Inspection on 09/10/07 for Christmas Lodge

This inspection was carried out on 9th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Christmas Lodge 25/10/06

Christmas Lodge 15/03/06

Christmas Lodge 20/07/05

Christmas Lodge 02/03/05

Christmas Lodge 19/10/04

Christmas Lodge 18/02/04

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 Christmas Lodge 196 Mount Vale York YO24 1DL Lead Inspector David White Unannounced Inspection 9th October 2007 09:00 Christmas Lodge DS0000015802.V348988.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 Christmas Lodge DS0000015802.V348988.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. Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Christmas Lodge Address 196 Mount Vale York YO24 1DL 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) 01904 647442 01904 675581 Mr Dale Andrew Graver Mrs Penelope Anne Graver, Mrs Lynne Dexter Mrs Carol Georgina Irvine Care Home 15 Category(ies) of Learning disability (15), Learning disability over registration, with number 65 years of age (15), Mental disorder, excluding of places learning disability or dementia (15), Mental Disorder, excluding learning disability or dementia - over 65 years of age (15) Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration is for 15 persons with a mental health disorder and/or a learning disability some of whom may be over 65. 25 October 2006 Date of last inspection Brief Description of the Service: Christmas Lodge is a care home providing personal care and accommodation for up to 15 people with mental health needs and/or learning disabilities. The home is located close to the centre of York and is within walking distance of the city the amenities and leisure facilities. The accommodation provided is both single and double bedrooms, self-contained units and a variety of spacious communal rooms. Christmas Lodge is privately owned by Mr and Mrs Graver and Mrs Dexter and was registered in 1998. There is a small garden at the front and a pleasant courtyard with parking at the back of the house. The full cost of a weeks stay at Christmas Lodge is £450 upwards. The service has a statement of purpose that explains the aims, objectives and philosophies of the home and this is available in alternative formats. The most recent inspection report is made available to anyone who wishes to see it. Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection has used information from different sources to provide evidence for this report. These sources include: • • • Reviewing information that has been received about the service since the last inspection. Information provided by the manager on an Annual Quality Assurance Assessment questionnaire. Comment cards returned from five people who live at the home, a relative and three health and social care professionals who have contact with the service. We went to Christmas Lodge without telling them that we were going to visit. This report follows the visit that took place on the 9th October 2007. The visit lasted for 5 hours with 4 hours preparation time. Time was spent talking to three people who live at the home, two members of the care staff, the manager and looking at some documents. This helped in gaining an insight into what life is like for people living in the home. The manager was available for most of the visit and the findings were discussed with her at the end of the inspection. What the service does well: Christmas Lodge provides a homely environment with a pleasant atmosphere for the people who are living there. This helps people to feel comfortable and safe. People living at the home are encouraged as much as possible to make their own choices and decisions. This gives them control about how they live their lives. People enjoy a range of activities that enables them to develop their own skills and pursue their hobbies and leisure interests. The home responds quickly if there are signs that someone is becoming unwell. This helps in making sure that people get the care and treatment they need as soon as possible. A healthcare professional commented that, “the home works well with other teams”. People who live at the home, relatives and staff all have full confidence that any concerns would be properly dealt with by the manager. This helps in making sure that people feel safe. Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 6 People who live at the home speak well of the staff team who work there describing them as “very nice and kind” and feel “we are treated well by all the staff”. The manager and the staff act in the best interests of people living in the home. A healthcare professional made comments that the staff team “protect the rights of the people at the home”. 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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Christmas Lodge DS0000015802.V348988.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 Christmas Lodge DS0000015802.V348988.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Good pre-admission procedures are in place so that people who are thinking about moving into the home can feel confident that their needs will be met. EVIDENCE: A range of information is offered to people who are thinking about moving into the home. This helps them with their decision-making about whether the home can meet their needs prior to them moving there. Pre-admission assessments are completed for all new admissions to the home. This involves the manager meeting with people who are being considered for a placement at the home and their relatives where appropriate, so that the needs of the person can be assessed. Information about the person’s care needs is also collected from all other available sources such as the placing authority. This helps to support the home in their decision making about whether they have the skills and resources to meet the person’s needs. People are invited for visits before moving in and are given copies of all assessments and care plans. A review of people’s placements takes place six weeks after their admission to discuss the person’s progress. Christmas Lodge DS0000015802.V348988.