Inspection on 26/07/06 for Elstree Lawns Nursing Home

This inspection was carried out on 26th July 2006.

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

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

Other inspections for this house

Elstree Lawns Nursing Home 10/06/08

Elstree Lawns Nursing Home 27/11/07

Elstree Lawns Nursing Home 26/04/07

Elstree Lawns Nursing Home 30/01/07

Elstree Lawns Nursing Home 01/11/05

Elstree Lawns Nursing Home 21/12/04

Elstree Lawns Nursing Home 30/06/04

Similar services:

Claremont House

Firstlings

Fen Road

Dial House Nursing Home

Croxley House

Eversley Nursing Home

Cresta Lodge

Chilton Meadows Residential & Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Elstree Lawns Nursing Home Barnet Lane Elstree Hertfordshire WD6 3RD Lead Inspector Alison Jessop Unannounced Inspection 26th July 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elstree Lawns Nursing Home DS0000019344.V305456.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. Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elstree Lawns Nursing Home Address Barnet Lane Elstree Hertfordshire WD6 3RD 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) 0208 207 3255/3271 0208 207 1149 www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Care Home 54 Category(ies) of Dementia - over 65 years of age (54), Mental registration, with number disorder, excluding learning disability or of places dementia (1) Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This home may accommodate people (aged 50 or over) with a diagnosis of pre-senile dementia who require nursing care. This home may accommodate one (named) service user under the Mental Disorder category. The home manager must inform the CSCI when the (named) service user admitted under the Mental Disorder category is discharged. 1st November 2005 Date of last inspection Brief Description of the Service: Elstree Lawns Care Home is sited in a large, three-storey building, which has been converted and extended to provide nursing care for those over 50 who have a diagnosis of dementia. The top floor of the building is no longer used for accommodation. All bedrooms are for single occupancy and 29 have en-suite facilities. Each floor has its own lounge and dining area and there is a hairdressing room for the residents’ use. The home is reached at the end of a long, secluded driveway and there is ample parking available in front of the building. There are gardens and patio areas to the rear of the home and these have been modified for the safe use of the residents. The home is set back from a busy road and is near to the village of Elstree and the town of Borehamwood. Facilities for shopping and leisure are within a short drive and there is a nearby bus service. The current accommodation charges range from £550 to £900 (£1000 for respite) per week. A copy of the homes most recent inspection report is displayed in the foyer of the home. Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Regulatory Inspectors carried this unannounced Inspection out over one day. Time was spent talking to service users, staff and visitors. The manager and his deputy were available throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: The layout of the dementia unit is problematic as there is not enough seating for all service users. The lunchtime routine was chaotic and it was impossible for staff to monitor food or fluid intake. This was a particular concern for those service users who are at risk of malnutrition. Only one choice of meal was available at lunchtime and although the manager stated that an alternative can be offered service users may not be aware that this is the case. One service user said ‘we get omelettes at every meal.’ It is required that an alternative choice is readily available to service users. Procedures relating to medication were generally satisfactory, however storage temperatures must be monitored and safely maintained. Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 6 One complaint had been made to the home however the complainant reports to the Commission that the complaint was not formally acknowledged and continues to be upheld. An allegation of abuse was reported to the Commission by an anonymous complainant who followed the homes whistle blowing procedure. The home had failed to report this to the Commission. The Protection of Vulnerable Adults Procedure had not been followed by the organisation, this being the second occasion that the procedure was not followed correctly. Inappropriate restraint techniques had been used when a service user displayed aggressive and physically abusive behaviour towards a senior member of staff. All staff require further appropriate training on dealing with challenging behaviour. 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. Elstree Lawns Nursing Home DS0000019344.V305456.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 Elstree Lawns Nursing Home DS0000019344.V305456.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes admission procedure ensures that service users are suitable prior to moving into the home. EVIDENCE: The Manager or deputy manager carry out a comprehensive needs assessment prior to accepting someone into the home. The deputy would normally carry out the assessment otherwise in her absence the manager would do so. The home does not provide intermediate care. Elstree Lawns Nursing Home DS0000019344.V305456.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans contained comprehensive information and enabled staff to offer individualised care to meet service users needs. Food and fluid intake of service users who are at risk of malnutrition had not been monitored or recorded. This could cause a potential risk to service users health and well-being. Service users are not treated respectfully or their dignity maintained. Medication procedures were generally satisfactory although care must be taken to ensure medication is stored in accordance with the manufacturers instructions to ensure its effectiveness. EVIDENCE: During the lunchtime period several service users with dementia walked around and staff were not aware of who had eaten a main meal. This was very concerning as it was evident that it was not possible to monitor food or fluid Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 10 intake. No food or fluid charts were observed on service users files, which is of particular concern for those that have care plans and risk assessments for risk of malnutrition. One service user spent the morning resting on her bed, a glass, which was full of juice, was left beside her bed and throughout the morning the inspector observed that the glass remained full of juice throughout the morning. No evidence could