Inspection on 19/03/07 for Clapham Lodge

This inspection was carried out on 19th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Clapham Lodge 08/11/07

Clapham Lodge 28/11/05

Clapham Lodge 23/06/05

Clapham Lodge 08/11/04

Clapham Lodge 20/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Clapham Lodge Woodland Close Clapham Village Worthing West Sussex BN13 3XR Lead Inspector Ms B Tye Unannounced Inspection 19th March 2007 10:00 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 Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clapham Lodge Address Woodland Close Clapham Village Worthing West Sussex BN13 3XR 01903 871326 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) Clapham Lodge Ltd Miss Christine Woods Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th November 2006 Brief Description of the Service: Clapham Lodge is a care home registered to accommodate up to 26 residents in the category of OP (Older Persons). Clapham Lodge is a large detached property, located in a rural setting, in Clapham Village. Accommodation is provided in single bedrooms located on the ground and first floors. Some of the accommodation consists of a bedroom, a sitting room/kitchenette and a bathroom. The communal areas, including a dining room and a lounge area are located on the ground floor. A vertical lift provides access to all floors. An extensive garden which includes lawns and flower borders is available to residents. The service is privately owned by Clapham Lodge Ltd, and the registered Managers post is currently vacant. The responsible person acting on behalf of the company is Ms Genevieve Reed. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the inspection all relevant information and correspondence relating to the home was examined. This included staff rotas, training records and a pre inspection questionnaire detailing all changes to the service since the last inspection. The inspection was unannounced and started at 10am. It took place over five hours. The inspector spoke separately to six residents and interviewed two staff who were on duty. The manager showed the inspector around the care home and was on hand throughout the inspection to answer any questions. A tour of the premises was undertaken. The inspector observed lunch being served and staff interaction with residents. Three care plans and the homes records were examined including, menus, rotas, staff checks, fire records, incident and accident reports and information relating to health and safety. This is the first inspection of 2006/2007. This is called a key inspection and will determine the frequency of visits/inspections hereafter. What the service does well: The home has a competent staff team who understand the needs of the people living there. The residents who were spoken to said they liked living in the home and that staff are very caring and considerate. Staff were observed interacting with residents in a respectful way. Several of the residents were happy to discuss the care provided at the home and all gave positive feedback. Residents are encouraged to persue activities of interest within the home. Medication records are in very good order with no gaps or errors, demonstrating staff do adhere to the homes policies and procedures. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Several requirements were made following the inspection; The staff supervision is not up to date and staff have not received an annual appraisals. Some of the homes records were not available to the inspector as these were kept in the owners office. The home needs to ensure that all records for the home are accessible to the inspector in future. Residents are provided with in-house activities but there are no organised activities outside the home for individuals or groups. One resident stated she ‘would like to get out more’. The home needs to ensure the residents are supported to pursue activities and interests in the local community. The majority of requirements related to health and safety issues of the premises. The proprietor and manager must ensure that the home is safe and the welfare of staff and residents is considered paramount at all times. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 7 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. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 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 Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. There is sufficient information available for prospective residents and their families to make a decision on whether they would like to live in the home. There is an assessment process in place to ensure that the home can meet individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager visits prospective residents in their present accommodation and carries out an in-depth assessment in order to ensure that individual needs can be met by the home. Residents confirmed that they and their families were able to make visits to the home prior to moving in. There is a Statement of Purpose and Service User Guide in place to inform prospective residents of the facilities available. The service user guide has been recently updated to include recent staff changes. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 10 Clapham Lodge does not provide intermediate care. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The health and social care needs of each person living in the home is well documented on their individual care files. Medication in the home is recorded and dispensed appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents care plans were case tracked. They had been recently updated and contained information regarding the health and social care needs of each person living in the home. Each included risk assessments for moving and handling, nutrition and pressure areas. There was evidence the plans had been reviewed on a regular basis and each was signed by the involved individuals, demonstrated the residents input into the care they received at the home. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 12 Staff handovers at each shift change during the day ensure each staff member is fully aware of the immediate needs of the residents. Daily records are kept on files and monitored by the manager. There was evidence on individual files of regular visits to the home from health professionals, including district nurses, regular visits from the GP, chiropodists and social workers. Staff escort residents to community health appointments as required. Residents in the home confirmed that they were treated in a respectful manner and all stated they received care in the way they preferred. One resident stated ‘ they are just wonderful here, they really look after us’. Medicine storage and records were examined. These have been well maintained and kept up to date with no gaps or errors. Medicines have been stored appropriately and records demonstrated they are administered safely to residents. Staff training and procedures for medication are in place to support staff practice. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents are able to exercise choice and control over their lives whilst living at the home. There are in house activities in place but outings to the local community are limited. Visitors to the home are made welcome. The menu at the home provides a variety of balanced food and specialist diets are catered for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents attend regular meetings as a group. This gives them the opportunity to voice any concerns and contribute to the decision making and running of the home. Activities are organised at the home on a regular basis, offering stimulation to those residents who are less able to explore interests outside the home. Residents spoken to praised the in house activities. One stated ‘ there is always plenty to do’. Due to limited transport the residents do not participate in organised activities outside the home. One resident said ‘ it would be nice to go out a bit more and Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 14 do things’. The residents who wish to go out are encouraged to do so with visitors. Others are escorted for walks in the grounds of the home. A requirement was made that the manager ensures the residents are given the opportunity to go out to community events and pursue activities outside the home. Residents’ visitors are welcomed to the home and feedback from residents confirmed that contact with family and friends are encouraged. An external company (who deliver frozen pre-packed meals on a twice weekly basis) provides main meals for Clapham Lodge. Food is then heated and served on the day. Breakfast and snacks are provided in house. Menus were examined and residents were asked their opinion of the meals provided. All residents spoken to stated they enjoyed the food and it was of a high standard. Alternatives are available and specialist diets catered for. The observed mealtime was very relaxed. Staff were observed chatting with the residents and the interaction between them was relaxed and respectful. The inspector noted during a tour of the kitchens that the home was using old and damaged plastic cups and bowls. A requirement was made for these to be replaced, as the deep scratches in the plastic posed a risk of infection spreading. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The home has provided residents with information in respect of complaints. Residents spoken to were aware of their rights and how to complain. Staff receive abuse training, and those spoken to were clear about appropriate action if they suspected abuse within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents spoken said that if they needed to make a complaint they would take it up with the manager. Although no residents spoken to have found it necessary to make a complaint, they told the inspector that they felt confident to speak to the manager or staff about any concern. The Complaints log was not available during the visit, as it was kept in the owners office which was locked. The manager stated there had been no complaints received since the last inspection. The manager provides Protection from Adult Abuse training to staff, on an annual basis. This ensures staff are aware of appropriate action should a suspected incident of abuse arise in the home. This training is supported by policies and procedures within the home. Recruitment records were not available during the visit as again, these were kept in the owners office. Records of CRB checks for staff were forwarded to the inspector following the visit. This demonstrated a previous requirement Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 16 has now been met to ensure staff had up to date CRB checks. This ensures the residents are protected by appropriate checks on staff prior to employment. A requirement was made to ensure all records be made available to the inspector during visits to the home. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Standards of hygiene and cleanliness are good throughout the home. Due the number of requirements made relating to the environment the inspector could not conclude that the residents live in a safe and wellmaintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was found to be clean and tidy throughout. Residents bedrooms were furnished with personal possessions and communal spaces were clean and comfortable. Following a tour of the home, several areas were found to pose a risk to the welfare and safety of the staff and residents. Some areas of the home were found to be extremely cold. Including the small residents lounge and the staff office. (The window had been broken and was boarded with card.) A Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 18 requirement has been made for temperatures throughout the house to be consistent and adequate heating provided. A downstairs toilet had no door due to rotten hinges, although tape had been put up, the toilet was positioned to the side of an access ramp and residents with limited mobility could easily fall into the doorway. A requirement has been made to make the doorway safe. Electric fires were in use in some of the rooms but no risk assessments had been undertaken. A requirement has been made to undertake this. A down stairs toilet had broken boxing around the pipes. Hazard tape had been placed over the top. A requirement was made to make the repairs needed in order to make the boxing safe. Doorstops are being used throughout the home in fire doors. Although the residents had signed disclaimers for their bedrooms the manager had not sought advice from the fire officer or completed risk assessments. A requirement was made for this to be undertaken. A convector heater was being used in a residents bedroom, the heater was extremely hot to touch and posed a risk to the resident. A requirement was made to ensure the heating proved was safe and temperatures regulated. A steep step in the downstairs hallway poses a risk to residents. Although a strip of hazard tape had been placed across this. The inspector felt more obvious health and safety signs should be displayed to prevent trips and falls. A light switch in the hallway was covered with electrical tape on one side. The manager stated ‘it had always been like that’. A requirement was made for the light switch to be repaired. Carpeting in the downstairs annex area was raised and attempts had been made for it to be stuck down with hazard tape. A requirement was made for the carpet to be re-tacked to prevent trip hazards. The fire alarm testing sheet (since 16 January 2007) and maintenance checks for equipment were not available to the inspector. Completed and up to date records were posted to the inspector following the visit to the home. The inspector informed the manager that the home must continue to ensure the residents and staff were safe from risks and their welfare protected at all times. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 19 Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Staff have been provided, whose numbers and skills mix are appropriate to the current needs of residents accommodated. Staff has been provided with training to ensure they are competent to provide for residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rotas for the home that showed that there are two members of care staff on duty throughout the day. There are also two awake members of staff during the night. In addition there is a member of the domestic staff to keep the care home clean, and also a member of the catering staff to prepare meals for residents. Two staff were spoken to during the visit. Both confirmed they had received inductions and training for their roles and were clear about their responsibilities. They confirmed the manager was very supportive and approachable. One stated ‘ it’s a pleasure to work here. All the residents and staff are great’. Three new members of staff has been recruited since the last inspection. Staff personnel records were in the owners locked office and although the manger had access she ‘did not know where they were’. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 21 The inspector recieved copies of the required CRB checks from the proprietor shortly following the visit. These confirmed staff had current checks in place, therefore meeting the requirement from the last inspection. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Residents and staff benefit from the leadership and management approach within the home. Due to the number of requirements made during the inspection, the residents’ safety and welfare cannot currently be considered a priority within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff feedback reflected that the manager provides a clear sense of leadership and direction. Staff spoken to stated she was ‘supportive and approachable’ enabling them to seek guidance as it was needed to ensure residents needs were met appropriately. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 23 Staff records showed that staff supervision and annual appraisals had not been completed for some time. A requirement was made to ensure this was undertaken. Accident records and risk assessments were up to date. However maintenance checks and fire records were not available. These were forwarded to the inspector following the visit to the home. The environmental risks identified during the inspection reflect that the health and welfare needs of the residents and staff are not being appropriately met by the home. Several requirements have been made to ensure these issues are addressed at the earliest opportunity. Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 1 X X X X X 1 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 1 X 1 Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. Standard OP38 OP36 OP37 OP38 Regulation 16 (2g) 36 17 (3b) 13 (4) Requirement To replace old plastic cups and bowls in order to reduce the spread of infection To ensure staff are supervised no less than 6x annually and receive annual appraisals To ensure the homes records are available for inspection at all times The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible are eliminated. Temperatures throughout the house to be consistent and adequate heating provided. Timescale for action 30/04/07 31/05/07 31/05/07 31/05/07 5. OP38 13(4) 6. OP38 13 (4) The registered person shall 31/05/07 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible are eliminated The broken toilet door positioned to the side of an access ramp to be made safe. The registered person shall 31/05/07 ensure that unnecessary risks to the health or safety of service DS0000014456.V331336.R02.S.doc Version 5.2 Page 26 Clapham Lodge 7. OP38 13 (4) 8. OP38 13 (4) 9. OP38 13 (4) 10. OP38 13 (4) 11. OP38 13 (4) 12. OP38 13 (4) users are identified and so far as possible are eliminated Electric fires in use in residents bedrooms should be risk assessed. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible are eliminated. Make the repairs needed to broken pipe boxing in toilet. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible are eliminated. To seek advice from the fire officer and complete risk assessments for use of doorstops in fire doors throughout the home. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible are eliminated. Health and safety signs should be displayed for the steep step in the downstairs hall, to prevent trips and falls. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible are eliminated. A broken light switch to be repaired to avoid electric shocks. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible are eliminated. The carpet in the downstairs corridor to be re-tacked in order to prevent trip hazards. The registered person shall ensure that unnecessary risks to DS0000014456.V331336.R02.S.doc 31/05/07 31/05/07 31/05/07 31/05/07 31/05/07 31/05/07 Page 27 Clapham Lodge Version 5.2 13 OP12 16 (2n) the health or safety of service users are identified and so far as possible are eliminated. A convector heater in a residents bedroom was extremely hot to touch and posed a risk. To ensure the heating proved is safe and temperatures regulated. To arrange a programme of activities with regard to the needs of the service user. To include leisure and recreational activities in and outside the home. 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Clapham Lodge DS0000014456.V331336.R02.S.doc Version 5.2 Page 29 - 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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