Inspection on 24/06/08 for Dunniwood Lodge

This inspection was carried out on 24th June 2008.

CSCI found this care home to be providing an Good service.

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

Dunniwood Lodge 22/06/07

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Dunniwood Lodge 229 Bawtry Road Bessacarr Doncaster DN4 7AL Lead Inspector Christine Rolt Key Unannounced Inspection 24th June 2008 09:45 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 Dunniwood Lodge DS0000070009.V365962.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 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. Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dunniwood Lodge Address 229 Bawtry Road Bessacarr Doncaster DN4 7AL 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) 01302 370457 01302 533568 dunniwoodlodge@mimosahealthcare.com None Mimosa Healthcare (No4) Limited Diane Katherine McKenna Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - code OP The maximum number of service users who can be accommodated is: 44 22nd June 2007 2. Date of last inspection Brief Description of the Service: Dunniwood Lodge provides personal care for up to 44 older persons. The home is purpose built care home providing accommodation on two floors accessed by stairs and a passenger lift. The majority of bedrooms have ensuite lavatories. Communal areas are spacious. The landscaped gardens are attractive with a summerhouse and ample garden furniture. The home is on a busy main road in Bessacarr near Doncaster with good bus routes into town. The weekly charges for the service in June 2008 ranged from £390.14 to £570.00. Hairdressing, chiropody and massage were charged extra. The acting manager supplied this information after the inspection. People living in the home are issued with copies of the service user guide. A copy of the statement or purpose and the latest CSCI inspection report were available in the main entrance. Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. This was a key inspection and comprised information already received from or about the home and a site visit. The site visit was from 9:45 am to 5:25 pm. The CSCI had not been formally notified that the registered manager had left and her name was still on the home’s certificate of registration. The acting manager completed an Annual Quality Assurance Assessment (AQAA), which was received after the site visit. Various aspects of the service were checked during the site visit. Care practices were observed, a sample of records was examined, a partial inspection of the building was carried out and service provision was discussed with the acting manager. The majority of people living at the home were seen throughout the day, and several were asked for their opinions of various aspects of the home and the care received. A visitor and a district nurse were also asked for their opinions. Questionnaires were sent to 10 people living in the home and ten relatives. Seven completed forms were received from people living in the home and four from relatives. Opinions and comments are included in this report. The care provided for three people was checked against their records to determine if their individual needs were being met. The inspector wishes to thank people in the home, their visitors, the district nurse, staff, and the registered manager for their assistance and co-operation. What the service does well: The home provided a good standard of care and people considered that the staff were helpful and kind. Comments made included: “Go out of their way to understand the personality of the resident, and they try to cater for their individual foibles and habits.” “I find the staff very friendly and approachable” “Day to day care needs” “… I have been very happy with the care she has received at Dunniwood Lodge.” Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 6 “I am satisfied.” “The staff have been very kind, and she has received good medical care and supervision.” “It does respect the dignity of the residents, it provides some activities and has recently upgraded its grounds to provide better sitting outside facilities. On the whole it does a good job.” What has improved since the last inspection? What they could do better: There were comments that demonstrated that the home did not always communicate what was happening. Some of these are already mentioned under the specific sections in this report. Other comments relating to lack of communication were, “They have never written to me about anything. There was recently a big changeover of staff, including the manager, but I was not officially informed.” “They do have a residents’ meeting to discuss activities or suggestions and complaints. My cousin cannot take part in these, and I am not made aware of any decisions.” When people were asked how the home could improve, one person wrote, “More regular feedback or contact with relatives” In addition to this Mimosa Care had not notified the CSCI that the registered manager had left and an acting manager was in post. This will be monitored and the next inspection may be brought forward. Dunniwood Lodge DS0000070009.V365962.R01.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. Dunniwood Lodge DS0000070009.V365962.R01.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 Dunniwood Lodge DS0000070009.V365962.R01.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): 3 and 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There were satisfactory arrangements for ensuring that people’s needs could be met prior to admission to the home. EVIDENCE: The majority of people said that they received sufficient information to enable them to make decisions and the acting manager said that on admission to the home, everyone was given a copy of the service user guide. Assessments were carried out and copies of the local authority assessments and the home’s own assessments were available on the three files that were checked. These provided detailed information of each person’s needs and wishes. The home did not provide intermediate care. Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 10 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): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were treated with respect. Medication recording procedures were met. Care and health needs were met but care planning could improve. EVIDENCE: People living in the home looked well cared for, clean and appropriately dressed. They said they were happy living in the home. Staff were observed treating people with respect and kindness, and interactions were good. People said that they received the care and support they needed and were treated with respect and dignity. Visitors confirmed this. Comments were, “General care is good”, Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 11 “The manager and senior staff … are all very professional and helpful. However, there seems to be rather a high turnover of carers, which makes it difficult to form personal relationships”, “Yes, she is always kept neat and tidy” “My mother has always received medical attention when it was necessary – GP and district nurse.” “They (staff) have been good to me.” Three care plans were checked in detail. Daily records provided information of how people had been throughout the day but did not always specifically show that a person’s individual needs had been met. Person centred care (covering physical, health, social and emotional needs) was discussed with the acting manager who said that this was already being discussed as a company issue. The care plans were reviewed monthly but there was no information to verify that people living in the home or their representatives were consulted about care plan reviews. The need for consultation was discussed with the acting manager. This would also meet the request of one relative who, when asked how the home could improve, wrote, “I would like perhaps a six monthly report from them on the condition and/or alteration in the health of the resident, where the resident concerned is not able to make their own assessment.” Files contained some risk assessments. However there were no risk assessments where people’s beds were against walls. The assessment of risk of injury to people and staff who were helping them was discussed with the acting manager. Accidents were recorded. The acting manager was advised to introduce 72hour monitoring sheets. These forms record the close monitoring of people who’ve had accidents or falls where no injuries are apparent at the time of falls and ensure that injuries are quickly noted. The acting manager was also advised to consider the implementation of a monthly Accident Analysis Sheet to monitor any patterns to falls. These were recommended as measures of good practice. Some relatives considered that generally they were kept informed of their relative’s wellbeing although one relative stated, “I am advised if she goes into hospital, but any other treatment or bruising I only find out if I seek out a senior carer and inquire.” Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 12 The acting manager said that relatives should be kept informed at all times. She was advised to consider Communication as part of the home’s quality assurance. The medication system showed a marked improvement from the previous inspection. The acting manager said that she carried out random checks of medication as part of the quality assurance programme. The medication was stored securely but in various parts of the home. The acting manager said that they were in the process of providing better storage in one central medication room. The medication for three people was checked. Medication tallied with the Medication Administration Record (MAR) sheets. Each medication was signed and dated on receipt and quantities were recorded. Handwritten entries were countersigned to ensure that the correct information was copied. There were no gaps in the Medication Administration Record sheets. Medication that needed to be kept cool was kept in the medication refrigerator. The temperature was recorded daily but this appeared to be below the prescribed limits and the acting manager was advised to have the thermostat checked. Controlled drugs were stored in a controlled drugs cupboard. The controlled drug register was checked. Medication was recorded properly with two signatures and a diminishing total. Dunniwood Lodge DS0000070009.V365962.R01.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): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were satisfied with their lifestyles at the home. EVIDENCE: The home employed an activities person who worked weekdays. A weekly programme of activities was displayed. People living in the home considered that there were always or usually activities that they could take part in. One person commented that they’d had a barbecue on the previous afternoon. The acting manager said that people wanted more outings and they were looking at providing these. People were observed spending the day as they chose, staff were heard to offer choices, and one person described what they liked to do during the day including having their breakfast in their bedroom. Information in care plans verified that people’s choices were taken into consideration. One person commented, “…People can come and go as they choose.” Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 14 Visitors said that they were made welcome. The dining room was clean, bright and welcoming. People living in the home said that they always or usually enjoyed the meals. A menu board informed people of the meals on offer. The cook said that choices were available and people living in the home verified this. Comments received about the meals were, “Very good”, “If one doesn’t fancy the main meal of the day, one can always have an omelette, or salad, or yogurt instead. The cook asks for suggestions for something that is not usually on the menu and we can have it if it is a reasonable request” and “My mother has enjoyed her meals – she doesn’t like to be over faced with large amounts and this was understood by the staff.” Dunniwood Lodge DS0000070009.V365962.R01.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): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People felt they were listened to and protected. EVIDENCE: The complaints procedure was displayed. The acting manager said that copies were also included in the service user guide, which was issued to people on admission. People said that they knew how to complain. A relative said that she had made two complaints to the home and in both cases action had been taken. One of her complaints was about missing clothing. The complainant said that a satisfactory outcome had been reached but clothing was still being misplaced. This was discussed with the acting manager who was advised to review the laundry system procedures as part of the Quality Assurance system. The complainant’s second complaint related to lack of communication. See section on Management. Other comments were, “The staff are always very kind and try to engage with my mother, to make her as comfortable as possible, and try to clarify what her wishes and needs are”, and Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 16 “Fortunately, in the 3 ½ years my (relative) has been there I have not had the need to make a complaint.” The acting manager said that refresher training in adult safeguarding was planned for July. The CSCI had been notified of an allegation of verbal abuse. The home had also notified Adult Safeguarding and POVA. The incident had been dealt with appropriately. Dunniwood Lodge DS0000070009.V365962.R01.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): 19 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided a pleasant environment for people to live in. EVIDENCE: The home created a good first impression. The home was pleasant and clean. There was a faint offensive odour in one part of the home and this was brought to the acting manager’s attention. The majority of people considered that the home was always or usually fresh and clean although one person had noticed that recently there were odours in the home. Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 18 The manager said there was a rolling programme for redecoration. The wall in one bedroom was damaged and this was brought to the acting manager’s attention for inclusion in the redecoration programme. In bedrooms, the majority of beds were against the wall. on Health & Personal Care) (See section above Paper Throughout the home, furnishings and furniture were in good condition. hand towels and liquid soap dispensers were available in lavatories and bathrooms to prevent cross contamination. Aids and adaptations were in place. The mechanical sluice had not been repaired and the acting manager said that she thought that this was going to be removed. Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were protected by the home’s recruitment procedures and staff were competent but would benefit from some additional training. The numbers of staff on duty met people’s needs. EVIDENCE: Some people considered that more staff were needed and comments on staff availability were, ““Depending on staffing situation”, “A little rushed in a morning but are short staffed” and “Short staffing” The acting manager said that the home was fully staffed. At the time of this site visit there were sufficient care staff on duty. Ancillary staff were also seen throughout the day. Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 20 People considered that care staff usually had the skills and experience to do their jobs and the acting manager said that the organisation was committed to meeting training needs. The acting manager said that staff received Skills for Care induction training and evidence of this was seen during the site visit. National Vocational Qualification (NVQ) training was also promoted. During the check of the three care plans, all contained information that each person had some sensory impairment; either sight, hearing or both. Also, a person living in the home considered that staff were not aware of people’s sensory problems and wrote, “On a personal note, I find it difficult to impress on the staff the problems I experience being registered partially sighted” The acting manager was advised to consider sensory awareness training to enhance staff skills and to ensure that people’s needs were met fully. The recruitment files for three members of staff were checked. All contained the relevant checks and information. Other correspondence was also available which showed that the system was robust. Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The acting manager promotes the welfare of people at the home, and it is run in their best interest. EVIDENCE: Since the last inspection, the registered manager had left. The Commission for Social Care Inspection had not been notified. An acting manager was in post. She said that she intended to apply for registration and was in the process of collating the required documentation. Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 22 The home had a quality assurance system that included audits of systems and records within the home and safety checks of the environment. Residents’ meetings were held regularly and the manager said that these were successful. Questionnaires were also given to people living in the home and were also available to visitors. The acting manager informed the CSCI of any incidents that affected people living in the home and the responsible person carried out visits to the home and produced reports. The acting manager was advised to include Communication and to assess the system for dealing with laundry as part of her quality assurance system. Money held on behalf of people who lived at the home was stored safely and individual account records were kept. A sample of these was checked and was correct. Receipts were available for purchases made on behalf of people living at the home and advice was given on numbering these and recording on the accounts sheet for ease of reference when auditing. Records and certificates were available to verify that service and maintenance checks were carried out. Mandatory health and safety training (i.e. moving and handling, basic food hygiene, emergency first aid, infection control and fire awareness) was ongoing and a staff training matrix was available with dates of the most recent training. The acting manager provided dates of future training. Dunniwood Lodge DS0000070009.V365962.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 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 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 24 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 Standard OP7 Regulation 15 Requirement More specific information must be provided in the care plans of how people’s identified physical care needs are to be met and that the daily records provide evidence of specific physical needs being met. The care plans must be reviewed in consultation with the named person or their representative, unless it is impracticable to do so. This will ensure that people living at the home receive a consistent level of care. 3 OP7 13 Risk assessments must be provided to determine the level of risk of harm to the individual and to staff where beds are against walls. The action taken to minimise the risk must be recorded. This should mean that any potential harm is reduced Mimosa Healthcare (No4) Ltd must give notice in writing that DS0000070009.V365962.R01.S.doc Timescale for action 30/09/08 30/09/08 4 OP31 39 31/07/08 Page 25 Dunniwood Lodge Version 5.2 the registered manager has left and detail the current management arrangements in place for the day-to-day running of the home. 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 OP8 2 3 4 5 7 OP8 OP9 OP26 OP30 OP33 Refer to Standard Good Practice Recommendations Implementing 72-hour accident monitoring sheets may ensure that injuries would be highlighted quickly where no injury was apparent at the time of a fall. Implementing an Accident Analysis Sheet would highlight the frequency and patterns of falls. The medication refrigerator thermostat should be checked to ensure that the refrigerator is running at the correct temperature for the stored medication. The obsolete sluice facility should be removed to create more space. Staff should be offered sensory awareness training to enhance their skills when helping people with sensory disabilities The Quality Assurance system should include: Communication: to ensure that people are consulted and/or informed where necessary e.g. people living in the home, relatives, staff and external bodies • Review of the laundry system to reduce frequency of misplaced and lost clothing Numbering receipts and entering on records would ensure ease of reference when auditing financial records. • 8 OP35 Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Dunniwood Lodge DS0000070009.V365962.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!