be found to suggest that the service user took any fluids. Weights of service users are however monitored and recorded. One service user has a grade three pressure sore, which is currently being treated by the nurses at the home however this had not been reported to the Commission in accordance with Regulation 37. Procedures relating to medication are generally satisfactory. The storage of medication must be within safe parameters. Medication that is not stored in accordance with the manufacturers instructions may no longer be effective. One service users family had consented to medication being given covertly, however the GP or pharmacist had not given their consent. The appearance of most of the service users particularly on the dementia unit was poor. Hair and teeth had not been brushed, men were unshaven and clothing was stained, creased or inappropriate for the hot weather. One service user ate her lunch and for some time after she had finished she continued to chew on food. A carer came along and without warning put a large spoon in the service users mouth to scoop out the food that she had been chewing. Elstree Lawns Nursing Home DS0000019344.V305456.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service.” The layout of the dementia unit is problematic. The lunchtime routine was chaotic and it was impossible for staff to monitor food or fluid intake. Service users ate cold food as food was served hot but had to wait long periods of time to be assisted with eating their food. Serious concerns were raised about this and an immediate requirement made for an appropriate dining area and more comfortable atmosphere to be adopted. Activities are offered to service users on a daily basis, an extra activity coordinator who has been appointed will ensure that appropriate activities will occur on both floors of the home. EVIDENCE: The activity co-ordinator was available and said that she currently organises and provides activities to all service users in the home. The manager has recently recruited another activity co-ordinator, which will ensure that all service users in the home are offered the opportunity to participate on both floors of the home. During the inspection on the ground floor service users participated in music and singing. No activities took place on the dementia unit Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 12 however this will happen more frequently when the new activity co-ordinaotor is in post. The lunchtime routine was disorganised and chaotic on the dementia unit. Due to the layout of the unit there is not enough seating for service users in the dining area. Some service users sat in the lounge area with small tables, which for some was appropriate, whilst others could not get access to their dinner as it was too far away. Food was served and left on tables for long periods of time and those that required assistance were given cold food as they had to wait to be assisted. The menu consisted of only one dinner and choices were not available. The manager stated that it was difficult for service users who have dementia to choose what they would like however he stated that there is always a second option available should this be required. One service user stated ‘we get omelette at every meal’. This may be as this is often the other option offered and service users may not be aware that another option is available. Elstree Lawns Nursing Home DS0000019344.V305456.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Protection of Vulnerable Adults Procedure had not been followed by the organisation, this being the second occasion that the procedure was not followed correctly. A senior member of staff had used inappropriate restraint techniques when a service user displayed aggressive and physically abusive behaviour towards them. A complaint received by the home that was made by a relative was not acknowledged and therefore the complaint was reported to the Commission for Social Care Inspection. The complaint continues to be upheld. EVIDENCE: A verbal complaint was made to the manager by a relative in June in relation to unexplained bruising found on the service user. Although the bruising was reported to Adult Care Services in accordance with the Protection of Vulnerable Adults Procedure, the complainant felt that the complaint has not been formally acknowledged. The complaint continues to be upheld and the manager and regional manager are actively working towards full resolution. A member of staff in accordance with the homes whistle blowing procedure had reported an allegation of abuse to the Commission for Social Care Inspection confidentially. The incident was not reported to CSCI or Adult Care Services by the home. The manager had also been instructed from senior management to carry out an internal investigation, therefore failing to Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 14 correctly follow the procedure or minimise further risk of abuse to service users. The outcome of the investigation was that a senior member of staff had used inappropriate restraint techniques when a service user displayed aggressive and physically abusive behaviour towards them. All staff require further appropriate training on dealing with challenging behaviour. Elstree Lawns Nursing Home DS0000019344.V305456.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Due to the age of the building, on-going maintenance and refurbishment is required to ensure that the environment remains safe. The dining area on the first floor is unsuitable and an alternative area for dining must be created for the safety of the service users. Many areas of the first floor were not adequately ventilated, causing concern for service users and staff during the hot weather. A lot of equipment in the home such as wheelchairs require repair or replacement as they are old and in a state of disrepair, this is a risk to the health and safety of service users and staff who operate such equipment. Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 16 EVIDENCE: Many areas of the home require to be better maintained. Although some decoration had been done, the home looked scruffy in some areas and bedrooms on the first floor did not look homely or comfortable. A number of taps around the home were not working and required replacing and light sockets were also faulty. A list of outstanding repairs was produced by the manager who stated that the items would be completed shortly. The second floor continues not to be accommodated by service users and is currently being used as a storage area. All Velux windows have been fitted with blinds. Many areas of the home were very hot and although fans were available they did not appear to be affective. An audit of equipment is required as some equipment such as wheelchairs was observed to be old, faulty and may require replacing. Elstree Lawns Nursing Home DS0000019344.V305456.