Inspection on 07/06/06 for Caxton Lodge

This inspection was carried out on 7th 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Caxton Lodge 04/12/08

Caxton Lodge 04/06/07

Caxton Lodge 01/12/05

Caxton Lodge 05/07/05

Caxton Lodge 02/12/04

Caxton Lodge 19/04/04

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

CARE HOMES FOR OLDER PEOPLE Caxton Lodge 25 Caxton Avenue Blackpool Lancashire FY2 9AP Lead Inspector Mrs Ruth Edgington Unannounced Inspection 9.15 7th June 2006 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 Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 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. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Caxton Lodge Address 25 Caxton Avenue Blackpool Lancashire FY2 9AP 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) 01253 356100 01253 356100 nichconnor@aol.com Mrs Isobel Conner Mr Nicholas Conner Care Home 11 Category(ies) of Dementia (11) registration, with number of places Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st December 2005 Brief Description of the Service: Caxton Lodge is situated in a residential area between Bispham and Norbreck, within easy access of shops and local amenities. The home can accommodate a maximum of eleven elderly persons, who have dementia. All bedrooms are for single occupation, none of which have en-suite facilities. The home has a separate lounge and dining room and sufficient toilet and bathing facilities to meet the needs of the residents. There is a passenger lift, which enables easy access between the ground and first floor. A copy of the Statement of Purpose/ Service user Guide is available for anyone making enquiries about the home. In addition there is a Brochure, copies of which are kept in the entrance hall of the home. The written information explains the care service that is offered and what the residents can expect if they decide to live at the home. A copy of the latest report is available for relatives to read if they so wish. Information received prior to this visit (07/06/06) showed that the fees for care at the home are from £279-£293 per week, which includes payment for chiropody and hairdressing. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit, which commenced at 9.15am and took place over five and a half hours. Prior to the visit the home owner completed a pre-inspection questionnaire and comment cards were received from three relatives. The home owner, manager, a member of staff on duty and two relatives were spoken to. Although the residents’ abilities to communicate varied greatly and in the main was very limited, information was gained from their comments and through observations made during the visit. A tour of the home was carried out and a selection of staff, residents and administrative records were examined. From the observations made, comments received and written documentation seen, the information has been put together to form this report. What the service does well: The resident in this home are well cared for. The management and staff were seen to be very caring in the way in which they looked after the residents and all personal tasks were carried out sensitively. The relatives are encouraged to be involved in the care provided and the management rely on the information that they can provided about individuals and their life styles before they came into the home to make sure that the needs of the residents are met. The questionnaires that relatives had completed prior to the visit included such comments as “ Staff are always ready to listen”, “This is a real home from home” and “I have always been fully consulted and actively involved in the care provided”. One relative wrote, “There is a great kindness shown in this home, they are to be commended.” The management and staff work closely with other professional such as the doctors and district nursing service to meet individual needs of the residents. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 6 Evidence was seen of the contacts made with the local Social Services department when concerns were raised over a resident’s relative, who eventually themselves became a resident in the home. What has improved since the last inspection? What they could do better: As stated previously the staffing levels in the home have improved, however at times there are only a minimum number of staff available, which results in the manager undertaking staff tasks and therefore not carrying out his role effectively. The recruitment procedures must be followed to ensure that the residents are protected. Staff must not be commence work until suitable written references and clearances through the CRB (Criminal Records Bureau) have been received. The manager and staff should continue to work towards obtaining the relevant qualifications. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 7 All information about the care of the residents and their daily activities should be reviewed on a monthly basis to make sure that any changes in their needs, personal care and health can be identified and met. The manager was reminded of the requirement to inform the Commission for Social Care Inspection (CSCI) in writing of any deaths and serious incidents that affect the well being of the residents. The programme of maintenance and redecoration should continue to ensure that the residents continue to live in a safe and homely environment. 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 DS0000009874.V286124.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The admission and assessment procedures were clear to ensure the care needs of residents are met. EVIDENCE: The manager confirmed that since the completion of the Pre-Inspection Questionnaire (PIQ) in March 2006, there had been one admission to the home. The records of this resident were looked at and were found to contain the required assessment documentation, which had been undertaken prior to admission. This particular resident was already well known to the management and staff and was a frequent visitor to the home. The records of two other resident were looked at in detail and their files contained full assessment details. This information had been completed before they were admitted to the home to ensure that the home could meet their needs. A copy of the letter sent by the management confirming that the home could meet their assessed needs was also seen on each individual file. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 10 One relative stated in a questionnaire that they had visited the home unannounced in order to gain the information that they required so that they could make an informed choice about the home and the care that the resident would be provided with to meet their needs. The member of staff on duty was able to describe the circumstances, which led to the latest resident being admitted, and was fully aware of the individual resident’s needs. