Inspection on 09/06/05 for Enmore Lodge

This inspection was carried out on 9th June 2005.

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

Enmore Lodge 07/08/07

Enmore Lodge 10/04/06

Enmore Lodge 28/11/05

Enmore Lodge 13/01/05

Enmore Lodge 01/06/04

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Delrose House Ltd

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

CARE HOME ADULTS 18-65 Enmore Lodge 34-36 Enmore Road South Norwood London SE25 5NQ Lead Inspector Mohammad Peerbux Unannounced Inspection 9 June 2005 9:30am 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Enmore Lodge Address 34-36 Enmore Road, South Norwood, London, SE25 5NQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8405 1831 020 8656 9792 Enmore Lodge Limited Care Home 16 Category(ies) of Mental Disorder (16) registration, with number of places Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: A variation has been granted to allow two specified service users over the age of 65 to be accommodated. Date of last inspection 13 January 2005 Brief Description of the Service: Enmore Lodge is a service designed to cater for sixteen generally younger adults with past / present mental illness. Using a long-term therapeutic model, service users are encouraged to engage in the day-to-day activities of the home, as well as become involved with the local community where wished, or where timetabled as part of their care programme. Enmore Lodge is a substantial building set back off Enmore Road with a large car park to the front and a paved patio area to the rear with a small plot of garden. The building is designed to provide single accommodation for all but two of the service users who share the sole double-occupancy room. The home is run by a partnership: Mr & Mrs Alawo are co-proprietors of Enmore Lodge Ltd and ensure the day-today progress and monitoring of the home, alongside a deputy manager. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes first inspection for the year 2005/06. It was an unannounced inspection and took place over three hours. Some times were spent looking at the policies and procedures, talking to staff and deputy manager and to some of service users. A tour of the building was also carried out. Service users spoken to stated that they were happy with the care being provided. What the service does well: The home encourages service users to make decisions about all aspects of their lives; this includes what to eat, where to go on holiday, for days out, and what clothes to buy. Service users spoken to felt that the staff have built a good relationship with them. Comprehensive information about the home and the services offered (included in the Statement of Purpose and Service User Guide) is available, and potential service users (and their relatives) are encouraged to visit the home, enabling an informed choice regarding the suitability of the home to be made. A sample of service user files was examined. The home was evidenced to have appropriate assessments and care plans in place. Service users’ care and support needs had been properly assessed, and the range of health, care and social needs presented were evidenced as being met. Service users were observed to be treated with respect by staff and to have their privacy and dignity respected. Comments from service users were generally positive, with indication that staff is kind and helpful in meeting their care needs. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 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. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,4 and 5 The Statement of Purpose, and Service User Guide provide prospective service users with details of the services the home offers. This enable them to make an informed decision about admission to the home .All prospective service users have their needs assessed prior to admission to ensure that the home and staff are aware of their assessed needs. All service users now have a contract between the home and service user. EVIDENCE: The home has a Statement of Purpose that complies with the minimum standards. This is very comprehensive and was last reviewed in December 2004. The Service User’s Guide is written in a format/language suitable for the service users. However it did not contain a copy of the last inspection report. The home must ensure that this is included in the Service User’s Guide. All service users are admitted via a Care Programme Approach referral through the integrated Community Mental Health Team, therefore full CPA service user plans usually accompany an admission. An in-house assessment tool is also available. Service User’s ages ranged from 30 to 72. A variance application has been approved by the former NCSC in respect of those service users over the age of 65. There were twelve service users living at Enmore Lodge at the time of the Inspection. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 9 All admissions are very carefully planned; short visits are followed by overnight and weekend stays, if appropriate. Placements are reviewed on a day-to-day basis and are not confirmed as permanent placements until a CPA meeting takes place after six weeks of placement. The home only admits emergency or short-term placements if the service user meets the homes admission criteria. All service users are subject to a local authority contract. The Registered Manager has developed a contract between the home and the service user. It was previously required that the registered person must ensure that the statement of terms and conditions for each service user includes all the elements listed in standard 5.2.This has now been achieved. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 and 9 Care plans are comprehensive and include detailed information about service users’ needs, personal goals, wishes and risk assessments. Service users are involved in decision making about their lives, they participate and can take some risks so that they live as normal a life as possible. However when assisting service users to take responsibility for their money accurate records of their expenditure must be kept to protect them.. EVIDENCE: Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 11 All service users have a care plan, which has been agreed with the Consultant or Community Psychiatric Nurse, and therefore is individually focussed and based on individual needs and aspirations. Key workers are assigned to a service user on a long-term basis. It was evidenced that the care plans are reviewed on a monthly basis. The rights of service users to make decisions about their own lives is central to the ethos of the home, support and guidance is given in all areas to ensure that service users are making decisions which are in their best interests. The home supports most of the service users to look after their own money. Service users receive pocket money on a daily basis or as and when needed. All transactions are duly recorded however the balance brought forward were not always completed. One service user’s money was sampled and it was noticed the money was over by 40 pence. The manager must ensure that accurate records are kept as far as service users’ monies are concerned. The service users are offered the opportunity to participate in the day to day running of the home and to contribute to the development and review of policies and services through regular house meetings and individual discussions with their key workers. A risk assessment is undertaken for each service user in relation to their mental health. Risk assessments were on file for service users detailing concern over certain behaviours or activities. Many areas of practice noted in the home during the inspection have been risk assessed and are duly recorded such as service users smoking or drinking. The recording of these risk assessments is in a clear and logical manner. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,13,14,15,16 and 17 Service users are encouraged to explore opportunities to enhance their quality of life as well as maintain and participate with friends and the local community, with the aim of maximum integration. The daily routines and house rules promote service users’ rights, and ensure equality and that all rights are enjoyed by service users. Service users are offered a healthy diet and have choices in meals offered. EVIDENCE: Promoting independence of the service users is a key area of the work the home undertakes. Many of the service user’s mental health issues affect their abilities to participate in independence tasks, staff work with service users to motivate and enable them to undertake as many tasks as possible. Most service users undertake or participate in doing their own laundry. Some service users are able to make snacks with support from staff and are involved in cooking. Activities are wide ranging, stimulating and fulfilling. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 13 Many of the service users are independent in going out of the home, undertaking shopping, visits to libraries and other community facilities. All service users have access to public transport. Staff support service users on outings to shops, local pubs and restaurants, swimming, bowling and cinema. Recently the service users have been to Derby Day at Epsom racecourse. All service users are registered to vote. The in house activities include regular birthday and special events parties, quizzes, pool, summer barbeques. The home does not provide a holiday for service users, as this is not included in the fees charged to local authorities. The service provider is still having discussion with purchasers regarding this subject. The matter of service user’s holidays is also discussed at reviews and service user’s house meetings. The home does, however organise day trips and service users are encouraged to partake in such outings and activities. The home respects the service user’s choice of whom to engage with; there are small Visitor’s Rooms available in the home for people to meet - without having to invade the ‘privacy’ of a service user’s own bedroom. Individual service users’ own space is also respected; many were individually furnished and kept to the level appropriate and suited to the specific service user’s character. Relationships both within and outside the home are encouraged. All service users have a key to their bedrooms. No service user is given a front door key, the reasons for this relate to the staff of the home needing to know who service users bring back with them and service user’s vulnerability to strangers outside of the home. The registered provider stated that service users are happy not having the front door keys. Service users spoken on the day of the inspection seemed happy, confident and comfortable in their surroundings. The service users design their menus with appropriate support from staff if required. The home keeps a clear and specific record of food consumed kept by service users which enable diet and weight to be monitored. Some service users are able to make snacks with support from staff and are involved in cooking. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 and 20 Service users’ personal, physical and emotional health needs are being appropriately met and reviewed. This ensures that the service users’ physical and emotional health is well maintained and therefore the quality of life experienced is also maximised. Service users’ medication is also well managed to ensure maximised good health. EVIDENCE: The personal support needs of individuals is varied .The community psychiatric nurse visits the home on a regular basis to see service users regularly and the home operates a key worker system. The home has forged partnerships with family, friends and professionals outside of the home for the benefit of the service users. The service users are all registered with a local General Practitioner. Records checked indicate that GP’s and other community based medical/health care professionals are contacted on an as needed basis. One service user is presently in hospital and awaiting possible surgery. It was evident that records of all medical/health appointment/visits were being maintained. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 15 The home has a policy on the administration of medication. Medications are stored in a locked cupboard. All medication administration records were up to date and accurate at the time of the inspection. It is recommended that the manager develop a service user’s medication profile with their photographs on them. This will help new staff to identify the service users more easily. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Complaints are generally managed well, which should ensure that service users’ and relatives’ concerns are listened to. The home’s policies and procedures help protect service users from abuse and help staff if they need to tell someone about any bad care practice they may see. EVIDENCE: The complaints procedure and book were seen. The complaints procedure was clear and contained all of the elements required to meet Standard 22 including a minimum response time of less than 28 days. There has been one complaint since the last inspection. The deputy manager assured me that it has been successfully resolved. The home has a detailed adult protection procedure and an appropriate whistle blowing procedure. It was previously required that the registered person must make suitable arrangements by training staff to prevent service user’s being harmed or suffering abuse or being placed at risk of harm and/or abuse. The manager stated that all staff apart from two have attended the training. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,26,28 and 30 The home is generally hygienic and clean, homely and comfortable; this environment therefore facilitates the service users’ health and emotional wellbeing. EVIDENCE: The home is suitable for its stated purpose. It is accessible, meet service users’ individual and collective needs in a comfortable and homely way. Service users’ bedroom are personalised to reflect their individual needs, and personalities. Overall the home was decorated to a reasonably high standard throughout and appeared to be very comfortable, bright and warm. The home has more than sufficient communal space that is both freely accessible to service users and is pleasantly decorated and furnished. There is ample space for all the homes service users to sit together in and receive visitors in private in either the homes lounge or the dinning room as they wish. In addition two small rooms also provide as private meeting / interview / quiet rooms at the front of the house upstairs. There is also a smoking room to the Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 18 rear of the house. The home has a small well-maintained garden with a patio area and lawn. The home is kept very clean and hygienic and free from offensive odours throughout. Systems are in place to control infection in accordance with relevant legislation and published professional guidance. However the COSHH cupboard was left unlocked (see standard 42). Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34 and 36 The service users are supported by appropriately qualified staff which raises the quality of staff and their practices. However not all staff have a job description and supervision records in place. One concern was identified in regard to recruitment checks not being completed satisfactorily, which impinge on the safety and protection of service users being ensured. EVIDENCE: The home has job descriptions for care workers only and these have clear lines of responsibility. Staff roles are well defined and are in keeping with the home’s current aims and objectives. However no job description was in place for the deputy manager or manager. The manager must ensure that all staff working in the home have a job description in place so that they are aware of their roles and responsibilities. Presently only the deputy manager has NVQ level 2 in the home. The home employs overseas trained nurses to work as care workers until they start their adaptation course to convert to UK registered. The manager stated that it is very difficult to recruit care workers. However he is actively looking into recruiting more staff. The registered person is reminded of the need to ensure Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 20 that 50 of the care staff has, as a minimum an NVQ level 2 qualification by the end of 2005. Three staff files were sampled at random. It was noted that one file did not have the staff identification or photograph. It was previously required that the registered person must ensure copies of Birth Certificates, Passports (if any); a recent photograph; enhanced CRB check and any other documents laid down in this standard or schedules are available for inspection in the home at all times in respect of all staff employed. This requirement will therefore be repeated. No supervision records were available at the times of inspection. The proprietor said that she has taken them home for updating. The manager must ensure that supervision records are available at all times in the home for inspection and that all staff receive regular supervision. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,40 and 42 The home has an excellent quality monitoring system. This ensures the home is run in a way that is in the best interests of the service users. Generally the health, safety and welfare of the residents and staff were being promoted and protected however there is a need for staff to be more vigilant with regards to the storage of cleaning fluids in locked cupboards. EVIDENCE: The Registered Provider who manages the home is a Registered Mental Health Nurse; he is in the process of completing an NVQ 4 in management. He has extensive experience of managing care establishments; having managed this home for eighteen years and ten years previous management experience in mental health hospitals. The deputy manager is undertaking the NVQ 4 in management and the NVQ assessor course. The home had an external audit, which was carried out on the 10th of May 2005.Most of points on the report were positive about the home and the care Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 22 being provided. The home has forwarded its annual development plan to CSCI, as this was a requirement from the last inspection. The home has a range of policies and procedures that are required by legislation. Those that were sampled were signed and dated. The home has in place a rolling programme of training in manual handling, food hygiene, first aid and medication. Certificates of which were available on request. Infection control training is being undertaken. Hazardous substances are stored in a cupboard but the door was unlocked. The home must ensure that the COSHH cupboard is kept locked at all times when not in use. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 3 x x x 3 Standard No 11 12 13 14 15 16 17 3 x 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 2 3 x 2 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Enmore Lodge Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 3 x 2 x G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5 Requirement The home must ensure that a copy of the latest inspection report is included in the Service User’s Guide. The manager must ensure that accurate records are kept as far as service users’ monies are concerned. The manager must ensure that all staff working in the home have a job description in place so that they are aware of their roles and responsibilities. The registered person must ensure copies of Birth Certificates, Passports (if any); a recent photograph; enhanced CRB check and any other documents laid down in this standard or schedules are available for inspection in the home at all times in respect of all staff employed. The manager must ensure that supervision records are available at all times in the home for inspection and that all staff receive regular supervision. The manager must ensure that all hazardous materials are kept Timescale for action 30/09/05 2. 7 17(2) 30/09/05 3. 31 18(1)(a) 30/09/05 4. 34 17(2) 30/09/05 5. 36 18(2) 30/09/05 6. 42 13(4)(a) 30/09/05 Page 25 Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 locked in accordance with Control of Substances Hazardous to Health Regulations.. 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 20 Good Practice Recommendations It is recommended that the manager develop a service user’s medication profile with their photographs on them. This will help new staff to identify the service users more easily. Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 Page 26 Commission for Social Care Inspection 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Enmore Lodge G53 S25780 EnmoreLodge V228160 090605 stage4.doc Version 1.30 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. 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