Inspection on 09/08/05 for Friars Lodge

This inspection was carried out on 9th August 2005.

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

Friars Lodge 04/08/09

Friars Lodge 22/09/08

Friars Lodge 28/09/07

Friars Lodge 15/11/06

Friars Lodge 01/12/05

Friars Lodge 09/03/05

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

CARE HOMES FOR OLDER PEOPLE Friars Lodge 18 Priory Road Dunstable Beds LU5 4HR Lead Inspector Leonorah Milton Unannounced 9 August 2005 th 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 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. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Friars Lodge Address 18 Priory Road Dunstable Beds LU5 4HR 01582 668494 01582 670966 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) Friars Lodge Ltd Mrs Sarah Kennett Care home 20 Category(ies) of DE(E) Dementia over 65 years - 20 registration, with number PD(E) Physical disability over 65 years - 20 of places OP Old Age - 20 Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 09.03.05 Brief Description of the Service: Friars Lodge was a private residential home, registered to provide for twenty older people, some of whom may have physical disabilities and/or dementia. The registration for physical disabilities was not applicable because the home was not adapted to provide for service users under this category. Existing service users who had mobilty and similar needs associated with old age could be accomodated under the category for old age (OP). Ownwership of the home transferred to Friars Lodge Ltd towards the end of 2004. The manager was appointed at that time. The directors of the new ownership were estabished care home providers in the vicinity. The home was located in a pleasant residential area of Dunstable within close proximity to the Priory and the town’s amenities.The building provided a comfortable environment. The bedrooms were distributed on three floors that were accessible by staircases and a series of chairlifts. Building works to install a shaft lift had commenced. Toilets and adapted bathing facilities were located for convenient access throughout the building. A large lounge/diner and a small visitors/television lounge were situated on the ground floor.The lounge overlooked an established and well maintained garden to the rear of the property. Parking was provided for a few vehicles to the front of the building. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 4.50 hours. The manager was present to assist for the majority of this time but had to leave before it’s conclusion and therefore did not receive a comprehensive feedback. The methods of inspection included a review of the case files for three service users, conversations with these three people and an assessment of their private accommodation and other areas of the building. Other relevant records were also inspected. Discussions took place with the manager and a care assistant. Briefer conversations also took place with the deputy and a senior care assistant. The evening meal was observed in progress. The home had a deserved local reputation for many years for providing a comfortable and caring service. However at inspection there had been significant shortfalls in the underpinning documentation to evidence practice and to maintain some aspects of the safety of the environment. The last inspection showed that the new ownership/management had begun to improve these situations. At this inspection whilst there had been progress to improve documentation and staff training, safety aspects of the service that had been detailed on the previous report had not been met. As a consequence notices were issued at this inspection that required the proprietor to take action within short timescales. What the service does well: The home, whilst adapted for the needs of frail older people, had retained its homely appearance. Areas of the building seen at this inspection were clean and orderly. Each service user spoken to at this inspection remarked on the comfort of the accommodation. The daily business in the home was conducted in an unhurried atmosphere that was conducive to service users’ well being. Complimentary comments were also passed about members of staff who were described as “kind”. One service stated that staffing arrangements were “satisfactory” and another person remarked on the respect they received from members of staff. Members of staff on duty were seen to engage service users in friendly conversation and to respond to requests for assistance promptly. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 6 Satisfaction was also expressed about meals in the home, breakfast and lunch being described as “lovely” and “ plentiful” but the evening tea as a little dull. Food stocks in the home were plentiful. Records indicated that referrals had been made to healthcare professionals as need be. The service users were all well dressed and groomed. There had been evident attention to their manicure and hair. What has improved since the last inspection? What they could do better: Reports under the previous ownership had raised concerns that the autonomy and choices of service users were being compromised because the reasons for limitations to their lifestyles had not been explicitly documented. There had been an evident effort under the new management to address these issues. However there continued to be some remnants of the previous culture. In some ways the approach to the care of service users was parenting rather than empowering. Examples of this was the comment passed by a service user that that she and others in the home were treated kindly but like children and the use of a restraining lap belt on a service user who on the day of this inspection was calm and occupied and showed no signs of agitation that may cause her to fall from the wheelchair. The team must receive guidance on approaches to service users that take account of the need to preserve their dignity and feeling of self worth. Training must also be provided on current best practice for working with people who have dementia. There had been a failure to take action of some maintenance and safety issues promptly. Windows that had been identified at the previous inspection of posing a risk of accidental fall had not been fitted with restrictors. The poor water flow to a service user’s washbasin that had been noted at her admission three weeks previously had not been repaired. There were delays to carry out tests on fire safety equipment, to carry out fire drills and to review the overall fire safety arrangements in the home. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 Service users had been provided with sufficient information about the service to enable them to make an informed choice about moving into the home. EVIDENCE: A service user who had been admitted to the home recently confirmed that she had been given copies of the home’s statement of purpose and service user guide and had visited the home several times before admission. Case files assessed at this inspection showed that contracts that included details specified by the National Minimum Standards (NMS) had been provided for each service user. Preadmission assessments of need had improved and whilst entries on the assessment for the most recent admission were a little brief, needs detailed by the NMS had been covered. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10. This was a caring service but one that showed a lack of understanding about the causes and effects of dementia and the need to preserve service users’ dignity by treating them as adults. EVIDENCE: Written care planning processes had continued to improve. The format for identifying assessments of need and how these would be met was of a good standard. The manager stated that she was aware that some progress was still outstanding to document limitations to freedom such as the use of restraints. Risk assessments were in place for the use of bedrails but did not sufficiently explain what the “ safety reason” was for their use. There were no guidelines in place for the appropriate use of the retraining lap belt. Daily progress reports had been maintained for each service user. The comments passed about the behaviour of a service user recently admitted to the home were inappropriate. They did not show insight into the trauma experienced by some service users as they enter residential care or take into account the particularly difficult family circumstances for this individual. The care plan also did not refer to these difficulties and the effect this might have on the service user’s emotional wellbeing. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 11 Whilst the procedures for the safe storage and administration of medications were not assessed in full it was noted that the senior on duty appeared confident in her abilities and knowledgeable about best practice for handling medication. She explained that she was undertaking a distance-learning course in medication procedures. It was noted that medications that must be stored under refrigerated conditions were kept alongside food in the kitchen refrigerator. These must be stored in an appropriate lockable container if this practice is to continue or alternatively a separate refrigerator designed for the storage of medications must be supplied. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 12 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 standard(s) 12,13,14,15 Daily routines in the home were organised for the benefit of service users. EVIDENCE: The service users who contributed to this inspection stated that they were satisfied with their day-to-day lifestyles in the home. It was explained that service users could get up and go to bed and take part in recreational activities as they wished. Some service users preferred to remain in their rooms. This preference had been accommodated. Meals were taken to service users in their private accommodation. There were no protocols for named personnel on each shift to monitor the arrangements for those service users who remained in their rooms but it was explained by a member of staff that such a system was not required as each member of the team was aware of the need to check on service users in their bedrooms. There was no advertised activity programme as required by previous reports. However service users stated that they were satisfied with the provision for activities, which were recorded as happening once or twice each week. Service users confirmed that their visitors were made welcome in the home. One person had continued to make trips out of the home for shopping, visits to the library and similar. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 13 One service user had continued to manage her personal finances. It was concerning that she that she could not secure money, papers or items of value because there was no lock to her bedroom door or a lockable facility within it. Menus showed a nutritious choice, however the hand written records of the daily provision did not correspond with the pre-printed menus seen at this inspection. Some service users took their meals on side tables. The reasons why service users did not join others at the dining table had not been documented as had been mentioned in the previous report. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 14 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 standard(s) 16,18 Satisfactory arrangements were in place to enable service users or their representatives to complain about the service. EVIDENCE: The previous report had noted, “The new proprietor had adopted the procedures provided by a professional consultancy. These were detailed and in accordance with the legislation. A summary of the procedure was identified in the service user guide.” At this inspection records indicated that complaints had been of a relatively minor nature and had been acted upon properly. It was noted that one record contained the proprietor’s response to a complaint but not the original letter of complaint, which was held at the central office. Complete records of each complaint must be held in the home and include any notes/reports of investigations. Training had been provided for some personnel to further knowledge about practice that could lead to the abuse of service users and how this must be prevented. Training was scheduled for others in the team. A carer stated that the training had been valuable and was relevant to all aspects of the delivery of care. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 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 standard(s) 19,20,21,23,24,25,26. The home provided a clean and comfortable environment but some aspects of safety had been compromised and posed a significant risk to service users. EVIDENCE: The building was clean, orderly, well decorated and furnished. The arrangements to prevent the spread of infection seen at this inspection were satisfactory. A mature garden to the rear of the property provided a good facility for service users to relax in. There was evidence to show that it had recently undergone some attention in an attempt to keep it up to the previous high standard. Privacy arrangements had improved by the fitting of a door to a ground floor toilet. Building works had commenced to install a shaft lift, the completion of which will greatly improve access to the upper floors for the less mobile. However action on risks to safety previously notified to the proprietor had been delayed Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 16 pending the start of the building works. This was not acceptable. Action on safety requirements must be given priority. This must include the issues mentioned in the summary of this report and the fitting of covers to the exposed radiator surfaces situated in the lounge and any others in the home that pose a risk of accidental burn. Bedrooms contained many items of a personal nature that reflected the occupant’s interests and past lifestyle. Rooms were without door locks or lockable facilities. This too must be addressed. It was noted that the two service users who shared a double room also had to share one wardrobe. Each must be provided with a wardrobe. The previous inspection had shown that there were problems with the heating systems of long standing. Free standing heaters that posed a risk of accidental burn had been used during cold weather. The requirement to ensure that the integral heating system be sufficient to heat the home will be carried forward on this report, the compliance date not due as yet. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 Staff presented as kind and caring but lacked knowledge in the care of those with dementia so that some aspects of service users’ needs remained unrecognised. EVIDENCE: Sufficient staff had been rostered to meet service users assessed needs. An established senior team had ensured that the staff had been supported and directed about their individual roles and the day-today routines of the home. The records for the daily rostering of staff were inadequate in that they did not show staff surnames, their job title, or the actual hours they were scheduled to work. The majority of the staff had worked at the home for a significant period and were well acquainted with service users’ needs. It was evident that they had a genuine interest in service users’ welfare. The provision for training under the previous proprietor had been inadequate. The new proprietors had been addressing this. It was difficult however to assess the current level of training at this inspection because the training record available after the manager had left the home had not been updated. However from discussions with staff it was apparent that there had been some improvement in safety training and procedures for the protection of vulnerable adults. There was still a need to ensure that all care staff have received training in safe moving and handling techniques and in the care of people with Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 18 dementia. As detailed elsewhere in this report some member of staff also needed guidance in service users’ rights to dignity and how they should be treated in order to preserve their self-esteem. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,35,36,37.38. The systems to manage the home had continued to develop the professional operation of the service but there had been omissions to safety requirements that put service users and others who used the building at risk. EVIDENCE: This was the manager’s first appointment to a manager’s post and she had experienced the inevitable difficulties of settling into a new role, which had been exacerbated by the change of ownership at her appointment. As mentioned on the report of the previous inspection, which took place shortly after her appointment, the manager had been well supported in her role. The organisation was a family run enterprise, the director of the organisation being her father and her line manager her sister in law. The deputy who had worked at the home for many years had also supported the manager in house. The manager spoke highly of the deputy’s skills and support. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 20 There had also been some settling in problems for personnel who were employed at the change of ownership. This seemed to have abated somewhat although it was reported that some members of staff were still a little reluctant to accept the change of culture that the new owners were gradually introducing. There had been staff meetings and the introduction of individual supervision and appraisal. Consultation had also taken place with service users and their representatives, some of who had also been apprehensive about the change of ownership. On the whole the change of management had been well managed but it was evident that the manager had been hampered in her efforts because staff recruitment problems had meant that she had spent some of her working time alongside the staff on direct care related tasks. She must not loose sight of her responsibility to ensure that statutory health and safety issues and requirements from reports that fall within her remit are met within the stated action timescales. Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 3 3 x 3 2 2 3 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x 2 3 2 1 Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 22 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 7 Regulation 12(2)(3) Requirement The registered provider must ensure that opportunities for service users to exercise choice and autonomy are offered. Where a service user lacks the capacity to make informed decisions or where a risk assessment indicates the activity would be a risk, this must be documented and the reasons for not offering choice and autonomy recorded. (Previous timescales of 01.05.04 and 31.04.05 had not been met). Medications must be stored securely. This must include those for storage under refridgerated conditions. A daily activity programme based on a survey of service users’ preferences most be advertised and implemented as part of the day-to-day routines in the home. Appropriate activities based on current good practice guidance must also be provided for service users with dementia.(Previous timescale of 31.05.05 had not been met) The registered person must provide: Timescale for action 31.10.05. 2. 9 13(2) 31.10.05. 3. 12 16(1)(2) (m)(n) 31.10.05. 4. 24 23(2)(m) 30.11.05 Page 23 Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 5. 19 13(4)(a) 6. 25 23(2)(p) 7. 30 18(c )(i) 8. 30 18(c )(i) 9. 30 18(c )(i) 10. 38 26(4) (c )(e) 1.Each bedroom door with a suitable lock with individual key that will also permit staff access in the event of an emergency. 2.A lockable facility to each bedroom (two in the event of shared rooms.) Service users must be given the keys to their rooms and the lockable facility unless their risk assessment indicates otherwise. (Previous timescales of 31.12.04 amd 31.06.05 had not been met) Restrictors must be fitted to all windows that pose a risk of accidental fall.(Previous timescale of 31.06.05 had not been met. An immediate requirement notification was issued at the inspection ) The integral heating system must be repaired so that the reliance on freestanding heaters to provide back up heating is unnecessary. Staff who carry out manual handling tasks must receive training in safe techniques to do so. Staff must receive training about the needs of service users with dementia and how these can be best met. Staff must receive guidance/training on how service users are to be spoken to/cared for to preserve service users dignity. 1.Fire alarms must be tested weekly. 2.Emergency lighting must be tested monthly. 3.Staff must attend a minimum two fire drills each year.(Previous timescale of 31.03.05 had not been maintained in full. An immediate requirement notification was 31.08.05 31.08.05. 31.10.05. 30.11.05 31.10.05. 1. 17.08.05 2. and 3. 31.08.05 Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 24 issued at this inspection) 11. 38 13(4)(a) Exposed radiator surface or hot water pipes must be covered to prevent the risk of accidental burn. 30.09.05. 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 22 Good Practice Recommendations The registered person should arrange for the premises to be assessed by a qualified occupational therapist. (Planned.) Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 25 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF 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 Friars Lodge I51 S62259 Friars Lodge V238566 090805 Stage 2.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!