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People are encouraged to make their own choices and decisions about how they live their daily lives. EVIDENCE: Each person has a person centred plan that details how they wish to be supported in meeting their needs. This takes into account people’s personal choices about their preferred daily routines and their likes and dislikes. The care plan is written in plain language and staff said they are “easy to follow and understand”. The home has introduced an “At a glance” section for the care plan giving brief overviews of each person to new staff so that they have an understanding of each person’s needs and the type of support they require. Each person has a key worker so that staff can spend individual time with people and the people who are living at the home said that they regularly meet up with their key worker to discuss their care. Care plan reviews also take place with the person using the service, their relatives and others who are Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 10 involved in their care. These meetings focus on the strengths of each individual and looks at ways of developing peoples’ skills so that their aims and objectives can be achieved. People who live at the home are encouraged to be independent and make their own choices and this could be observed at the time of the site visit. Risk assessments are in place to help people to maintain their independence in a safe way. The assessments include information about why decisions have been made where people could be restricted in what they can do. The manager said that reviews of risk assessments are ongoing although there is no written evidence in the care records to show when the reviews are taking place and the outcomes from these. One person living at the home has an external advocate who provide support in helping the person to make their own decisions about various aspects of their life. Daily records are detailed and informative and reflect the cares that are being given. Information about the people living at the home is passed on between shifts so that staff are informed about any changes to care. Christmas Lodge DS0000015802.V348988.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who live at the home enjoy a range of activities to suit their personal needs and have involvement with the local community. EVIDENCE: The home is good at encouraging people to maintain their independence and develop their skills. One person is doing a distant learning course, others attend college and another person has a work placement. Some people attend local day services. One person living at the home grows carrots in the home’s garden and has recently won a prize for their achievements in a local day service competition. One person likes to go to church and community services are used to provide transport to support the person to be able to do this whilst others like to visit the local pubs. Some people enjoy watching television and can now do so in two separate lounges. Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 12 The home has a “residents committee” who have input into the planning and running of activities and mealtimes. People have the opportunity to go on outings and have a holiday although some prefer not to take up these options. One person said they had enjoyed trips out to places such as Scarborough and another talked about their holiday in Great Yarmouth. The records from the house meetings that are regularly held between people living at the home and staff show that holidays are already being planned for Skegness and Spain for next year. The staffing rotas are in the process of being changed so that there will be more staff on duty at a weekend and this will enable more outings to take place at this time. The home does have their own transport although this is not currently in use; however, some of the staff are insured to use their own cars so that they can take people out. Visiting arrangements are flexible in the home. Some people prefer to go and visit their families and friends. On the day of the site visit one person living at the home was getting married later that day and arrangements had been made for those people wishing to attend the wedding and reception to be able to do so. People living at the home said that the meals are “very nice”. People have a choice at mealtimes and this was observed at the time of the site visit when the mealtime could be seen to be relaxed and unhurried. People said “There is always enough choice of food” and the menus are varied to cater for people who do not eat meat and for those people who prefer to have healthy eating options. Most people are able to eat their meals independently and special cutlery had been bought to let one person eat their meals without staff assistance. There is a water machine in the dining room so that people can help themselves to a drink of water at any time and other snacks are available between mealtimes. Christmas Lodge DS0000015802.V348988.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People’s personal and healthcare needs are well met in a very caring and respectful way. EVIDENCE: Each person’s personal plan describes how support is to be given in the way the person prefers. People living in the home said that staff are “very kind and respectful” and this could be seen at the time of the site visit. Comment cards returned by people using the service all said that they are “treated very well indeed” and on the day of the site visit people were very complimentary about the staff team and the support they receive. Health and social care professionals made comments that “staff are supportive to people living at the home without creating dependence”. All of the people who live at the home have a General Practitioner (GP), dentist, and optician and have access to other healthcare services. One person said that they had been having problems with their glasses and recently saw an optician about this. Referrals are made to other specialist services where Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 14 necessary. Comment cards received from health and social care professionals who have involvement with the home said that “staff work well with specialist teams and advocate on behalf of the people at the home to protect their rights”. The care records show that staff are responsive to changes in people’s healthcare needs and act quickly to address any changing needs. Healthcare information and records of appointments and outcomes from these are well documented in each person’s individual diaries so that staff are clear about any changes to care. All but one person has their medication administered by staff. A risk assessment has been carried out on the person who administers their own medication to show that this person is able to do this safely. The medication records are up to date and accurate and medication is stored safely. All staff who administer medication have received the appropriate training. Christmas Lodge DS0000015802.V348988.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Systems are in place for dealing with concerns or complaints and to safeguard people who are living at the home from any harm. EVIDENCE: The home has a complaints procedure that provides information about how to make a complaint and what will happen afterwards. People living at the home said that they receive “Very good care” and have “full confidence” that any issues of concern would be properly addressed by the manager. A comment card returned by a relative said “the home always listens to any concerns and acts appropriately”. Since the previous inspection visit neither the home or the Commission for Social Care Inspection have received any complaints about the service. There is an adult protection policy and procedure in place to provide guidance to staff on what actions they need to take to safeguard people from abuse. All staff have recently had some refresher adult protection training and staff on duty at the time of the site visit knew what they would need to do in response to any suspected or actual incident of abuse. People who are living at the home said that in general they “get on, although there are times when personalities clash”. However, despite this people did say that they always felt safe. Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home provides a clean, comfortable and safe environment for people living there. EVIDENCE: The home has a welcoming and friendly atmosphere. Accommodation is over three floors that can only be accessed by stairs, however, there is ramped access to and from the home so that people with mobility problems are able to enter the home. The accommodation includes two self-contained flats that have en-suite facilities. Bedrooms are personalised to suit individual tastes and toilets, bathrooms and shower areas are accessible for people at the home. Aids and adaptations are in place to support people with their independence and mobility and this includes a bath and wet room shower area for this purpose. Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 17 Since the last inspection visit some improvements have been made to the environment. The dining room has been extended to improve the amount of space at mealtimes and to create additional lounge space. Following the introduction of recent smoking legislation a summerhouse has been built in the grounds of the home to accommodate people who choose to smoke. A number of windows have also been replaced to improve the comfort and safety for people. The lounge is about to be fitted with a new carpet and is also to be redecorated. The home was clean and tidy at the time of the site visit. Procedures are followed to reduce any risks of infection and staff receive training updates so that they are aware of up to date in infection control legislation and procedures. Christmas Lodge DS0000015802.V348988.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Sufficient staffing levels and a well-trained staff team help to make sure that people receive the care they need. EVIDENCE: Staffing levels are sufficient to meeting the needs of the people living at the home. People using the service said, “There are always enough staff about” and the recent recruitment of two more members of staff will add to this. Staffing turnover is low and this enables people living at the home to receive consistent care from a staff team who have a good understanding of their needs. One person said, “we could not wish for a better group of staff”, another made comments that staff are “very nice”. The staff files of the most recently recruited members of staff show that proper recruitment procedures are followed with all the necessary checks in place prior to new staff starting in post so safeguarding people from potential harm. Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 19 All staff have formal induction when they start working at the home so that they are clear about their roles and responsibilities and about the aims and objectives for the service. Staff said that they receive a range of training to support them in doing their jobs and the training records are able to support this. Some specialist training has been provided to give staff a better understanding of the needs of people with mental health problems. Most of the staff team have now completed the National Vocational Qualification (NVQ) programme and this has helped in developing a more knowledgeable and skilled workforce. Staff meetings are regularly held and staff said that they are encouraged to voice their views and opinions about the home. They also receive regular supervision so that they are supported in their job roles and any staffing issues can be addressed. Christmas Lodge DS0000015802.V348988.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is managed well and proper attention is given to maintaining peoples’ health and safety. Whilst the home acts in the best interests of people living there, some improvements could be made so that the views of relatives and others with an interest in the home can be taken into account. EVIDENCE: The registered manager is well experienced in running the home and has completed management qualifications to develop her management skills. The manager is committed to maintaining good standards of care in order to improve the quality of life for people living in the home. She has an “open door” approach to management so that she is always accessible to people to offer and provide support. Both staff and people living at the home expressed Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 21 full confidence in the manager’s abilities. A member of staff said “you could not wish for a better manager” and one person living at the home described her as “firm but fair minded and on the ball”. There are some systems in place to seek the views of people using the service about the running of the home. A resident’s committee meet to discuss aspects of the home and their views are passed on to the manager who acts on the information received where appropriate. House meetings are also held between staff and people living there and records are kept about what has been discussed and agreed. In the past a questionnaire has been sent to each person living at the home to seek information from them about the home and it is planned that this will be repeated in the near future. However, at the present time there are no systems in place to obtain the views of relatives or others who are involved in the home. This should be done so that the home know what they are doing well and are alerted to any areas where they need to improve. The health and safety practices help to maintain a safe environment. Fire safety is well maintained through fire safety checks and regular staff training. The home has carried out a fire risk assessment of the premises in consultation with an independent health and safety company and this is being further developed. Other health and safety systems and records are well maintained and staff receive a range of health and safety training. Christmas Lodge DS0000015802.V348988.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 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 X 2 X X 3 X Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA9 Good Practice Recommendations Risk assessments should be reviewed on a more regular basis so that any changing needs can be identified and acted on. Better arrangements should be put in place to seek the views and opinions of relatives and other people who have contact with the home. This will enable more people to have a say in what the home is doing well and in identifying any areas for improvement. 2 YA39 Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Christmas Lodge DS0000015802.V348988.R01.S.doc Version 5.2 Page 25 - 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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