Inspection on 01/06/07 for Courtlands Lodge

This inspection was carried out on 1st June 2007.

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

Courtlands Lodge 05/05/06

Courtlands Lodge 12/09/05

Courtlands Lodge 02/06/05

Courtlands Lodge 13/01/05

Courtlands Lodge 12/07/04

Courtlands Lodge 19/02/04

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

CARE HOME ADULTS 18-65 Courtlands Lodge 25 Langley Road North Hykeham Lincoln Lincs LN6 9RX Lead Inspector Vanessa Gent Key Unannounced Inspection 1st June 2007 09:30 Courtlands Lodge DS0000002618.V336480.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 Courtlands Lodge DS0000002618.V336480.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. Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Courtlands Lodge Address 25 Langley Road North Hykeham Lincoln Lincs LN6 9RX 01522 693800 01522 687628 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) Life Care (UK) Ltd Ms Melanie Ludkin Care Home 29 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (24), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (5) Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users in the home with Nursing needs does not exceed 24 (MD) and the maximum number of service users with Personal Care needs only, does not exceed 5 (of which 2 are under the category of MD and 3 are under the category of MD(E)). 5th May 2006 Date of last inspection Brief Description of the Service: Courtland’s Lodge is a privately run care home providing nursing and personal care for up to twenty-nine adults of both sexes with a mental disorder, including five residents over 65 years of age. It is situated in North Hykeham, approximately three miles from the centre of Lincoln. The home is located in a cul-de-sac, close to a main road and bus route into Lincoln. North Hykeham has a range of community facilities including a variety of shops, post office, swimming pool, public houses and food outlets. The home is a single storey building consisting of eleven single and nine double rooms. Communally, there are two lounges/day rooms, one large dining room, seven toilets, two bathrooms and two shower rooms. The spacious garden is well maintained to provide a secure, tranquil outdoor area for residents to use. There are ten car parking spaces at the front of the home. The philosophy of care states that its aim is to provide residents with a secure, relaxed and homely environment in which their care, well being, comfort and development are of prime importance. The provider keeps a printed copy of the latest statement of purpose, service user guide and inspection report at the home available for people using or enquiring about the service. The fees range from £361 for low to £395 for high dependency and residents with nursing needs. Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit was made to the home as part of a key inspection. It started at 14.00 and lasted 5 hours. Information already held on file was used to plan the visit. The main method of inspection used is called ‘case-tracking’, which involves selecting a proportion of residents, and tracking the care they receive through the checking of records, discussion with them, the care staff and observation of care practices. The site visit focused on how the residents feel about the service provided. Four residents’ assessments and care plans were examined to ensure the health, safety and welfare of the residents is checked and that residents are allowed dignity, autonomy and choice. A partial tour of the home was made and a sample of other records examined. Ten survey forms were received from residents. Six residents filled in their own surveys; four had help from staff. All are positive about the level and quality of care given; most said they can choose and do what they want at most times of the day. All know who to speak with if they are not happy with any aspect of the home. All said the home is always clean, fresh and tidy at all times. Six residents feel that staff always listen to them and take notice of them and four feel this is usually the case. One resident comments, “They are really caring and concerned about our wellbeing. I for one cannot fault it.” Five staff on duty and nine of the twenty-six residents, including those being case-tracked, spoke with the inspector. The inspector was introduced to and chatted briefly with most of the other residents, and joined them at the birthday tea put on for one of the residents. The manager was available throughout this inspection visit. For residents with communication difficulties, staff used a variety of methods to help the inspector understand the residents during the visit. Staff demonstrate a thorough knowledge of residents’ communication methods. What the service does well: The home is run by a competent, confident manager and supported by a good staff team who are well-trained and give care and support to the residents. Residents confirm the home is comfortable, clean, homely and well-run and that there is a happy atmosphere. Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 6 The Manager uses several different methods of finding out the residents’ and staffs’ wishes and preferences to ensure that residents and staff are fully involved and to put improvements in place. These include annual questionnaires, group discussions, residents’ meetings, staff training and meetings and supervision support. The provider is supportive of the manager and staff and encourages plenty of training to ensure that the care given to residents is safe at all times. 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. Courtlands Lodge DS0000002618.V336480.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 Courtlands Lodge DS0000002618.V336480.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): 1, 2, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home acquires a good knowledge of the resident and residents can have a good amount of information about the home before coming to live there. They are assured that the home can meet their needs and that they can be comfortable living at the home when they move in. EVIDENCE: The statement of purpose and the service users guide are comprehensive and inform prospective residents of what to expect, if and when they come to live at the home. A copy is available for all prospective residents to make sure they know what is available at the home. New residents are assessed fully both before and on admission to the home. This is confirmed in the care plans examined. Most residents say they had some choice about coming to live at the home. One resident commented in the surveys returned, “My care workers arranged it for me”. A letter accompanies the assessment that assures the resident that the home can meet their needs. Courtlands Lodge DS0000002618.V336480.