Inspection on 27/10/05 for George Mason Lodge

This inspection was carried out on 27th October 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

George Mason Lodge 18/04/06

George Mason Lodge 31/05/05

George Mason Lodge 26/01/05

George Mason Lodge 19/08/04

George Mason Lodge 16/03/04

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

CARE HOMES FOR OLDER PEOPLE George Mason Lodge Chelmsford Road Leytonstone London E11 1BS Lead Inspector Rob Cole Unannounced Inspection 27th October 2005 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 George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 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. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service George Mason Lodge Address Chelmsford Road Leytonstone London E11 1BS 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) 020 8496 3000 London Borough of Waltham Forest Mr Peter Kenneth Stanley Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st May 2005 Brief Description of the Service: George Mason Lodge is a registered care home for elders situated in the Leytonstone area of the London Borough of Waltham Forest. The home is run by the Local Authority. The home also includes the provision of a nine bedded intermediate care facility that was set up in March 2003 to provide a period of short term rehabilitation, using specialist occupational and physiotherapy interventions to a similar group pf service users. It is a joint health and social services undertaking with the overall managerial responsibility vested in the registered care manager. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 27/10/05 and was unannounced. The inspector had the opportunity of speaking with service users, relatives, staff and the homes acting senior residential social worker was present throughout the inspection. Overall the inspector was satisfied that this is a well run home, providing high levels of individualised care to service users. Service users spoken to expressed satisfaction with the home, as did relatives. One relative informed the inspector that they were “Really happy with the home”. There are some issues that must be addressed, as highlighted in the report. What the service does well: What has improved since the last inspection? What they could do better: Despite the overall quality of care provided, there are some issues that must be addressed. As at previous inspections, the home is still in need of replacing rotting window frames around the building. Thorough pre admission assessments must be carried out and recorded for all prospective service users, and it is required that the fire risk assessment is subject to regular review. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 6 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. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 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 George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 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): 1,2,3,4,5 and 6 The inspector was satisfied that service users are provided with sufficient information about the home to make an informed choice as to move in or not. This information is provided through written documentation and the chance to visit the home. However, the home must ensure that comprehensive pre admission assessments are carried out on prospective service users. EVIDENCE: The home has a Statement of Purpose and Service User Guide in place. Both documents are clear and comprehensive. The Statement includes details of the organisation and management, the aims and objectives of the home and all information required by Schedule 1 of the Care Homes Regulations 2001. The Statement also includes a section on the homes Intermediate Care Unit (ICU). The Service User Guide includes details of the physical environment and the homes complaints procedure. All service users are provided with a statement of terms and conditions, which includes fees payable and what they cover, accommodation provided and the care and services which the home offers. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 9 These statements are signed either by the service user, or their representative as appropriate. The home has copies of community care assessments carried out by social services for service users. The senior staff on duty informed the inspector that either the home’s manager or deputy manager will visit prospective service users in their own homes to carry out a pre admission assessment. However, these assessments are not recorded. It is required that not only are assessments carried out, but they are clearly recorded, so that the home can demonstrate what the needs of individual service users are, and whether or not the home is able to meet those needs. Since the previous inspection the home has now become registered to admit service users with dementia and mental health issues. The inspector was informed that the home had a number of vacancies. However, at the time of the inspection the proposed dementia unit was undergoing a considerable amount of redecoration, to the extent that during the daytime several service users did not have access to their bedrooms or some of the communal areas, noticeably the corridors. It is the view of the inspector that whilst this situation remains the same, the home would not be able to meet the needs of prospective service users in the areas of the home undergoing decoration, and that no further admissions should be made to these areas of the home that are been decorated until the work is complete. At the last inspection it was found that a service user had been inappropriately admitted to the home, and that the home was unable to meet all their needs. The inspector was pleased to note that this service user has since left George Mason Lodge, and moved on to more appropriate accommodation. The home has an admissions procedure. This states that prospective service users will be given the opportunity of visiting the home prior to making any decision as to move in or not. Service users will initially move in on a six week trial basis, after which a placement review meeting will be held, attended by the service user, their family, social worker and staff from the home. Service users spoken to confirmed to the inspector that they had indeed had the opportunity of visiting the home before moving in. Through observation and discussion there was evidence that the home is able to meet the collective and individual needs of service users. Staff demonstrated a good understanding of individual service users needs, and were seen to support them in a sensitive manner. Staff showed a good ability to communicate with service users, some of whom have complex communication needs. The home has a designated nine bed ICU Unit. The Unit was well maintained and decorated to a high standard, and all service users have their own ensuite bedroom. The home also has a therapy room for service users in this unit. The George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 10 unit is staffed by a therapy team consisting of physiotherapists, rehab assistants and occupational therapists and care staff. Service users in the ICU unit said they were generally satisfied with the level of care and support provided. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 11 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 and 11 The inspector was satisfied that the home is able to meet the personal and health care needs of service users. Medications are stored, recorded and administered appropriately, and care planning is of a good standard. EVIDENCE: All service users have care plans in place. Plans are in plain English, and drawn up with the involvement of service users, their relatives and staff from the home. Plans covered medical, mobility, health and social and leisure needs. There was evidence that plans are reviewed monthly. Daily logs are maintained, and these are linked to care plans. Service users also have risk assessments in place. These are clear and comprehensive, and based around the individual service user. For example, it has been identified that one service user is prone to wandering outside the building, a risk assessment is in place around this, including strategies to manage and reduce the risk. All service users are registered with a GP, and are able to keep the GP they had prior to admission where practical. Service users have access to health care professionals as appropriate, and since the last inspection there was evidence that service users now have access to regular dental and eye care. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 12 Records are maintained of medical appointments, but these are kept in several different places, e.g. some are recorded in the homes diary, some in service users daily logs, while there are separate books for recording dental appointments and appointments with the optician, thus making it difficult to track and monitor the health care received by service users. Further, records are not comprehensive, for instance one service user was recently seen by a dentist, the record of this appointment merely states “needs further treatment”, but there was no indication of why or when this treatment would take place. It is required that clear, comprehensive and easily accessible records are maintained of all medical appointments, including details of any follow up action necessary. The home makes use of the Continence Advisory Service, and used continence products are disposed of appropriately. Service users are able to see visiting health professionals in private. The home has a comprehensive medication policy in place, and staff receive training before they are able to administer medications. The supplying pharmacist carries out a monthly visit to inspect the storage, recording and administration of medications within the home. Medications are stored securely in locked cabinets within each unit. Records are maintained of medications entering the home and of those that are returned to the pharmacist. Medication Administration Record (MAR) charts are maintained, those checked by the inspector appeared to be accurate and up to date. Since the last inspection hand written entries on MAR charts are now signed. Through observation and discussion there was evidence that service users privacy and dignity is respected. The laundry system helps ensure that service users only wear their own clothes, and all were appropriately dressed on the day of inspection. Screening is provided in shared bedrooms, and staff were seen to knock and wait before entering bedrooms. The home seeks and records the wishes of service users on arrangements to be made in the event of their death, and staff informed the inspector that service users are able to remain in the home with a terminal illness, as long as the home can meet their medical needs. One service user expressed sadness over the death of another service user to the inspector, the inspector was pleased to note the level of support provided to this service user, and the fact that they were supported to attend the funeral in line with their wishes. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None The standards in this section were not tested as part of this inspection, but will be assessed during the next inspection. EVIDENCE: The standards in this section were not tested as part of this inspection, but will be assessed during the next inspection. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 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 the following standard(s): 16,17 and 18 It is the view of the inspector that the home has taken appropriate steps to help ensure the safety and protection of service users. Polices and procedures are in place around complaints and adult protection, and staff have undertaken suitable training. EVIDENCE: The home has a complaints procedure. An abbreviated version of this was prominently displayed within the home, and this made appropriate reference to the CSCI. The home maintains a complaints log. The inspector was satisfied that any complaints received by the home are appropriately recorded and investigated. Service users and relatives spoken to demonstrated a good understanding of whom they could complain to if they so wished. The home is run by the Local Authority, and has a copy of the Local Authorities adult protection procedures. All but one of the staff team have undertaken training in adult protection issues, and this person is due to attend training in January 2006. Staff spoken to demonstrated a good understanding of the issues around adult protection. There was evidence that service users legal rights are protected, for example all service users are on the electoral register, and service users spoken to informed the inspector that they are able to vote in elections. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 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): 19,20,21,22,23,24,25 and 26 The inspector believes that physically the home is suitable to meet its stated purpose. Service users have adequate communal and private space, and the home was generally well maintained and domestic in character. EVIDENCE: The home is situated in the Leytonstone area of the London Borough of Waltham Forest, close to shops, transport networks and other local amenities. The home is built over three floors; service users are accommodated on all three floors. The home was generally well maintained. Some work has been done to address rotting window frames since the last inspection, but more still needs to be done. Staff informed the inspector that hopefully this work will be done in the near future. The home provides adequate communal sitting and recreational space for service users, consisting of sitting rooms, dinning areas and a well maintained garden with appropriate garden furniture. The home has a designated smoking area. The home was generally clean and tidy, and furniture was well maintained and domestic in character. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 16 The home has suitable bathing and toilet facilities to meet service users needs. These are situated throughout the home with locks fitted. Many of the baths are adapted to make them accessible to service users. On the day of inspection bathrooms and toilets were clean, tidy and free from offensive odour. All bedrooms in the ICU are ensuite. At the last inspection one toilet was found to be unmarked, this has been addressed. The inspector checked several service users bedrooms, all of which were clean, tidy and free from offensive odours. Bedrooms were decorated to service users personal tastes, with family photographs much in evidence. Rooms had adequate furniture, including wardrobes and chest of draws. Bedding, carpets and curtains were well maintained and domestic in character. Bedrooms meet National Minimum Standards on size requirements. All bedrooms have central heating, and radiators all have appropriate protective covering. Lighting in rooms is domestic in character, and there is emergency lighting situated throughout the home. Bedrooms have adequate natural light and ventilation. The home has a policy in place on infection control. There are sluice rooms on all floors, and used continence products are disposed of in a macerator. Protective clothing such as gloves and aprons are available for staff. The home employs designated laundry staff, and the laundry room was well maintained, with an impermeable floor. Hand washing facilities are situated within the laundry room, and throughout the home. As stated, at the time of inspection there was a considerable amount of decorating work taking place within the home. Both communal space and service users bedrooms are been redecorated, and whilst the inspector recognizes that this work has caused some temporary inconvenience, it is nevertheless a welcome development. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 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): 27,28,29 and 30 It is the inspector’s judgement that the home is staffed in sufficient numbers to meet service users needs. Staff appeared to be well motivated and to have a good understanding of their roles and responsibilities. The inspector was particularly impressed with the level of training provided around mental illness and dementia. EVIDENCE: The home provides 24-hour support, including an emergency on-call procedure. As well as care staff, the home employs therapy staff, administrative staff, laundry staff, cleaning staff and cooking staff. There was a staffing rota on display within the home, this accurately reflected the actual staffing situation on the day of inspection. All staff are provided with a copy of their job description, and staff spoken to demonstrated a good understanding of their roles and responsibilities. All staff employed by the home are 21years old or above. The home has policies in place on equal opportunities and recruitment and selection. As the manager was not present, the inspector was unable to check staff employment records, and these will be checked as part of the next inspection. All staff undertake a structured induction programme on commencing work at the home, which includes service user issues and health and safety. Training is on going, and the home keeps records of staff training. These evidenced that George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 18 staff have recently attended training in first aid, IT skills, food hygiene and manual handling. The inspector was pleased to note the level of staff training taken in preparation for the homes registration to admit service users with mental health issues and dementia. Training in these areas has been comprehensive and widespread, and not just restricted to the care staff. Of the ten care staff employed at the home the inspector was informed that eight either have or are currently working towards a relevant care qualification, and that the other two are scheduled to begin such a qualification next year. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,37 and 38 The inspector was satisfied that the manager is sufficiently experienced to carry out their duties, and that George Mason Lodge is generally a well run and well managed home. EVIDENCE: The home has a manager, deputy manager and acting senior residential social worker in place. The manager has twenty one years experience of working in residential care, including seventeen years in a managerial capacity. They have a qualification in social work, and NVQ Level 4 in management. Service users spoken to informed the inspector that they found the manager to be approachable and accessible. Staff meetings, service user meetings and staff supervisions all contribute to the quality assurance within the home. The home issues questionnaires to service users and their relatives to gain their feedback on the running of the George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 20 home. Completed questionnaires seen by the inspector contained generally positive feedback. The home had copies of previous inspection reports available to view. Record keeping was of a good standard, records were stored securely, staff and service users can access their records as appropriate. However, the home could not evidence that monthly unannounced Regulation 26 visits have been taking place. It is required that they take place, and that a copy of the report of this visit is retained in the home and available for inspection, and a copy forwarded to the CSCI. All staff receive formal supervision. Supervision is shared between the home’s manager, deputy manager and senior residential social worker. Since the last inspection there was evidence that supervision now tales place at least six times a year. Supervision covers performance, training and service user issues. Staff also receive an annual appraisal. The home has various health and safety policies in place, for instance on infection control and COSHH. Staff undertake statutory health and safety training, including first aid and manual handling. Fire fighting equipment was situated throughout the home, and was last serviced in June 2005. Fire exits were clearly signed and free from obstruction. There was evidence of regular fire drills, and fire alarms are tested weekly. Alarms were last serviced on the 9/9/05. The home had a fire risk assessment in place, however, this dated from August 2001, and it is required that this is reviewed. The home had in date safety certificates for PAT and electrical installation, and since the last inspection for gas safety. There was evidence that the lifts, hoists and hydraulic baths are all serviced as appropriate. COSHH products were stored securely, and there were well stocked first aid boxes around the home. The home tests and records fridge/freezer and hot water temperatures. George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x x 3 3 2 George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23 Requirement The registered person must ensure that the rotting window frames are repaired or replaced. (Timescale 30/9/05 not met) The registered person must ensure that thorough preadmission assessments are carried out on all service users prior to them been admitted to the home, to ensure the home can meet all the assessed needs of service users. (Timescale 30/9/05 not met) The registered person must ensure that clear, easily accessible and comprehensive records are maintained of all medical appointments, including details of any follow up action necessary. The registered person must ensure that monthly unannounced Regulation 26 visits take place, and that the home retains a copy of the reports of these visits available for inspection, and that a copy is forwarded to the CSCI. Timescale for action 28/02/06 2. OP3 14 28/02/06 3. OP8 13 28/02/06 4. OP33 26 28/02/06 George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 23 5. OP38 13 and 23 The registered person must ensure that the home’s fire risk assessment is subject to regular review. 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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 George Mason Lodge DS0000036539.V257674.R01.S.doc Version 5.0 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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