Inspection on 13/03/07 for Earls Lodge Care Home

This inspection was carried out on 13th March 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Earls Lodge Care Home 03/10/06

Earls Lodge Care Home 13/06/06

Earls Lodge Care Home 28/11/05

Earls Lodge Care Home 21/08/05

Earls Lodge Care Home 14/07/05

Earls Lodge Care Home 24/03/05

Earls Lodge Care Home 15/10/04

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

CARE HOMES FOR OLDER PEOPLE Earls Lodge Care Home Queen Elizabeth Road Wakefield Yorkshire WF1 4AA Lead Inspector Elizabeth Hendry Key Unannounced Inspection 13th March 2007 09:30 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 Earls Lodge Care Home DS0000044498.V332877.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. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Earls Lodge Care Home Address Queen Elizabeth Road Wakefield Yorkshire WF1 4AA 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) 01924 372005 01924 372011 www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Ms Amanda L Bennett Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing arrangements for a maximum of 25 nursing and 25 personal care places Daytime 1 RN and 4 care assistants (upstairs) 4 care assistants (downstairs), one of whom is a senior care assistant Night-time 1 RN and 2 care assistants (upstairs) 2 care assistants (downstairs), 1 of whom is competent to administer medication Maximum of 25 nursing at any one time Can accommodate one named service user who is under 65 years of age 3rd October 2006 2. 3. Date of last inspection Brief Description of the Service: Earls Lodge Care Home was purpose built to provide personal and nursing care for 50 older people. The home is situated in close proximity to Pinderfields Hospital on Queen Elizabeth Road, Wakefield, close to main bus routes from Wakefield town centre. The home is surrounded by gardens that provide a pleasant environment for service users to sit in. It is a two storey building with nursing care provided on the first floor of the home. There are pleasant lounges and dining areas on both floors. All rooms are single and most have en suite facilities. A team of qualified nurses, care assistants and ancillary staff work at the home and the local doctors and their Primary Health Teams support them. The proprietor is Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited). The manager informed the Commission for Social Care Inspection on 13/06/06 that fees range from £370 to £420 per week and that these charges were unchanged on 3/10/06. Additional charges include hairdressing, private chiropody and newspapers. A small charge is made for some activities such as Bingo and trips out. Information about the home is available to potential residents via the Statement of Purpose, Service User Guide and the last inspection report, all of which are available in the home’s reception and are given to all potential and current residents. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this full inspection, two inspectors from the Commission for Social Care inspection (CSCI) undertook a visit to the home. The visit started at 09.30 am and finished at 6:00 pm on 13 March 2007. As part of this inspection, CSCI have had contact with the following people – service users, their relatives, the service provider, staff members, social workers and GPs. During the site visit records, observations and discussions, with both residents and staff, were undertaken. In writing this report, information and evidence was not only obtained by way of visiting and looking around the home but information and evidence was obtained from notifications sent to the CSCI since the last key inspection in 2006, questionnaires and the last inspection report. At the time of writing this report, three relative questionnaires, one care manager questionnaire and five health care professional questionnaires had been returned to CSCI. The inspection has concluded that service users’ needs are generally met. Service users reside in a relaxed homely environment. The inspector would like to thank the service users, manager, assistant manager and staff for their hospitality and patient co-operation throughout the inspection. What the service does well: Of those service users spoken with, all spoke highly of all members of staff commenting that nothing is ever too much trouble. Support systems in place within the home ensure that both service users and members of staff have access to either a member of the care team or management to discuss any concerns as they may arise. The systems and procedures followed by the staff at the home make sure that the healthcare needs of people are assessed and recorded, and opportunities are created to make sure these needs are met. The systems operated within the home promote and maintain people’s health and ensure access to health care services to meet assessed needs. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 6 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. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 7 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 Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 8 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems operated by the home ensure that people only move into the home after having had their needs assessed and are assured that these will be met. The home does not provide intermediate care, EVIDENCE: All of the service users’ files seen on the day of the site visit included a comprehensive pre admission assessment based on activities of daily living, which included past medical history as well as current needs. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans contain basic information relating to the personal and healthcare needs of the service user. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Care plans do not identify all service users’ health and welfare needs. Neither are they individualised to reflect the individual service user’s likes, preferences and wishes. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 10 All four care plans examined were found to lack detail. For example, when a need is identified in the care plan, such as the individual service user’s care needs, it identifies what the service user’s needs are but then fails to advise staff how those needs are to be met in the home. Of the care plans examined, three did not contain any evidence of service user or representative agreement. Similarly, risk assessments are in place, however they lack detail and do not address all the risks, eg manual handling, as described more fully within the health and safety section of this report. When the inspectors observed members of staff interacting with service users, they felt that generally staff were kind and well meaning. However, some staff were overheard discussing issues which were private to individual service users in a communal area. Of the five health professional questionnaires returned, one said that they felt the home meets all of the health care needs of the service users, three said usually and one declined to comment. Daily records contained details of clinical intervention but lacked detail of how the service user chose to spend their day. A number of care assistants were observed failing to explain or reassure service users when undertaking moving and handling tasks, in particular when using hoists. This has the potential to cause a great deal of anxiety particularly for those service users who are unable to verbally communicate. A sample of medication administration records were viewed and checked against drugs held within the home and were found to tally. Medication was found to be stored in accordance with the Royal Pharmaceutical Guidelines of Great Britain. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 11 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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst service users are supported to maintain contacts, more needs to be done to ensure the home supports daily and social activity. Service users are not always enabled to make choices in relation to their meals and the standard of cleanliness within dining rooms is lacking. EVIDENCE: Many service users were sitting within the communal lounges chatting to one another. Staff members were very busy on the day of the site visit, however they were observed responding to service users when anything was asked of them. Throughout the site visit, service users’ family and friends were visiting. At the time of writing this report, three relative questionnaires had been returned to CSCI, all indicated that they were made to feel welcome in the home and that they are able to visit with their relative in private if they wished to do so. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 12 Discussions with service users were very complimentary about the food, confirming all meals being tasty and of a good quality. However, on the day of the inspection, a member of staff was heard asking members of the kitchen if a service user had gravy on their dinner, when they replied that they did not know, the member of staff poured gravy over their lunch instead of asking the service user. Staff confirmed that snacks and drinks are available throughout the day. Menus displayed within the dining rooms did not represent what was available on the day of the inspection. A discussion took place with the registered manager regarding how the menus were developed and the importance of the menus accurately reflecting what was available each day. One service user’s care plan identified that they did not like fish. On the day of the visit, fishfingers were being served for lunch, no alternative meal was offered to this service user. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 13 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints made to the home are listened to and acted upon. The home’s policies and procedures ensure that service users are protected from possible abuse. EVIDENCE: The home’s complaints policy and procedure is clearly written, easy to understand and is available in a number of different formats. Each service user is given a copy of this procedure upon admission into the home within their Service User Guide. Information received prior to the site visit identified that there had been two formal complaints made to the home since the last inspection. The home’s complaints book viewed during the site visit confirmed this. Both complaints were seen to be recorded, investigated and responded to within given timescales. A discussion took place with the registered manager surrounding the need to record in greater detail the outcome for each complaint. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 14 Staff training files indicated that all staff are given basic training in adult protection on commencement of their employment, additional training is available once this has been identified within individual development plans. The manager confirmed that there is a senior member of staff on at all times to provide support should this be required. Of those staff spoken to, all were aware of the procedure to follow and how to contact Social Care Direct should they need report possible incidences. At the time of writing this report, the home did not have any ongoing adult protection alerts. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The decoration and furnishing of the home was, on the whole, of a reasonable standard but improvements to the cleanliness and decoration of communal dining rooms would further benefit service users. Infection control systems currently in place do not fully protect or promote the wellbeing of both service users and staff. EVIDENCE: On the day of the visit, a tour of the home was undertaken. The overall standard of decoration and furnishing found throughout the home was found to be good. However, further redecoration, in particular to communal bathrooms, Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 16 would improve the environment for all service users. The majority of fixtures and fittings were domestic in nature and of a good quality. The registered manager explained that all service users are given the choice of where to sit. The home has three good sized communal living rooms and two large dining rooms. The manager spoke of having a full time maintenance person within the home to undertake day to day repairs within the home. All service users spoken to said that their bedrooms were comfortable and that they had everything they needed. On the day of the site visit the home was found to be clean and tidy, however offensive odours were present within the first floor sluice room, corridor and ground floor corridor. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ needs are sufficiently met by the numbers and skill mix of staff. Some staff have achieved, and more are to begin, NVQ Qualifications thus ensuring that service users receive care from staff that have undertaken training relevant to their role. Service users are protected by the home’s recruitment policy and practices. EVIDENCE: One of the relative questionnaires returned to CSCI indicated that they felt that there were times when there was not enough staff on duty. However, on the day of the inspection, service users’ care needs had been met and the home appeared to be running well. Despite questionnaires indicating that there is not enough staff on duty, the staff rota confirmed that, while staffing levels are relatively low, staff on duty are able to meet the personal needs of each service user. There is, however, little time to spend with service users exploring and developing interests in activities and hobbies. Service users Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 18 spoken with were very complimentary about all members of staff. Staff were observed interacting with all