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, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans clearly define the needs of the resident as a whole person. Care plans involve the residents and provide staff with enough detail for them to care safely and appropriately for them. Residents contribute to the running of the home, make decisions, mostly live the lifestyle they wish and take risks in their lives to suit their needs and wishes within their personal limitations. EVIDENCE: From comprehensive pre-admission assessments, the staff create the care plans with involvement of residents wherever possible. Evidence of this is in the care plans, with either the resident or their representative signing in them. Some residents confirmed their involvement and say they can look at them at any time. Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 10 Each resident has a key worker with whom the care plans are completed and developed. The care plans are comprehensive documents that are easy to read and clear to understand. They are kept in an orderly state, with risk assessments, care plan issues, health needs assessments and other documents evident. The care plans are reviewed every two months or more often as necessary. A social history or ‘pen picture’ of each resident would enhance the care plans further. When asked in the survey if they make their own decisions about what they do each day, eight out of ten residents responded that they only sometimes can. The remaining two replied that they always have choice. The survey also asked if they can do what they want at various parts of the day. The majority confirmed they can indeed do what they want most of the time, including evenings and weekends. The one person who replied no says, “I would like 1-1 to go out more.” Another resident says, “I just try to relax and take each day as it comes.” At the visit to the home, residents said they go where they want; a few go to Day Centres and some go out on their own. Staff say they take residents out to shops and the pub, for instance. In order to involve residents and staff more fully in the running of the home, the manager offers questionnaires, resident discussion groups and staff meetings regularly. Some residents are keen to take part in all aspects of the home. The care plans show that risk-taking is carefully and fully assessed. Residents confirm they can take risks and that staff support and help them lead as normal lives as possible. Courtlands Lodge DS0000002618.V336480.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, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients are ably supported in their activities and lifestyles by caring staff who respect the residents’ wishes. EVIDENCE: Activities are mostly limited by what the resident wants to do. A few go to day centres but most prefer to stay at the home or be reasonably independent. Activities for groups and individuals are provided in the home. The results of the arts and crafts are visible around the home. Some enjoy music and karaoke. Some state they help tend the garden. One resident enjoys being a drummer in a music group. One says they go to the local sports centre. Staff say that they take residents out but agree they are sometimes restricted by the number of staff on duty as to what they can do and where they can Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 12 take them. One resident comments in the survey, “I would like 1-1 to go out more.” Some residents say they like to help keep their own rooms clean and tidy. Residents have keys to their own rooms and can come and go as they wish. They say staff respect their rights at all times and they can and do have their say. This is confirmed in the residents’ comments such as, “my decision each day is ‘To keep myself clean and tidy and to eat well’.” Residents say the food is reasonably good and plenty of it. They have choices every day and can opt for something different if they want. As seen in the care plans, staff liaise with the dietician if a resident is in need of specialist advice for their nutritional needs or becomes frail and poorly. Courtlands Lodge DS0000002618.V336480.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, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and healthcare practices adequately inform staff of how to meet the health, psychological and social needs of the residents and support them at all times. EVIDENCE: Residents say they are happy with the support they receive from staff and the manager. When asked if the staff treat them well, eight out of ten replied in the survey that they always do. Two say they usually do. An added comment says, “They are really caring and concerned about our wellbeing. I for one cannot fault it.” The care plans seen inform staff of how to apply care and meet the health, psychological and social needs of the residents at all times. Staff work in teams with a nurse as lead, each resident having a key worker. Together they care for the resident as a whole person. Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 14 Liaison with healthcare professionals is recorded in the care plans. The preinspection questionnaire, returned by the manager, lists the healthcare professionals and others, in the community and at hospital, involved with the residents at any time. Residents say they are taken to the doctor’s or the GP is called to them if they are unwell and a staff member accompanies them if they have to go to the hospital. The inspector observed a medicine round and inspected the medication practices in place. They are adequate to protect residents. Training has been given to update the nurses’ medication skills and practices. The manager is looking at the care staff being trained in the basic safe administration of medicines, so they are aware of the effects and possible side effects of the drugs taken and how to manage the residents in an emergency situation. Courtlands Lodge DS0000002618.V336480.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, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and investigated in an appropriate manner. Residents feel safe and comfortable in the home. EVIDENCE: The staff and manager say all complaints are taken very seriously. Two complaints have been received and investigated since the last inspection. Measures have been put in place to ensure that the care for residents is continuing to improve and is caring and safe. All ten residents, in the survey, say they know who to go to if they are not happy and they know how to make a complaint. A resident says, “but I don’t complain much …”. Residents say, “There’s nothing to complain about here; it’s OK.” “If things are not right they put it right or try their best.” Residents say they feel safe at the home and the “staff are lovely” “very friendly”. In the resident survey, comments include, “I am reasonably happy here …” One staff was suspended following incidents of medication errors; measures such as extra training and supervision were put in place to ensure further errors were avoided. A staff dismissed after a report of an allegation of abuse. Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 16 Staff told the inspector that they would “definitely always” report any incident of adult abuse and are aware of the policies the home has in place to protect the residents and them. All staff are up-to-date with training for safeguarding adults. The manager says there is ‘zero tolerance’ for any bullying or abuse within the home. Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, clean, attractive environment to ensure the residents are well cared for and feel ‘at home’. EVIDENCE: Residents says the home is clean, tidy, fresh and comfortable. They like their own rooms, the communal areas and the garden. The lounges and dining room are spacious, light and airy. The garden provides a secure, tranquil outdoor area for residents to sit in. One hundred percent of residents in their survey ticked that the home is always fresh and clean. A resident comments , “It is very clean & like the cleanliness you would expect to find in a hospital.” The home has an ongoing programme of re-decoration and re-furbishment. The manager sets out in the pre-inspection questionnaire the work done and Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 18 the furniture replaced so far and what is in line to be done in the coming year, both inside and outside the home. The Environmental Health Officer has visited recently and given the home a ‘clean bill of health’ in the areas of the kitchen, laundry and other areas covering hygiene and cleanliness. The Fire Safety Officer has also visited the home since the last inspection. The home is up-to-date with fire awareness training and measures to keep the residents safe at all times. Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 19 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, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are safely recruited & knowledgeable in their care of the residents. Staff are caring to residents, are concerned about them and treat them well. EVIDENCE: The home employs a manager, deputy manager, six trained nurses, fifteen care staff and six ancillary staff. Staff say they work as a close team, some having worked there for many years. The duty rotas provided by the manager prior to the inspection shows that, for the dependency levels and numbers of residents, there are enough staff on duty at any time. The manager states, in the pre-inspection questionnaire, that many the residents could need extra supervision because of challenging behaviour. Staff say there are enough of them on duty most of the time although they would like more time to take residents out when they want. One resident says, “I would like 1-1 to go out more.” Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 20 The inspector observed staff speak pleasantly to residents; residents confirm this. “They are really caring and concerned about our wellbeing. I for one cannot fault it.” A resident told the inspector that the staff are professional and caring to them. The recruitment and induction of new staff, as seen in the staff files and speaking with staff, is safe enough to protect the residents at all times. Staff say they do not work alone until their induction is completed, (approximately two to three months), and they feel confident in their tasks. Thirty-nine percent of care staff have undertaken national vocational qualifications (NVQs) to help them understand the residents’ needs and be able to care for them better. The PIQ states, and their records confirm, that staff have undergone an intense programme of training since the last inspection. Staff confirm that the provider supports them enthusiastically in their training. The provider arrived during the inspection and confirmed that he is keen that all staff are highly trained and must be able to care safely and well for the residents at all times. There is a regular supervision of staff programme in place. Staff say it helps them feel well supported by the manager and deputy. Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 21 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, 38, 39, 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The staff are led by a caring, supportive manager. The manager and staff are highly knowledgeable, caring and supportive of the residents. EVIDENCE: The manager is a qualified nurse and has achieved the registered manager’s award. She has many years experience of caring for people with mental health conditions. The manager has an ‘open door’ policy. Residents say they can go to her any time and she listens to them. Staff say they feel she supports them in their duties. Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 22 The provider visits the home monthly, unannounced, to check that residents are happy with their care, staff are enough in numbers, recruited safely and well trained, and that the home is clean, tidy and hygienic. He reports his findings to the manager and the commission each month. The manager gives residents an annual survey to check that the service provided is what they want and need. She analyses these to help her put measures in place to continually improve the facilities and care provided. She also holds regular residents’ meetings for them to discuss their wishes for the running of the home and staff meetings to encourage them and share with them how the service could be improved. Measures are in place for the continuing maintenance and upkeep of the home. Maintenance records are satisfactory. The Environmental Health Officer found no issues at their last inspection visit. The fire Safety Officer has visited and any recommendations put in place. The policy for fire safety was updated on 3rd January 2007. Fire safety training is due to be updated on 6th June and health and safety training on 8th June 2007. Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 23 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 3 2 3 3 3 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 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 3 4 X X 3 X Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. Refer to Standard Good Practice Recommendations Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Courtlands Lodge DS0000002618.V336480.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!