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9, &10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Promotion of health is taken seriously, however shortfalls in the reviewing of care plans could potentially put residents at risk. EVIDENCE: Since the previous inspection on 01/12/05, the manager has introduced new care planning documentation, which covers all aspects of the resident’s health; personal and social care needs to ensure that these are met. Examination of records showed that significant events had been recorded and daily entries made confirming the care given. The records of the residents were looked at and these clearly described their health care needs. The care plan of the most recent resident was in the process of being completed. During the visit observations were made of this particular resident Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 12 being attended to by the district nursing service who were treating a condition that had occurred prior to admission. Examination of the records showed that new care plans had not been reviewed. The manager confirmed that the priority had been to implement the new documentation for all residents and this had taken some time, but that he would ensure that all care plans were reviewed on a regular basis in line with the requirements. It was noted from information recorded on the Pre-Inspection Questionnaire from the home, that one resident had developed a bedsore. From examination of this resident’s care plan and the district nursing notes, confirmation was gained that the appropriate care and treatment and provision of a special mattress and bed had resulted in the bedsore healing completely. Observation were made during the visit of the caring approach of the management and staff towards the residents and the practices in the home ensured that residents were treated with respect and their right to privacy was upheld. One relative stated in the questionnaire they completed, that they had always been fully consulted and actively involved in the care of their relative and the support that they received was “well above what one would expect”. During the previous inspection it was noted that the medication procedures were not being followed correctly. From examination of the records and observations made during the visit, evidence was seen that the medication procedures were now being followed. All staff who administer medication have received appropriate training. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 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 the following standard(s): All the above standards were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents receive a healthy varied diet according to their assessed needs and preferences. The social, cultural, religious and recreational interest of the residents continue to be met within their capabilities. EVIDENCE: The documentation seen included information on the likes, dislikes and abilities of the individual residents, which in the main was acquired through discussions with their relatives. From observations and examination of care plans it was clear that the condition of the residents had deteriorated since the previous inspection. Their ability to exercise choice and control over their lives is dependent on their ability to understand and make their wishes known. The relatives are very involved in the lives of the residents and many visit on a daily basis, although on the day of the visit many of these were on holiday. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 14 The family of one resident confirmed that they were always made very welcome and kept informed of any changes that occurred to the health and well being of the resident. It was noted that residents were dressed in their own clothing, which was very individual and appropriate for their age and daily activities. Comments received through the questionnaires indicated that activities were usually arranged for the residents and one relative commented that they felt that this was a very difficult group to involve in any activities because of their needs. None of the residents were able or wish to attend outside clubs or churches, however local clergy make visits to the home. Observations of one resident’s documentation made it very clear that they did not wish to be involved in any religious activities and this was respected. Observations were made of the meals being provided and the assistance given to the residents during the mealtime. The residents have their main meal of the day in the evening as this was felt to be more beneficial for them. The care plan of one resident had identified the need to improve their dietary intake, this had resulted in an increase in their weight and improvement of their health. Only one resident was requiring a special diet at the time although other resident received additional supplementary build up foods as required. Relatives are encouraged to stay for meals and comments received confirmed that they were satisfied with the meals being provided. One relative stated that the meals were well balanced and always adequate. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 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 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 the service. The arrangements for handling complaints ensure that people feel confident that their complaints will be listened to and taken seriously. Procedures for dealing with and reporting abuse were in place to ensure that people are adequately protected. EVIDENCE: The home has a detailed complaints procedure, which is made available to all residents and their relatives on admission and a copy is displayed in the hallway. The visitors spoken to said that if they had any concerns they would discuss them with the homeowner or manager, but they were very satisfied with the care and attention that the residents received. From other comments received it was confirmed that one relative felt very comfortable discussing with the manager some queries that they had and which were resolved to their satisfaction. The home keeps record of any complaints and compliments made. Many compliments have been made but no complaints. A procedure was in place for dealing with allegations of abuse. The manager and member of staff spoken to had a good understanding of the procedures to be followed in the event of any abuse or suspicion of abuse or neglect. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 16 The manager confirmed that training for staff on abuse had been identified and arrangements were in process for this training to take place, which in some cases would be updating the knowledge that they had. The daily visits and involvement by relatives provides additional monitoring of the practices being carried out in the home. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The programme of redecoration and maintenance should continue to ensure that that residents live in a safe, and homely environment. EVIDENCE: Some improvements have been made since the previous inspection, which included redecoration to the lounge, dining room and hallway. A tour of the home showed that the communal rooms had been rearranged to provide a separate lounge and dining-room, which enables staff to have greater observation of the residents and assist those who need help with their meals. The residents’ bedrooms were very personalised, which is very helpful in making the resident feel secure with items around them that they are familiar with. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 18 One of the reasons that the most recent resident choose the home was that his wife was already a resident. Their bedrooms have been furnished to enable them to spend time together in their rooms if they so wish and the position of their bedrooms also allows them to have their own bathroom. Observations of residents’ bedrooms indicated that in some rooms the easy chairs were in need of varnishing or replacing as they were showing signs of deterioration. The manager produced a maintenance book in which any item requiring attention was recorded and dealt with. The manager confirmed that after the visit he would go into each room and take a very critical look at the furnishings, fittings and overall condition of each room to ensure that any improvements required could be identified and steps taken to improve the standards. The home was clean and free from any offensive odours or obvious hazards to the well being of the residents. This home was originally two properties and the home owner is intending in the future to revert the premises back, which would reduce the size of the home and the occupancy levels to seven residents. The relatives have been informed of the proposals and that the home would not be admitting any future residents. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All the above standards were looked at. Quality in this outcome area is adequately. This judgement has been made using available evidence including a visit to the service. Shortfalls in the recruitment of staff and number of staff available could potentially leave residents at risk. EVIDENCE: There have been two new staff members employed since the previous inspection and a further member of staff was in the process of being recruited for night duty. The files of the two members of staff were examined and it was noted that both had commenced working for the home before clearances had been received through the Criminal Records Bureau. In the case of one of these staff members there was evidence of clearance through the Protection of Vulnerable Adults procedure, which had been received prior to them starting. It was also noted that the management had accepted two references that had been provided by one member of staff. These were written ”To whom it may concern” and there was no evidence that these had been followed up . The manager was informed that this was not acceptable. From examination of the staff files evidence was gained that all staff receive appropriate induction training and formal supervision in line with the requirements. Evidence was seen of staff training, which had been arranged, Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 20 this included Health and Safety, Medication, Moving and Handling and Abuse training. For some staff these courses will be to refresh their knowledge, One member of staff had achieved level 3 NVQ qualification and arrangements are being made for two other staff members to commence NVQ training. Examination of the staff rota’s indicated that one member of staff was on holiday and another was off sick, therefore leaving only minimum cover on at any one time. Although an increase had been made to the number of staff employed, given the complex needs of the residents, this still requires the manager to be practically involved in the provision of care. The member of staff on duty confirmed that they felt supported and that enjoyed their work. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38 Quality in this outcome group is adequate. The judgement has been made using available evidence including a visit to the service. The home is run in the best interests of the residents EVIDENCE: The registered manager confirmed that he would complete NVQ level 4 in Care by September 2006 and that he was to undertake refresher courses, which included Health and Safety and administration of medication. Due to the staffing numbers in the home the manager is still spending time carrying out tasks that should be undertaken by care staff, which results in his time not being used effectively. All health and safety checks were being carried out in line with the requirements and equipment was being serviced regularly. It was noted that the electrical wiring certificate is due for renewal in October 2006 and the home owner confirmed that this would be checked before that date. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 22 Comments received and observations made confirmed that whatever shortfalls there were in the home, the needs of the residents came first. One relative said, “ There is a genuine kindness shown in the home, they are to be commended”. The management rely on the relatives for information and verbal feedback about the service provided. Questionnaires are available for relatives to complete but in the main the relatives and visitors are very involved in all aspects of the care provided. Visitors spoken to confirmed that they could not fault the care provided. Written evidence was found to confirm that staff were now receiving formal supervision on a regular basis. The manager confirmed that they were working towards the IIP Award and written confirmation of this was available. This shows a commitment to staff training and development. The residents’ financial records were looked at and it was noted that the home did not handle any monies on behalf of the residents. The relatives provide the support that the residents require in this matter. The management were reminded of the requirement to inform CSCI in writing of any notifiable incidents in line with Regulation 37. The policies and procedures are reviewed in line with changing legislation, however the home does not have a policy equality and diversity and therefore it was recommended that the manager incorporate into the policies how the home meets the issues relating to individual residents equality and diversity. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 23 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 x x 3 x x x 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 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 3 x 2 Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered provider must ensure that care plans are reviewed at least once per month. (Timescale of 01/02/06 not met) The registered provider must ensure that there are sufficient numbers of staff on duty to enable the manager to carry out his role effectively. All staff must have a satisfactory check from the Criminal Records Bureau and POVA check in place before commencing employment. (Timescale of 01/012/05 not met) Timescale for action 07/06/06 2. OP27 18 07/06/06 3. OP29 19 07/06/06 4 OP38 37 The registered person must 07/06/06 notify the Commission in writing of any accidents, injuries, illness, communicable disease or other event that adversely affect the well being and safety of the residents. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 25 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. 5. Refer to Standard OP19 OP27 OP28 OP31 OP33 Good Practice Recommendations A planned programme of maintenance and redecoration of the home should be produced. The registered provider should ensure that there are sufficient numbers of staff on duty at peak times of the day to enable the manager to undertake managerial tasks. A minimum of 50 of care staff should achieve NVQ level 2. The registered manager should complete the required level 4 NVQ. The registered provider should produce a policy on equality and diversity for residents. Caxton Lodge DS0000009874.V286124.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 DS0000009874.V286124.R01.S.doc Version 5.1 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. 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