service users and, despite being very busy, were seen to take a proactive role with regards to meeting service users’ requests. The Manager spoke of the home’s recruitment procedure and induction process. Records viewed confirmed that these policies are always adhered to. Four staff files were inspected on a sample basis. Enhanced Criminal Records Bureau checks and, where applicable, POVA First checks were in place for all members of staff. Information received prior to the site visit indicates that 36 of all care staff hold an NVQ level 2 in Care or above. At the time of the site visit, a number of staff were about to commence the award. During the visit, the registered manager provided the inspector with historical training records. These records indicate that staff have received mandatory induction training in key areas such as infection control, fire safety, first aid and health and safety. Moving and handling training records did not contain details of what techniques had been practised or the equipment used during the training and a recommendation has been given that this is addressed. Staff spoken to said that they receive informal supervision and support from their colleagues and formal supervision on a regular basis from the Registered Manager. Supervision records viewed during the site visit supported this. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Quality assurance procedures within the home ensure the home runs in the best interests of the service users. The management of the home is good and records are generally well managed. The manager provides clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. The health, safety and welfare of service users and staff are not always promoted and protected. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home places a high priority on ensuring quality care for all residents. In addition to the annual inspection from CSCI, the home undertakes regular quality audits, frequent service users’ meetings and annual visitor questionnaires. The Registered Manager said that the findings are then used to help improve the overall service residents receive. The Registered Manager has a clear understanding as to the goings on within the home, service users spoke of the manager undertaking care and domestic duties when needed and providing an open door to discuss personal issues and worries. Staff confirmed that the manager is approachable and understanding and actively encourages their personal development. Records are generally well maintained, accurate and regularly reviewed. No financial records relating to both the home and the service users’ finances were inspected on this occasion, however no incidents surrounding the management of service users’ monies has been reported to CSCI. The Registered Manager provided details of the management of service users’ monies prior to the site visit. This confirmed that service users receive their full personal allowance to dispose of as they wish and that records are kept within the home of any transactions involving service users’ finances. When the building was inspected, no fire exits were blocked and the fire extinguishers seen had been serviced. Of those staff files sampled, all had undertaken fire safety training. Information provided to the CSCI identified servicing of the gas installations, central heating system, fire equipment, portable electrical appliances, hoists and call systems. The home has a full time maintenance person who oversees the day to day repairs in the home. Moving and handling risk assessments did not contain sufficient information for staff to follow. Of the four service user risk assessments examined, all were found to lack detail and did not fully identify the risks nor did they provide clear guidelines for staff to follow in order to minimise these risks. Staff were observed transferring a service user using a stand aid hoist. The individual was unable to weight bear and displayed a great deal of anxiety in the use of the hoist. Staff performing this manoeuvre did not communicate with the service user about what was going to happen or why they were using the hoist. This hoist and sling was then used to transfer four other service users, however when questioned staff were unclear as to why they had to use the stand aid hoist as opposed to a regular hoist. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 21 One service user’s moving and handling plan stated that they were able to mobilise with the use of a Zimmer frame, however staff were seen to hoist this service user and then transfer them into a wheelchair. Other risk assessments examined did not contain a signature nor were they dated. This practice places service users at risk of injury. Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Timescale for action 31/05/07 2. OP38 OP30 13(5) Care plans must be developed to detail how all of the service users’ personal needs are to be met. Care plans must include details of pressure relieving aids being used and what equipment is being used to maintain safety during moving and handling procedures. 30/04/07 The registered person shall make suitable arrangements to provide a safe system for moving and handling service users. All staff must undertake practical training in the safe moving and handling of service users, this must include practical training in the use of all equipment used within the home and the importance of risk assessing before undertaking any moving and handling procedure. Detailed moving and handling risk assessments must be in place for each service user. Clearly explaining what equipment, method, and staff should be involved in the transfer. The registered manager must ensure that this DS0000044498.V332877.R01.S.doc Version 5.2 Earls Lodge Care Home Page 24 training is satisfactory, appropriate and is at all times adhered to. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care plans should: Give specific detail of service users’ current needs. Detail actions necessary to maintain service users’ safety. Be newly developed when a review indicates a change of needs or an assessment highlights specific needs. Include details of resident’s abilities. And Daily records should give detail other than just clinical interventions made. Cleaning schedules should ensure that good standards of hygiene are maintained in all areas and offensive odours are eliminated. Menus displayed around the home should reflect what is available. Choices should be available for all meals to ensure service users’ preferences can be catered for. Staff should consult with service users prior to serving their meals to obtain their preferences at each meal time. 2. 3. OP26 OP15 OP10 Earls Lodge Care Home DS0000044498.V332877.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 Earls Lodge Care Home DS0000044498.V332877.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. 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