed information on how to provide pressure area care. The District Nurse visits daily to support staff and commented, the staff here are very good, they carry out the plan and do everything we ask them to do. Each person has a Key Worker who reviews the plan with individuals each month. How plans are reviewed has changed since the last visit and now concentrates on significant events during the last month. This was discussed with the manager, as the care plan was not reviewed and changes had not been incorporated into this. It is recommended that the review process be evaluated. One plan was for a person who had recently moved to the home and another plan examined was for someone receiving respite care. In both plans, a preadmission assessment had been carried out and a basic plan recording preferences for daily support had been completed. The plans had been developed each day and staff reported new information was recorded. Since the last Key Inspection the Pharmacist Inspector had carried out a visit to the home to thoroughly inspect the Medication systems within the home. The visit concluded that there were serious failings with regard to storage, administration systems and practices in the home. The staff have reviewed all practices in the home and have received updated training. This visit now demonstrates that Medication is stored appropriately in the home, and staff were implementing safe administration practices. Medication Administration Records (MAR) were completed appropriately for dispensing Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 14 medication. A small number of medicines were stored within a secure fridge; a record of the maximum and minimum temperatures had been recorded daily. During discussion, staff demonstrated a good knowledge of peoples needs and were observed providing sensitive care throughout the visit, including talking to people about what was happening, and giving choices. People in the home were well presented, wearing their own clothes, which were ironed and clean. One person commented You have to make the best of yourself, cant let standards drop. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are involved in daytime activities of their own choice in the home. Individuals can welcome family and friends into the home throughout the day, who can join any activity or event. EVIDENCE: On the day of the visit the hairdresser was visiting the home and this planned activity was recorded on the chalkboard in the hallway. People who use the service and staff revealed that other regular activities include having a manicure, talking to people, dancing and craft and exercise activities and reminiscence sessions. One person reported the staff always organise things for us to do, but most of us like to just sit and chat or watch Television, I like it when we all get together and talk about things, things we used to do. Staff stated that different activities are explored in line with peoples interests, although people are able to choose whether or not they attend. The day Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 16 following our visit, people had booked to go to a local pub for a Christmas meal. Visitors were observed coming to the home throughout the day, and discussion with people confirmed they are able to have visitors at any time. Many people spoke about going out with family and friends to visit places of interest. One family member spoke with us and reported that they were very happy with the support given by staff, and they were encouraged to visit and continue to take an active part in the persons life. Lunch was shared with people who use the service. A menu is displayed on a chalkboard in the dining room. On the day of the visit, lamb casserole with potatoes and vegetables was served and rice pudding for dessert. An alternative was available upon request. People spoke highly of the meals served. Comments included, they always cook good meals here and you never want for anything, its very good. One plan examined included information for the support required for eating. The plan contained details of suitable foods and how this was to be presented. Staff reported that food is liquidised separately to retain different textures and tastes of foods. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given information to make a complaint so that where any concern is identified they are confident this will be acted upon. EVIDENCE: The home has a Complaints Procedure, which is displayed in the home and within the Service User Guide. There have been no complaints made since the last visit to us. Discussion with people who use the service revealed they would report any concerns to the staff or manager. Staff have received training for how to ensure people are protected from harm and recognising signs of abuse. Discussion with staff revealed they would have no hesitation reporting any concerns and discussion took place regarding the safeguarding procedure and roles. The manager reported that the service is not responsible for maintaining personal finances. Small amounts of money can be safely held and a record of monies or valuable would be maintained. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 24, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to decorate their room with personal possessions so that it is comfortable and pleasing to each person. EVIDENCE: Some areas of the home have been redecorated and refurnished over the past year, raising the standards in the home. The house is a large home and the provider acknowledged during the last visit, that there needs to be an on-going programme of maintenance to ensure all areas are well maintained. We examined five bedrooms and found all areas to be clean and tidy and all rooms had been individually furnished according to the interests of people using the service. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 19 One double en-suite bedroom has been changed to provide two single bedrooms with a shared bathroom. One bedroom contains a single bed, bedside cabinet, chest of drawers and chair. There is very limited space to walk in the room and most of the room is under a sloping roof, which means that the person or staff could not stand up. The provider needs to submit detailed plans including the height of the room to us and demonstrate how this room meets the current standards and is suitable to meet the needs of any person admitted to the home. The registered person should not admit any person to this room until we have assessed this is suitable and safe to use. The new corridor to the second single room had had loose tiles and a new carpet had not been fitted. Discussion with the manager confirmed that due to the needs of the person accommodating this room could this could present as a trip hazard and the carpet in the bedroom was creased. The manger arranged for this to be addressed on the day of the visit. There are sufficient bathrooms and bathing areas on each floor and near to bedrooms. Where assessed people are provided with equipment to support safe bathing and mobility. The home has a team of domestic staff who ensure the home is kept clean and tidy and is a pleasant place to live. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to have confidence in the service provided as staff receive the on-going training needed to support people. There is a good recruitment procedure to ensure that people are suitable to work in the home. EVIDENCE: On the day of the visit there were three staff on duty on each shift and the manager and deputy manager work across the shifts. There were twenty-two people residing at the home, and the manager reported that the peoples needs could be met within the current staff group. We examined two staff files of people who started to work at the home since the last visit. This demonstrated the homes recruitment procedures were of a good standard. All individuals completed an application form, two written references were obtained along with a copy of identity, a PoVA First (Protection of Vulnerable Adults) and a Criminal Records Bureau Check (CRB) was obtained. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 21 Discussion with staff and observation of daily events revealed that people were sensitively supported. People using the service spoke very highly of the staff and the support provided. Comments included, theyre lovely, always got a smile for you, nothing is too much trouble, you couldnt ask for better, and the staff are fantastic, we have some laughs together. Al staff have now completed training for meeting the needs of people with dementia. Discussion with staff demonstrated they were aware of how to improve practices and the environment to improve the standards of care for people with dementia. One staff reported, that the home could have memory boxes with objects or photographs by each persons room, and make it easier to find and identify the persons bedroom. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manager has a clear understanding of the key principles and focus of the service. People using the service are able to benefit from a professional management approach and a supported team. EVIDENCE: It is evident from observation and discussion with staff, that the new manager is enthusiastic and committed to promoting peoples rights and providing a good service. The new manager is working closely with the existing team of Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 23 staff and has identified where the standards can be reviewed to improve the quality of care provision in the home. The manager is working in a supernumerary capacity, and this means that care staff are able to have more time to support people in the home. Staff reported that this means they have more time to spend with people and engage in activities and talking to others. Throughout the visit the manager was open and transparent in all areas of managing the home. Staff reported they would have no hesitation approaching her. The manager has begun to develop a quality assurance programme, which includes a quality review of the premises, medication, food and the general service. Questionnaires are provided for people who use the service, professionals and relatives to comment on the service. The home has been without a registered manager since July 2006. The new manager has submitted an application with us to begin the Fit Person Process and to become the Registered Manager. Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 24 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 3 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 X X X 2 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP23 Regulation Reg. 23 (2)(a)(f) Requirement Plans must be submitted with regard to the new single bedroom. This is because the registered person must demonstrate the room is fit for purpose. Timescale for action 03/02/09 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 Statement of Purpose needs to be reviewed to reflect the current activities provided in the home and the management arrangements. To ensure all decisions regarding the end of life and resuscitation are recorded including the assessment of a persons capacity. Plans of care are to be reviewed on a monthly basis and any changes or developments are to be incorporated into the plans to reflect up to date needs. DS0000004919.V373712.R01.S.doc Version 5.2 Page 26 2. OP7 3. OP7 Bonehill Lodge Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bonehill Lodge DS0000004919.V373712.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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