Inspection on 01/06/06 for Caxton Lodge

This inspection was carried out on 1st June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Caxton Lodge 06/02/07

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Caxton Lodge North Road Ripon North Yorkshire HG4 1JP Lead Inspector Rob Padwick Unannounced Inspection 1st June 2006 12:15 Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 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 Caxton Lodge DS0000064853.V295427.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 Adults 18-65. 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. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Caxton Lodge Address North Road Ripon North Yorkshire HG4 1JP 01765 604418 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) info@homestogether.net www.homestogether.net Homes Together Ltd Position Vacant Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category LD may also have associated physical disability and/or a sensory impairment N/A Date of last inspection Brief Description of the Service: Caxton Lodge is registered to provide residential, personal, and social care for nine service users with learning disabilities, some of whom may also have an associated physical disability and/or a sensory impairment. The home comprises of a large victorian building which has been extensively modernised. The home is situated near to the town centre of Ripon to which service users have access via the home’s minibus. Communal facilities such as lounge and dining room are located on the ground floor. Service users’ bedrooms are situated on the ground and first floor. The There is no lift to the first floor so only those service users who have good mobility have rooms on that level. Fees charged by the home are from £750 to £ 1,200 with additional charges made for holidays, toiletries and chiropody services. Homes Together Ltd, which owns the service, provides information to service users in their Statement of Purpose and Service User Guide. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service first opened in September 2005 and this was the first time it has been inspected by the Commission for Social Care Inspection Eight people were living in the home at the time of this inspection. Several had previously lived in other homes run by the same provider and transferred to this service when it first opened. During the inspection, a tour of the building was undertaken, and time was spent talking with the service users in the communal areas of the home and observing their daily lives. Further time was spent reading care plans and files and talking to staff and the acting manager. Comment cards were distributed to Health and Social Services staff associated with all of the 8 service users accommodated, together with their relatives and the home’s doctor. Three relatives provided written replies and two others were subsequently contacted by telephone. Three written responses were received from the health and social service staff, whilst another three provided verbal comments. The findings from this visit were generally good, but the use of door wedges represented a health and safety hazard to service users and the outcome judgement relating to conduct and management was therefore rated as poor on this occasion. Action has subsequently been taken to remedy this practice. The judgements made in this report are based on the above sources and on additional information submitted by the service provider. What the service does well: What has improved since the last inspection? What they could do better: In order to ensure that the health and safety of service users, staff must be adequately trained in the correct administration of medications. The home’s recruitment procedures need strengthening to ensure that only people who are safe to provide care to service users are employed. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 6 The use of wedges to hold fire doors open must stop. Alternative means of keeping fire doors open must protect service users and staff in the event of fire. In the mean time risk assessments must be carried out to identify ways of managing any risks posed. Person centred care plans should be developed for all service users and Learning Disability Award Framework (LDAF) accredited training should be given to new staff employed, in order that the service users needs can be better met. Feedback received from service users, relatives and professionals associated with the home should be fed into the home’s quality assurance so that its performance against its stated aims and objectives can be measured and the service can be improved in line with the needs and wishes of service users. 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. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The Quality in this outcome area is good. Service users had been assessed, in order to ensure that the home could meet their needs. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Many of service users had formerly been accommodated in other homes within the provider group, prior moving to Caxton Lodge. Arrangements concerning the assessment of their health and welfare had previously been inspected and judged to be satisfactory. Service users confirmed that they had been consulted about their move to Caxton Lodge and examination of a sample of their files indicated that reassessments of their needs had taken place in partnership with them and their representatives. Health and Social Services staff involved in the assessments of service users commented positively about this practice. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 The Quality in this outcome area is good. Individual needs and choices of service users were being appropriately reviewed, in order that the service can continue to meet their health and welfare. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The random sample of service user files inspected contained copies of care plans that documented the individual service user’s needs, with guidance to staff on how these should be met. Staff indicated that care plans were discussed with service users and evidence was seen that these were being monitored and reviewed appropriately and that action was being taken to involve the service user and their representatives in this process. The acting manager stated that a recent re evaluation of the opportunities for a service user to participate in community-based activities had followed a holistic Person Centred approach. It is recommended that this approach be adopted for all service users in order to provide a more thorough approach to care planning, which incorporates both the individual service user’s strengths and their areas for potential development. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 10 Observation of the care practices and discussion with service users indicated that they were supported to make decisions about their lives. Inspection of one case file provided evidence that an advocate had been engaged to assist with the process of ensuring that a service user received a re assessment of needs by the Local Authority commissioning the placement. Resident meeting minutes were examined and these confirmed that service users were consulted and able to participate in decisions about the home. Staff were observed supporting service users to be as independent as possible and assessments of identified areas of known risk were included in the case files inspected. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 and 17 The Quality in this outcome area is good. A range of opportunities are provided to ensure that service users have access to appropriate activities. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Discussion with staff and service users and inspection of the home’s records indicated that a variety of culturally and age appropriate activities were available for service users to participate in. The provider submitted information as part of the inspection process that both individual and group activities were accessed and that these included Gym, horse riding and swimming sessions, together with participation in various youth clubs and day services. Service users were seen leaving for and arriving home from various activities. Staff confirmed that service users were able to become involved with the local community and one service user talked about the voluntary work they do twice a week in a local charity shop. Two service users said that they were looking forward to attending a music event the forthcoming weekend, whilst others were Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 12 observed coming and going from their daily activities. Service users are able to use the home’s minibus for attending community activities. The home had various policies that encouraged appropriate personal, family and sexual relationships and questionnaire feedback received from relatives and professionals indicated that relatives were welcomed into the home. Case files contained evidence of this and discussion with one of the service users confirmed that he regularly went home to stay with family at weekends. However, subsequent discussion with two parents indicated that they felt that communication with staff about their relatives needs could be improved. Observation of the care practices in the home indicated that service users’ rights were respected and that routines were flexibly based, in order to meet with their individual choices and needs. A full time activities coordinator is employed in the home and discussion with her indicated that she encourages service users to be independent, by involving them in day-to-day activities such as helping with the preparation of daily meals. Service users confirmed that the food was good and discussion with the activities coordinator indicated that they helped choose what food was to be served. Inspection of case files indicated that service users nutritional needs were being monitored and evidence of healthy eating programmes was seen displayed on the wall in the kitchen. On the day of this inspection, the main meal of the day consisted of roast leg of lamb that had been obtained from a local farm shop, together with Yorkshire puddings and fresh vegetables and this was sampled and found to be of good quality. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The Quality in this outcome area is Adequate. The personal support given to service users met their wishes and needs but the medication procedures need strengthening, in order to ensure their health and safety. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Staff were observed supporting service users respectfully and discussion with service users confirmed that their care was delivered in accordance with their wishes and needs. Guidance based on the assessed needs of service users was included within the care plans that were examined. Information on the service users condition, medical and other associated relevant considerations were well documented. Case files examined and discussion with staff indicated that service users emotional and physical needs were being met. Daily recordings and monthly summaries of the service users development were seen; together with evidence that care plans were being reviewed, in order to ensure that the care delivered continued to meet their needs. Staff had received in house training in the safe use and handling of medication, but the inspection of the home’s records showed that one service user had not Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 14 been issued with his medication as prescribed. Discussion with the acting manager indicated that this was because the service user got up late that day. A requirement is made in these matters and a recommendation made that staff receive medication training from an accredited source. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The Quality in this outcome area is Good. Service users concerns were listened to and acted upon but the complaints procedure needed to be better publicised. Staff demonstrated an appropriate understanding of the policies and procedures for safeguarding service users from abuse. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Observation of service users and discussion with them indicated that their views were listened to and acted upon by staff and that they had no complaints about the service they received. Resident meeting minutes confirmed that service users were consulted about developments within the home. The provider organisation has developed a complaints policy in a format that is accessible to service users and the complaints log indicated that a complaint had been received from a service user and that appropriate action had been taken to resolve this. However, relative comment cards received indicated that the home’s complaint’s procedure should be publicised more. Policies and procedures for the protection of service users from abuse were available, and training on the subject had been delivered to staff. The acting manager indicated that on one occasion prior to him taking up his post, Adult Protection concerns had not been followed correctly, but measures to ensure this situation did not reoccur, had now been addressed. Staff spoken to were sensitive to issues relating to the vulnerability of the service users and demonstrated an awareness of the appropriate measures for managing such concerns. The homes procedures for dealing with service users’ finances were randomly checked and found to be satisfactory. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 16 Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The Quality in this outcome area is Adequate. The physical environment was appropriate to meet the service users needs but the use of door wedges was a potential risk to service users safety. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home was comfortable, clean, hygienic and domestic in nature. Ramps were in place to provide wheelchair users access to the ground floor and garden areas and the building was large, roomy and well maintained. However, a number of fire doors on the ground floor were wedged open, in order to enable service users easier mobility around the home. This practice is unacceptable and an immediate requirement in respect of these matters was made on health and safety grounds. (See Standard 42) Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 The Quality in this outcome area is Adequate. Service users are placed at potential risk by poor recruitment practice and some shortfalls in staff training. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The acting manager supplied information that indicated service users were supported by staff that had received training to do their jobs. In house sessions on a range of topics had been provided over the past year including; training on autism and challenging behaviour, adult abuse, health and safety, food hygiene, fire and nutrition. The acting manager confirmed that 4 of 13 care staff currently employed in the home held an NVQ2 qualification and discussion with a staff member indicated that another 3 were due to complete such a programme within the next few weeks. Staff were observed to be approachable and respectful of service users and those spoken to were enthusiastic and interested in their jobs. The minutes of regular staff meetings indicated that the acting manager ensured that staff were being kept updated and aware of their responsibilities. The home had a recruitment policy and procedure for the protection of service users. However, the random sample of staff files inspected indicated that these procedures needed strengthening. The file of a newly recruited staff member contained evidence of relevant identity, health and criminal record checks but Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 19 only one written reference could be found and a requirement is made in these matters. Discussion with staff and the acting manager indicated that the service users individual and joint needs were largely being met. Staff were enthusiastic about their jobs and confirmed that they had been given opportunities to enhance their skills. A staff training matrix was seen and inspection of staff records confirmed that new staff undertook an induction programme. Records inspected indicated that staff were receiving regular supervision together with appraisals of their performance. However, discussion with two relatives and a member of Social Services staff indicated that the home could benefit from a training and development plan that was more directly linked to service users individual needs. This issue was borne out by observation of one individual seen sitting alone and listening to music on his own, with little staff interaction for much of this inspection. Recommendations are made in these matters. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The Quality in this outcome area is Poor. The management systems for the home were being developed to support staff in the provision of care to service users. However, service users were placed at risk by the use of door wedges to hold fire doors open. The quality assurance systems for the service needed to be fully implemented, so that the home’s performance against its stated aims and objectives can be measured and improved. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The acting manager had been in post for a period of approximately 2 months prior to this inspection, following the resignation of the previous manager and had been transferred from another service within the provider group. The acting manager is a qualified psychiatric nurse and discussion with him confirmed that he has completed his NVQ in management. Staff indicated that the acting manager was “fair” and that he had instituted some improved administrative and managerial systems to assist with the efficient running of the home. Evidence was seen of staff meetings and individual staff development sessions, to ensure that staff were aware of their responsibilities. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 21 Discussion with staff and inspection of the resident meeting minutes confirmed that service users were consulted about the home. The provider organisation has a quality assurance system for reviewing the development of the home and questionnaires had been prepared for obtaining feedback from service users, relatives and professionals associated with it. However, these had not yet been issued and a recommendation was made that they are circulated and the responses received, fed into the homes annual appraisal of itself against its stated aims and objectives. The acting manager submitted evidence that indicated that health and safety checks were being carried out, in order to ensure the welfare of service users and staff and a random check of the home’s records confirmed this. However, a number of fire doors were being wedged open in order to enable to service users greater mobility throughout the building. This situation was unacceptable, and an immediate requirement was left in respect of this matter. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X X 1 X Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20YA20 Regulation 13 (2) Requirement The registered person must ensure that medication prescribed to service users is administered correctly. The registered person must ensure that staff files contain 2 satisfactory references. The registered person must ensure that Fire doors are not wedged open. Timescale for action 01/06/06 2 3 YA34YA34 YA42YA42 19 13 (4) (5) 01/06/06 01/06/06 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 4 Refer to Standard YA6YA6 YA20YA20 YA35YA35 YA35YA35 Good Practice Recommendations The registered person should ensure that holistic person centred care plans are developed for all service users. The registered person should ensure that staff receive accredited training in the safe use and handling of medication. The registered person should ensure that relevant training that is linked to the service users needs is delivered to staff. The registered person should ensure that Learning DS0000064853.V295427.R01.S.doc Version 5.2 Page 24 Caxton Lodge 5 YA39YA39 Disability Award Framework (LDAF) accredited training is delivered to new staff in order to underpin their knowledge for progress towards achieving R/NVQ’s. The registered person should ensure that questionnaires are circulated to service users, relatives and professionals the results received fed into the services quality assurance system, so that that the home’s performance against its stated aims and objectives can be measured and improved. Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Caxton Lodge DS0000064853.V295427.R01.S.doc Version 5.2 Page 26 - 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!