Inspection on 17/05/06 for Gibsons Lodge

This inspection was carried out on 17th May 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Gibsons Lodge 17/01/08

Gibsons Lodge 29/05/07

Gibsons Lodge 19/12/05

Gibsons Lodge 04/07/05

Gibsons Lodge 22/11/04

Gibsons Lodge 27/05/04

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

CARE HOMES FOR OLDER PEOPLE Gibsons Lodge Gibson`s Lodge Nursing Home Gibson`s Hill London SW16 3ES Lead Inspector Margaret Lynes Key Unannounced Inspection 09:25 17th May 2006 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 Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gibsons Lodge Address Gibson`s Lodge Nursing Home Gibson`s Hill London SW16 3ES 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 8670 4098 020 8670 4261 Gibson`s Lodge Limited Mrs Shola Oluyemisi Adedugbe Care Home 46 Category(ies) of Dementia - over 65 years of age (14), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (8), Old age, not falling within any other category (24) Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of 14 service users in the DE(E) category. Six specified service users in the Dementia - over 65 (DE(E)) category who are in excess of the 14 DE(E) service users that the home is registered for may reside at the home. As and when any of these service users are no longer in receipt of services from this home, the places will revert back to the Old age (OP) category. Six specified service users in the Dementia - over 65 (DE(E)) category who are in excess of the 14 DE(E) service users that the home is registered for OP service users, including the six specified service users referred to in condition no. 2. In order to cater for the needs of the service users, staffing levels must be maintained at the following levels: One of the qualified staff on each shift must be RMN qualified. The number of carers on each shift must be increased by one, thereby giving seven carers on each day shift and four on duty overnight. 23rd January 2006 3. 4. Date of last inspection Brief Description of the Service: Gibson Lodge is a 46-bed nursing home set in a quiet residential area, yet well placed for access to local transport links. The home caters for up to 14 elderly residents with dementia, and 32 elderly infirm clients. Accommodation is provided in a mix of single and double rooms. There are several communal areas, and the home benefits from a very attractive, large garden. The stated aim of the home is to provide the residents with a secure, relaxed and homely environment in which their care, well being and comfort are of prime importance. The home provides information about its services in a Service User Guide, which is made available to current and potential Service Users. Additional information can be found in the home’s Statement of Purpose. The current weekly fees (as provided at the time of this inspection) range from £505 £625. Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During the course of the last inspection year Gibsons Lodge received an additional visit due to concerns that requirements made in inspection reports were not being promptly met, it met at all. While it was evidenced (at that additional visit) that the existing requirements had been met, four issues were raised with regard to service user files. This visit incorporated these four issues, along with inspection of the key Standards. This visit has resulted in twelve new requirements being made, including the work that still needs to be done with regard to the four issues mentioned above. Following a visit to the home from the London Fire and Emergency Planning Authority (LFEPA) in January, the Commission was concerned to receive a copy of a Notice indicating that the home did not meet fire safety standards. This prompted a letter to the proprietor of Gibsons Lodge from the Commission reiterating how serious an issue this was, and seeking assurances that the issues raised would be dealt with. The proprietor duly gave written assurances that the matters had been attended to. It was of further concern to therefore receive a copy of a second Notice from the LFEPA stating that the earlier Notice had not been complied with and granting a short extension on the deadline for compliance. On this key inspection it was evidenced that the Notice had finally been met however it reflects poorly on the home both that the Notice had to be issued initially and also that the Commission was given assurances that the matter had been dealt with only to later find out that it had not. It should be noted that the home is currently without a Registered Manager, as the previous incumbent chose to move on to pastures new a little over a month before this inspection. Evidence to support the comments below was gathered from a range of sources – the service users themselves, relatives and visitors, members of staff and inspection records. What the service does well: What has improved since the last inspection? Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 6 Following the additional inspection mentioned overleaf, the manager was asked to improve four areas of record keeping, and to look into ways to bring the overall standard of care up to the next level – from an adequate service to a good service. Clearly, with the departure of the manager, proactive plans to improve the service have not been put into place. What was noticeable, however, was that there appeared to be better camaraderie between the staff of all grades, which in turn can only improve the level of service provided to the residents. 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. Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 is not applicable) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home conducts pre-admission assessments so that the needs of potential service users are identified. This means that each service user can be reassured that the home has taken into account their individual needs, and feels that it can meet them; and the staff in the home can be as familiar as possible with new service users, and have an understanding of what specific service they will need to provide. EVIDENCE: The files of six recently admitted service users were examined. All files contained the home’s own pre-admission form, duly completed, and also information from the placing Authority (where there was one). Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service user plans seen did not adequately covered the social care needs of the service users. This means that the staff team may not be fully aware of the differing needs of their residents, and know what specific care should to be given. Incomplete medication administration records means that potentially, service users health may be compromised. Lack of information regarding the action residents would like staff to take in the event of their [the service users] death means that it is feasible that their wishes may not be followed. EVIDENCE: While all of the service user files inspected contained a care plan, and indeed improvements had been made in that almost without exception monthly reviews were being carried out, and staff were cross referencing the plan to the daily records, not all of them contained reference to the individual service user’s cultural and ethnic needs and preferences – including meeting religious needs. Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 10 With the exception of the errors found on the medication administration charts, it was felt that service users health needs were being adequately met. Issues with the medication charts have been raised on previous visits and although there had been improvements, this has not been sustained and a number of errors were again found. These errors, more than any other issue have led to the poor rating of these particular Standards, as while the care records needed to be better, the care given was adequate. The service users spoken with were unanimous in their praise of the staff team, commenting that they found them helpful, kind, and respectful. Although the resident information records that are used have specific space in which staff can record a resident’s wishes in the event of their serious illness and death, staff were not making use of it and nothing had been recorded in the files inspected. This is important information and staff must make every effort to obtain it. The home also needs to have in place a resuscitation policy and procedure, which includes guidance for staff when calling an ambulance. Three recommendations have been made with regard to recording – specifically 1] for staff to ensure that they record when relatives have been informed about accidents; 2] to ensure that staff document when they have followed specific care instructions (i.e. if a care plan says a service user needs to be toileted every 2 hours then staff need to evidence that this is being done); and 3] to be consistent in the proforma used to document wound care. Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home now an activities co-ordinator who provides a number of recreational activities, so as to satisfy the service users social and recreational needs, and individual choice and control is encouraged. This means that the lifestyle in the home more closely matches residents’ expectations and preferences. Service users receive well-cooked meals, however more consideration needs to be given to the variety of food offered and [on occasion] the presentation of it. Visitors are made welcome. EVIDENCE: The service users spoken with said that they felt that they were provided with a sufficient number of activities however one visitor commented that more consideration could be given to what channel the television is on, as often it was just blaring out with a programme that none of the residents appeared interested in. As commented in previous sections, more attention needs to be given to assessing each service users social needs so that appropriate activities can be planned for them. These assessments must give consideration to religious needs as one resident stated that they would very much like to see a vicar on a regular basis but no such arrangements had been made. Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 12 The food provided for lunch during the inspection appeared well presented, appetising and hot. The evening meal, however, was not so well presented, with little consideration given to how foods were mixed together. Several service users expressed a wish for the occasional salad, but said that it was never on offer. Comment was also made about changes being made to the advertised meal, without consultation. The menu itself lacked imagination, with similar meals being offered on consecutive days, particularly with regard to the dessert. The home has a very able chef and more should be made of his talents. Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure in place, which is accessible to service users. There is also an adequate adult protection procedure in place which, if followed by staff, will offer sufficient protection to service users. EVIDENCE: The complaints log contained just one entry, which did not actually relate to a complaint about the home but rather about the service received prior to a resident arriving at Gibsons Lodge. At previous inspection visits the need for the home’s adult protection policy and procedure to be revised has (on a number of occasions) been highlighted. At long last the documents have been amended to bring them into line with the Local Authority’s multi-agency procedure but for some reason the manual still also contains the old procedure. This should be removed to avoid confusion. The home had also been asked to revise the restraint procedure. While there was no evidence of a revised document on this visit, the Inspector is aware that a revision has been done, as it was present in one of the proprietor’s other homes. A copy should, therefore, be obtained for this home. It was noted in the minutes of a staff meeting the previous November that bruising was discussed. Staff were apparently advised that in the event of bruising or any other adult protection concerns, an investigation was at the Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 14 manager’s discretion. This is incorrect and it is of concern that in spite of the revised procedure staff were still being wrongly advised. A requirement has been made, therefore, for the registered person to ensure that all staff are familiar with the correct adult protection procedure. Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In general the premises were well-maintained. Service users were therefore being provided with a safe and comfortable environment. EVIDENCE: A tour was made of the communal areas and some of the bedrooms. They were found to be clean and comfortable. Redecoration of the entrance hallway was underway. The colours chosen were light pastel shades, which brightened the hallway and were pleasant to look at. A number of service users were asked for their opinion of the home and their own bedrooms. They were unanimous in stating that they were satisfied with the home environment and its facilities. The visitor who was present during part of the inspection shared this view. It was particularly pleasing to note that on entry to the home there were no unpleasant odours. Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The rota provided indicated that staffing numbers were satisfactory, given that there were seven vacancies. This means that the needs of service users should be attended to promptly. Following on from a Statutory Enforcement Notice, the recruitment practice had improved. On this visit, however, there had been a little slippage, meaning that service users were not being fully supported and protected by the recruitment practice. On this visit it was not possible to evidence that the staff team in general had attended any recent training. This means that it is feasible that the staff team has not had the appropriate training to care for the service users at Gibsons Lodge. EVIDENCE: The staffing levels for this home have been agreed at 3 qualified staff with seven carers on in the morning; two qualified staff with seven carers on the afternoon/evening shift; and 2 qualified staff with four carers on duty overnight. An additional carer (included in the aforementioned numbers) had been required last year due to the high number of service users in the home with dementia. Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 17 The rota provided indicated that there were a satisfactory number of qualified staff on duty (albeit it was not possible to determine that there was an RMN on each shift [as previously required] as this information was not recorded on the rota – a requirement will be made to this effect) however on most shifts the number of carers was one below that required. This having been said, the home, at the time of this visit had seven vacancies. Provided the carer numbers are increased as the occupancy level rises, then the current levels are deemed to meet the minimum numbers required. Recruitment practice had improved greatly so it was a pity to find one file where the member of staff had started work with only one reference. More attention also needs to be paid to checking employment histories - to ensure that any gaps are explained and also that an explanation is given as to why (where applicable) an individual had left previous employment working with vulnerable people. The staff files inspected were very good with regard to evidencing induction of new staff. What could not be evidenced however was any other training that might have been undertaken, and there was no indication that a staff development and training plan had been put into place. A number of care staff had achieved NVQ level II awards. Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A number of concerns regarding quality assurance, staff supervision and the lack of a registered manager means that the health, safety and welfare of both service users and staff is neither promoted or protected to the extent expected. EVIDENCE: While the proprietors have taken identified a potential new manager, until that individual has actually commenced in that post and been registered it is not possible to determine that they are suitable for the position, albeit on paper they would appear to have the relevant qualifications and experience. Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 19 The previous manager had slowly started to build quality assurance systems but since her departure, although some audits have been carried out, the developmental work has come to a halt. The new manager needs to work on quality assurance systems as a matter of urgency therefore, and they must include periodically seeking the views of service users, relatives, friends and other visitors, staff and stakeholders. The results of these surveys should be made public. A small number of the service users in the home have their pocket money looked after at the proprietor’s head office. While this is not problematic, provided they have access to it at all times, there must also be records kept in the home should the service users have any queries, and so that there is a clear audit trail (as staff in the home may have to purchase items on the service user’s behalf). There was nothing to evidence that care staff were receiving regular supervision. Even in the absence of a registered manager this task can be undertaken by the senior nurse or, indeed, by the proprietor’s general manager. The vast majority of the maintenance contracts for the home were up to date, including electrical installation, fire fighting equipment, hoists, the lift, portable electrical equipment, pest control and waste disposal. The home is to be commended for receiving a hygiene award from the Local Council’s environmental health department following a recent food hygiene inspection. The only outstanding issue was an annual check of the water systems re Legionella disease. Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 2 X 2 Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 21 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. 2. Standard OP7 OP9 Regulation 15 13 Requirement Service user plans must include reference to social care needs. Staff must ensure that they accurately complete medication administration charts at all times. Staff must ascertain and record the wishes of each service user in the event of their serious illness/death. A resuscitation policy & procedure also need to be established. Service users must be provided with a varied menu, which is in accordance to their established preferences. The registered person must ensure that all staff are familiar with the correct procedure to follow in the event of suspected abuse. The staff rota must indicate the qualifications of nursing staff. The registered person must ensure that all staff provide the required documentation before commencing work. The registered person must ensure that there is a staff DS0000019026.V295611.R01.S.doc Timescale for action 30/06/06 17/06/06 3. OP11 12 30/06/06 4. OP15 16 17/06/06 5. OP18 13 30/05/06 6. 7. OP27 OP29 17 19 30/05/06 17/06/06 8. OP30 18 30/06/06 Gibsons Lodge Version 5.2 Page 22 9. OP31 8 10. OP33 24 11. OP35 17 12. OP38 23 training and development plan in place and that training can be evidenced. The registered person must employ and submit for registration a manager as a matter of urgency. The registered person must ensure that there are satisfactory quality assurance systems in the home. The registered person must ensure that a copy of all financial transactions made on behalf of service users is kept in the home, so that there is a clear audit trail should one be required. The registered person must ensure that there is an annual test conducted on the water system re Legionella disease. 30/06/06 30/06/06 30/05/06 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP8 OP8 OP8 OP12 OP15 OP27 Good Practice Recommendations Staff should ensure that they record when they have followed specific care instructions (i.e. regular toileting). Staff should be consistent in the use of proforma to record wound care. Staff must ensure that they document when relatives have been informed of accidents to service users. Further consideration should be given to activities, in particular the use of the television. Attention should be paid to how meals are presented, so that they appear appetising. It would be helpful if the rota indicated which care staff had achieved an NVQ award (or for this record to be readily available elsewhere) Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 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 Gibsons Lodge DS0000019026.V295611.R01.S.doc Version 5.2 Page 24 - 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. 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