Inspection on 05/09/05 for Bowles Lodge

This inspection was carried out on 5th September 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bowles Lodge 24/09/08

Bowles Lodge 11/04/07

Bowles Lodge 03/05/05

Bowles Lodge 21/12/04

Bowles Lodge 13/08/04

Bowles Lodge 04/11/03

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Bowles Lodge All Saints Road Hawkhurst Kent TN18 4HT Lead Inspector Gary Bartlett Announced 05 September 2005 09:00 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 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. Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Bowles Lodge Address All Saints Road Hawkhurst Kent TN18 4HT 01580 752775 01580 754622 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Kent County Council Mrs Beverley Seal CRH Care Home 36 Category(ies) of Old age (36) registration, with number of places Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 03 May 2005 Brief Description of the Service: Bowles Lodge is a Linked Service Centre owned and operated by Kent County Council. It offers residential care for 36 older people and there is a day centre on the site. The Home is a detached, purpose built, premises on one level with 34 single bedrooms and one shared bedroom. There are staff call points and television points in all bedrooms. There are telephone points in some bedrooms and at other places around the Home. There is a large garden to the rear of the building and car parking to the front. Bowles Lodge is located near to the centre of Hawkhurst village with easy access to bus services. The nearest shops and other amenities including churches, library, chemist, post office and public houses are within half a mile.The Home’s senior staffing team comprises the Manager, a Senior Team Leader and Team Leaders. The Home employs Care Workers who work a roster that gives 24-hour cover and additional staff for catering, domestic and administration duties. Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Bowles Lodge from 9.00 a.m. until 5.20 pm. During that time the Inspector spoke with some residents, visitors and staff. Parts of the Home and some records were inspected. A relatively large number of comment cards were received prior to the inspection. Residents and their relatives responded that they liked the home and staff gave good care. Responses from health professionals also indicated good standards of care and good communication, with helpful staff. Statements on comment cards included: • “cannot speak highly enough of the care my mother receives at Bowles Lodge” • “It is a wonderful home” • “The Home has always been very supportive” • “I’m very well treated and I don’t wish for anything more” The Manager was on a secondment at the time of the inspection and the Deputy Manager was acting as temporary manager. For the purpose of this report she will be referred to as the Manager. The Manager and staff gave their full co-operation throughout the inspection. Not all Standards were inspected on this occasion and this report should be read in conjunction with that of the unannounced inspection conducted on 3 May 2005. What the service does well: Staff operated a good pre-admission assessment process and were helpful in assisting residents to settle in to the Home. Residents spoke highly of the staff who were seen to be attentive and responsive to residents’ needs. General health needs were well recognised and managed. The Home maintained close links with residents’ relatives and the local community. Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 7 contacting your local CSCI office. Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 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 standard(s) 1, 3, 4, 5 and 6 The Home’s Statement of Purpose and Residents Guide provided residents and prospective residents the information they need to make a decision about moving into the Home. Good pre-admission assessments and the opportunity to visit the Home prior to admission ensured residents were appropriately placed and the Home could meet their needs. The Home did not provide intermediate care. EVIDENCE: The Manager said the Statement of Purpose was accurately descriptive of the aims, objectives, philosophy of care, services and facilities and terms and conditions of Bowles Lodge and copies of the Residents Guide were provided for each resident or their representative. These were not inspected on this occasion. Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 10 The Manager described how a pre-admission assessment was made of each prospective resident using an aide-memoir. Records seen indicated prospective residents, their families, advocates, and relevant health care professionals were involved in the assessment process. The Manager said prospective residents or their families were able to visit the Home before moving in. A visitor present confirmed this, who also said staff had been “wonderful” in assisting the resident to settle in. Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 11 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 standard(s) 7, 8, 9 and 10 Residents’ health and welfare would be better promoted by daily records being more consistently maintained and risk assessments being recorded when necessary. The Homes procedures for storing and administering medicines protected residents. EVIDENCE: Each resident had a care plan and three were inspected in detail. Although there continued to be improvement in the plans, a record had not been made of a significant event in regard to a residents’ health and in another, risk assessments had not written in response to a significant recent deterioration in the resident’s mental health. Consequently it was not clear that staff were being made fully aware of residents’ welfare and how to meet their care needs. There were some very good examples of daily records of care and staff commencing the afternoon shift were seen to receive a detailed handover. Residents and their relatives felt that staff were kind and caring. Staff were seen to be very considerate of the age and dignity of residents and to treat Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 12 them with courtesy. The problems caused by the absence of toilets easily accessible to wheelchair users is detailed under Standard 21. The Home had comprehensive procedures for the storage and administration of residents’ medicines to protect residents. Staff were seen to adhere to these and to liaise with District Nurses, General Practitioners and Pharmacists where necessary. Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 13 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 standard(s) 12, 13, 14 and 15 Residents had some choices about their daily lives, were able to have visitors at any reasonable time and enjoyed continued links with the local community where this was their preference. Dietary needs of residents were well catered for with a balanced and varied selection of food that met their tastes and choices. EVIDENCE: Residents indicated they were happy with the daily routines and flexibility offered. The flexibility of breakfast times was greatly appreciated. During the inspection a number of visitors were seen in the Home and the visitors book recorded regular visits by families, friends and others. Residents could meet with visitors in a designated room, various communal rooms or in their bedrooms. A visitor described how they could visit at any reasonable time and was always made welcome by staff. Residents said they were happy with the arrangements. A statement on a comment cards included “The staff are always friendly and most helpful when you visit or call. Also the staff always make time to talk to you. You are always made welcome” Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 14 Staff, residents and a visitor described how visits to and from the local community were arranged according to residents’ wishes and taking account of their needs. The Manager stated residents were supported to manage their own affairs for as long as they wished. It was evident from viewing some residents’ bedrooms, they were encouraged to bring with them into the Home personal possessions. The Manager was aware that a more homely environment would be achieved by replacing unnecessary hospital beds but was constrained by available resources. Residents confirmed that they were aware they could access their own records, although one resident did ask “why would I want to read about what I have done? It can’t be that interesting, I’d rather watch the tele”. Residents described how the television was generally on throughout the day and they would change the channel by mutual agreement mostly in the evenings. Residents spoke favourably of the meals, said they had plenty to eat and enjoyed the choices available to them. The meals were well presented and looked appealing. Lunch was taken in a relaxed atmosphere and staff were seen to offer assistance in a discreet and sensitive manner. The menus seen were varied and alternatives were offered. A statement on a comment card included “my mother always comments on how good the meals are and does enjoy them very much” Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 15 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 standard(s) These Standards were not inspected EVIDENCE: Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 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 standard(s) 19, 21, 22, 24, 25 and 26 Residents generally enjoyed a clean environment and those spoken with liked the Home. Toilet facilities were not adequate for wheelchair users and caused embarrassment and inconvenience. The environment did not ensure residents’ comfort and safety. EVIDENCE: Those parts of the Home inspected were clean and free from unpleasant odours. A statement on a comment card included ”..The Lodge is always clean and tidy” Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 17 The Manager stated that professional advice had been sought about the internal fire-doors that connected rooms 1 and 2 of each unit and could only be opened from one side. The Home was waiting for written confirmation these doors could be dispensed with and would then furnish the rooms in such a manner that complied with the Standards and allowed the residents clear floor space. Since the last inspection, a decommissioned water heater causing obstruction for people using a sink had been removed and the kitchenettes were being refurbished. Residents’ safety had been further enhanced by the Manager having ordered radiator covers. As noted in previous inspection reports, a wheelchair-dependant resident had described how the toilets were too small to accommodate their wheelchair or allow sufficient room for manoeuvring. The Manager described how Kent County Council had acknowledged the need for this to be addressed and various options were being considered. The laundry was clean although it was seen that parts of the walls still needed to be repaired to ensure adequate cleanliness and a separate hand wash basin had not yet been fitted. The water supply to various parts of the Home was still problematic with low water pressure or no hot water supply at all. The Manager said this was being addressed. Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Recruitment processes are robust and offer protection to people living at the Home. The Home was addressing the training of staff so they had the skills to meet the needs of the residents. EVIDENCE: Residents, visitors and health care professionals spoke highly of the staff: Statements on comment cards included: • • • • “..nothing is too much trouble for the staff” “..the staff were caring and loving” “ …have the greatest admiration for the way the staff look after/entertain the residents – and are very grateful to them” “The staff are very kind and caring towards all patients in the home. Not once have I seen them get annoyed…” Staff were seen to be attentive and demonstrated a commitment to meeting residents needs. The Manager explained that in view of the rural location of the Home flexibility was offered to staff to accommodate their individual requirements whilst Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 19 always ensuring staffing levels were geared to peak times of activity. Residents benefited from a resultant low staff turn over. Some use of agency staff was still necessary to maintain adequate staffing levels. Records seen indicated that robust recruitment procedures were used and ensured residents received care only from staff that had been properly vetted. Each staff member now had an individual Qualification and Training Profile and there was a training matrix for easy monitoring of staff’ training/update requirements. The Manager described how the NVQ training had been disrupted by the demise of a training organisation but alternative trainers had been identified and NVQ training was recommencing. Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35, 36, 37 and 38 The Home protected residents’ financial interests. The Home regularly reviewed aspects of its performance through a programme of self-review and consultations, which included the opinions of residents and relatives. The Home could not demonstrate it was able to ensure residents’ safety in that an instance of poor practice was observed and the kitchen was in need of a deep clean. EVIDENCE: The Manager was on a secondment at the time of the inspection and the Deputy Manager was acting as temporary manager. Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 21 The Manager described how residents and their representatives or relatives were regularly asked for their views about the service.. The registered Manager was the delegated budget holder for the Home with supervision and support being provided by Kent County Council. Business accounts were not inspected on this occasion. A staff member explained that the Home encouraged residents to manage their own financial affairs or to have assistance from their families / representatives. The staff member demonstrated a sound system of holding and recording residents’ cash, which facilitated ease of monitoring. Residents’ relatives did not express any concerns about the Home’s management of monies or valuables held on the residents’ behalf. During the inspection, areas identified as being in need of attention to ensure residents’ safety were very quickly addressed. Staff were seen to be diligent in minimising risks to residents by carefully placing equipment to avoid obstruction and in ensuring COSHH requirements were adhered to. Records of maintenance and safety checks were seen to be in order. Staff spoke of regular supervision to monitor staff performance and provide guidance where necessary to ensure a good service was offered to residents. Records seen indicated that staff had recently undertaken fire safety training. The kitchen was in need of a deep clean and parts of the kitchen needed to be made good to maintain food hygiene standards and protect residents. Foods were seen to be stored in accordance with guidelines. A staff member was observed to put a resident at potential risk by not using the footplates on a wheelchair. The resident’s care plan was inspected and there was not any reason stated for the footplates to not be used. The Manager undertook to remind staff of their responsibilities in respect of this. Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x 2 2 x 2 1 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 3 3 3 3 2 2 Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 17 Schedule 3 Timescale for action “The registered person shall Action plan maintain records as specified in to be Schedule 3 in that daily records received by of care must be maintained CSCI by particularly where there have 30/10/05 been instances of note The registered person shall Action plan ensure that unnecessary risks to to be the health or safety of service received by users are identified and so far as CSCI by possible elimated in that risk 30/10/05 assessments must be written in respect of detrimental changes in residents health or welfare “The registered person shall To be ensure that the Home is completed conducted so as to make proper by provision for the care of Service 31/01/06 Users and that suitable or sooner equipment and facilities are provided for Service Users who are old, infirm or physically disabled” and “The registered provider shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of the Service User” in that appropriate toilet facilities must be provided for wheelchair –dependant Version 1.40 Page 24 Requirement 2. 7 13(4) 3. 21 13(4) Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc 4. 25, 26 12(1)(a) 23(2)(c)(j ) 5. 24, 26 12(1), 13(3)(4)( c) 16(2)(j) Service Users. This remained a requirement from previous inspections and the given timescale had not been met Failure to comply with this timescale may result in enforcement action. “The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users”“The registered person shall having regard to the number and needs of the ensure that equipment provided at the care home for use by service users or persons who work at the Home is maintained in good working order” In that an adequate supply of water must be available to all parts of the Home. This was being addressed, however this remained a requirement from previous inspections Failure to comply with this timescale may result in enforcement action “The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home”, in that: 1. The walls of the laundry and, where necessary, of toilets must be made good to promote infection control and adequate hygiene standards. 2. Adequate water supplies must be provided to the toilets for hand-washing. These remained requirements form previous inspections Failure to comply with this To be completed by 31/01/06 or sooner To be completed by 31/01/06 or sooner Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 25 6. 38 13(3) 13(4)(c) 16(2)(j) 7. 38 13(4) timescale may result in enforcement action “The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home”, in that current food hygiene regulations must be maintained through: 1. The kitchen must be deep cleaned 2. The fabric and furnishings of the kitchen must be made good where required to maintain satisfactory standards of hygiene. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible elimated in that wheelchairs must be used with footplates unless there is a recorded directive stating otherwise Action plan to be received by CSCI by 30/10/05 Action plan to be received by CSCI by 30/10/05 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. 2. 3. Refer to Standard 24 26 28 Good Practice Recommendations It is strongly recommended that hospital style beds are only used where assessed as being necessary to meet the service users needs It is strongly recommended a dedicated hand-wash basin be supplied in the laundry It is recommended that a minimum ratio of 50 trained members of staff (NVQ2 or equivalent) be achieved Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent TN16 9NT 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 Bowles Lodge H56-H06 S37778 Bowles Lodge V238710 050905 Stage 4.doc Version 1.40 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!