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s recruitment policies and practices increase service users safety. EVIDENCE: Records relating to recruitment are satisfactory. Minimal evidence relating to staff training was found and a requirement has been made for a training plan to be submitted to CSCI. 66 of staff currently has an NVQ qualification. All staff confirmed that they receive supervision. Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36, 37 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The homes budgets do not appear to be able to meet expenditure for essential items. This is causing the home to become run down and staff are not provided with essential tools to carry out their job effectively. A quality assurance audit of the home was carried out internally however the results of this did not appear to match the observations of the inspector. Risks to service users health and safety were not minimised as window restrictors had been removed in bedrooms. Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 19 EVIDENCE: The manager stated that his medical reference is holding up his submission of his application for registration. He is going to ensure that this is completed as soon as possible. Throughout the inspection a common theme emerged in relation to the lack of finances available. Staff spoken to said that some of the taps in the bedroom had not been working for two months and that when they ask for new equipment or replacement items they are told that there is not enough money in the budget. The manager appeared to be doing a juggling act with budgets and was having to constantly re-prioritise. A quality assurance self-assessment had been carried out in the home and the results did not appear to match the observations of the inspector. Relatives meetings are held twice a year where feedback can be gained in a formal manner. Service users can open an account within the home where BUPA can safely store service users money and pay for personal items. Records of each transaction are maintained and receipts maintained. The bank account that is held by BUPA does incur interest, however staff were unable to state how this is allocated to service users. An allegation of abuse that was reported to CSCI confidentially by a ‘whistleblower’ was not reported to CSCI by the home. The manager has completed some health and safety training and has taken on this responsibility. Generic risk assessments have been reviewed. One service users bedroom window restrictor had been taken off, the service user is partially sighted and a concern was raised about safety, as the window ledge was very low. Another service user living on the first floor has made an attempt to climb out of a first floor window. Although a risk assessment was in place and staff are carrying out hourly monitoring, it was recommended that the service user is moved to the ground floor in order to eliminate any risk. Although one bedroom door had a door guard, the door was propped open using a chest of drawers. Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 20 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 3 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 X 2 X 3 2 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 3 2 3 3 2 2 Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 21 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 2 3 4 Standard OP8 OP9 OP10 OP15 Regulation 12(1)(a)& 13(4)(c) 13(2) 12(4)(a) 16(2)(i) Requirement Food and Fluid intake must be monitored and recorded. Medication must be stored within stated temperatures. Service users dignity must be respected at all times. Adequate food and fluid must be available to service users at all times and food must be available at a suitable temperature. The registered person must ensure that all complaints received are responded to formally informing them of any action to be taken. The registered person must make arrangements to prevent service users from being harmed or being placed at risk from abuse. Service users must not be subject to restraint unless this is the only practicable means of securing the safety of that or any other service user. Individual care plans must include guidelines on dealing with aggressive behaviour. The registered person must DS0000019344.V305456.R01.S.doc Timescale for action 31/08/06 26/07/06 31/08/06 31/08/06 5 OP16 22(3)&(4) 31/08/06 6 OP18 13(6) 31/08/06 7 OP18 13(7) 31/08/06 7 OP19 23(2)(b) 26/09/06 Page 22 Elstree Lawns Nursing Home Version 5.2 & (c) 8 OP20 23(2)(a)& (g) ensure that the home is kept in a good state of repair. All outstanding maintenance issues must be dealt with within reasonable timescales. The Registered Provider must 26/09/06 provide adequate dining facilities for all service users in the home. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM TWO PREVIOUS INSPECTION REPORTS.THE PREVIOUS TIMESCALE WAS NOT MET. An audit of equipment must be undertaken and all equipment used must be maintained and in good working order. Room temperatures must be monitored and the home must be adequately ventilated. A training plan must be submitted to CSCI. The person currently managing the service must submit an application to register with the Commission for Social Care Inspection. A copy of the agencies annual accounts and budget projections must be submitted to CSCI. The registered person must notify the commission of any allegation of misconduct. A regular audit of window restrictors must be undertaken to minimise any risk to service users safety. Doors must not be propped open unless methods used have been agreed by the fire safety officer. 31/08/06 9 OP22 23(2)(c) 10 11 12 OP25 OP30 OP31 23(2)(p) 18(1)(c) (i) 9(1) 31/08/06 26/09/06 26/09/06 13 14 15 OP34 OP37 OP38 24(3) 37(1)(g) 13(4)(a) (b)&(c) 23(4) 26/09/06 26/08/06 26/08/06 16 OP38 26/08/06 Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 23 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. 2. 3. Refer to Standard OP9 OP14 OP38 Good Practice Recommendations It is recommended that consent is also gained from GP’s and pharmacists when administering medication covertly. A suitable method of offering choice at mealtimes should be introduced. It is recommended that the service user who has made attempts to climb out of windows is moved to the ground floor in order to protect his safety. Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 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 Elstree Lawns Nursing Home DS0000019344.V305456.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. 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