Inspection on 10/02/06 for Hamilton Lodge

This inspection was carried out on 10th February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hamilton Lodge 15/09/09

Hamilton Lodge 11/06/09

Hamilton Lodge 07/05/08

Hamilton Lodge 15/05/07

Hamilton Lodge 20/07/06

Hamilton Lodge 06/09/05

Hamilton Lodge 25/03/05

Hamilton Lodge 01/11/04

Hamilton Lodge 15/12/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Hamilton Lodge Rectory Road Great Bromley Colchester Essex CO7 7JB Lead Inspector Neal Cranmer Unannounced Inspection 10th February 2006 09:30 Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 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 Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 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 Adults 18-65. 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. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hamilton Lodge Address Rectory Road Great Bromley Colchester Essex CO7 7JB 01206 230298 01206 231166 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) Hamilton Lodge Trust Limited Mr E Curtis-Oram Care Home 40 Category(ies) of Learning disability (40), Learning disability over registration, with number 65 years of age (40), Physical disability (40), of places Physical disability over 65 years of age (40) Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may accommodate 40 persons of either sex under the age of 65 with learning disabilities who may also have physical disabilities The home may accommodate 40 persons of either sex aged 65 years and over with learning disabilities who may also have physical disabilities The total number of service users accommodated in the home must not exceed 40 persons 6th September 2005 Date of last inspection Brief Description of the Service: Hamilton Lodge is a care home registered to provide personal care and support to forty people who have a learning disability and/may also have a physical disability. Registered accommodation is provided in three units, which cater for varying levels of dependency and need. The main residence is the large country manor house, Selbourne Court is a newer, separate, ground floor unit built on a site adjacent to the main house and the third unit is a small cottage where service users experience small group living on a domestic scale. Each unit is staffed separately and led by a home manager. The home is set in vast well maintained grounds, located in the small rural village of Great Bromley, geographically central to the larger towns of Clacton-on-Sea, Colchester and Harwich. Public transport to the towns, however, is minimal, but the home has four vehicles, which include a mini bus with a tail lift for the use of service users. Service users also have access to a taxi or public transport if they wish. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place over one day in February 2006, lasting 7.00 hours. The inspection process included: discussion with service users and one of the two home managers. Tour of the premises included observation of the home’s communal living areas and gardens. During the course of the inspection a range of documentary evidence was sampled. The home continues to be in the midst of a major programme of re-provision which is progressing well. The programme is designed to support service users to move on into accommodation that is more appropriate to continuing to manage their ongoing needs. This programme continues to be facilitated by a project team from Essex Social Services. Twenty-one of the forty-three Standards were inspected, of these eleven were meet, six were minor shortfalls, with the remainder being major shortfalls. What the service does well: What has improved since the last inspection? The home’s Statement of Purpose has now been amended and reviewed and now meets with regulatory requirements. Although staffing levels have been reduced as the programme of re-provision moves forward, strategies have been put in place to facilitate service users’ ongoing access to community-based activities. Records pertaining to service users’ healthcare needs have been much improved. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 6 The requirement from the previous inspection for the home’s complaint procedure to include the contact details for the local Commission for Social Care Inspection office has now been addressed. 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. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. Service users are provided with the necessary information they need to make an informed choice about the home’s ability to meet their needs. The home does not have a pre-admission assessment upon which to determine the ability to meet the needs of service users. Although the home has contracts of residency, these require development to comply with regulatory requirements. EVIDENCE: The home’s Statement of Purpose was sampled and seen to have been revised in October 2005. It covered the following areas: • • • • • • Summary of the purpose of the home Description of support facilities Number of places provided Relevant qualifications of all staff Procedure for making a complaint The range of people for whom the service is intended Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 9 The home is currently going through a programme of re-provision and, subsequently, at present is not admitting any new service users. No evidence was available at the time of the inspection to indicate that the service has a needs assessment for use for any future admissions. Three service users’ contracts of residency were sampled. These were provided as contracts and service users’ charters of rights and although they were quite well documented and informative, they were nevertheless written in very generic terms and not individualised to the needs of each respective service user. They were all based on a pledge from the home and the respective service user. Many of the areas necessary to be included under National Minimum Standard 5 were omitted, for example: • • • Rooms to be occupied Notice periods Fees to be charged and by whom they were to be paid Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. The home is working to the philosophy of Person Centred Planning, although this is in its very early stages and requires further development. Evidence suggests that service users are supported to make decisions in respect of their everyday lives, dependent upon their individual needs. Risk assessment activity seen was minimal and requires significant further development. EVIDENCE: Three care plans were sampled which evidenced that the home is working to the philosophy of Person Centred Planning, each plan consisting of: • • • A support plan overview Monitoring sheet Review sheet Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 11 The three plans varied greatly in terms of the way in which they were presented; one was very scant in terms of information, whilst the other two were significantly better. Overall, the format of the care plans was good, although the files were heavily burdensome with paperwork which made finding a way through them difficult and often very time consuming. Evidence seen/witnessed during the re-provision programme clearly indicated that advocates have very much been involved in supporting the service users during this period of change. Discussion with service users clearly indicated that they were well aware of what was going on and had been consulted with on all aspects. The three care plans sampled contained some evidence of risk assessment having been undertaken. However, only one was current with the other two not having been reviewed for up to three years. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 16 and 17. Further development is necessary to ensure that service users are involved in age and peer appropriate activities. Service users are supported to take part in community based activities. Evidence would suggest that service users are supported to make decisions about there everyday lives. Arrangements for the preparation of food at the home continue to be an issue, although the registered provider is aware of this issue and is taking actions to address this matter. EVIDENCE: Three care plans were sampled in respect of service users’ educational/ occupational activities. One service user’s plan indicated them taking part in an in-house activity referred to as ‘Experiencing my world’ as well as attending an external sensory room, the objective being to encourage and further develop the service user’s communication skills. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 13 A second service user’s file indicated that the service user attends college one morning a week for a session on ‘experiencing cooking’, with a further session on communication. The third service user’s plan sampled included individual session plans on: • • • • Leisure skills Communication Cooking Identifying emergencies. Evidence would suggest that access to education and occupation activities still remains limited. At the previous inspection concerns were raised pertaining to staffing levels and the impact this had upon service users being able to access community based activities. Discussion with the manager and staff indicated that staffing restrictions continue to pose problems, however the Disabilities Trust has been proactive in agreeing and authorising overtime to facilitate ongoing access to community based activities. Both staff spoken with spoke of service users accessing meals out, bowling, shopping as well as attending football matches. The daily routines at the home were seen to promote independence, choice and freedom of movement. Service users were heard to be referred to by their preferred terms of address; the care plans sampled evidenced the title by which service users preferred to be known. Staff were witnessed interacting with service users and not exclusively with each other. Service users were witnessed choosing to take themselves off to quiet places to spend time alone. Service users have unrestricted access to all areas of the home and its grounds, dependent upon their individual needs. The recommendation made at the previous inspection that all drinks should be individually prepared, as opposed to being dispensed directly from a gallon container, has now been addressed. The Standard pertaining to meals and food preparation continues not to be met. However, significant improvement has been made, although full compliance will not ultimately be achieved until the re-provision programme is completed. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20. Service users’ physical, emotional and healthcare needs are well met. The home’s medication procedures were inspected and found to be safe and robust in terms of keeping service users safe. EVIDENCE: All service users are registered with a General Practitioner and records sampled in respect of service users’ healthcare needs were generally good, although the layout could be improved to be more easily accessible. The records sampled included: • • • • • • • • Accident records Medical appointments Management plan for dietary needs Weight records Speech and language reports Fluid charts Bowel charts Medication profile. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 15 The home’s (main house) medication procedure was inspected. Medication is only dispensed by senior staff/night staff following completion of the Essex County Council’s medication workbook. In addition, the home manager spoke of having scheduled in update training from the home’s pharmacist. The home does not maintain any controlled medicines. The home manager also spoke of having requested training to be provided to staff on the administration of Rectal Diazepam; currently the policy is to contact the emergency services. Medication records sampled on the day of the inspection were all found to be in order. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22. The home’s complaint procedure now meets with regulatory requirements. EVIDENCE: The requirement from the previous inspection for the complaints procedure to include the contact details of the Commission for Social Care Inspection has now been addressed. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The home continues to fail to meet this Standard due to the age and condition of the building, although a programme of re-provision is well under way which will ultimately address this shortfall. The home’s laundry facilities are adequate to meet the needs of the service users. On the day of the inspection the home was clean, tidy and free from any offensive odours. EVIDENCE: Environmental issues due to the age and condition of the building continue to impede the home’s ability to be fit for its stated purpose. However, this is fully recognised by the registered provider and has subsequently been the driving force behind the re-provision programme. The home’s laundry facility is situated well away from food preparation areas, separated by two doors and in a position within the home where it does not intrude upon service users. The washing/drying machines are industrial in nature. The laundry room has a sluicing facility with hand washing facilities Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 18 situated nearby. The laundry room’s floor was impermeable and the walls were tiled finished so as to be readily cleanable. The infection control policies/procedures were unavailable for inspection at the time due to currently being worked on. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 36. Service users are supported by a team of staff who are competent and generally well trained. Evidence would suggest that the current staffing levels at the home are barely sufficient to meet the needs of service users. There is a formal supervision process in place at the home, although evidence presented suggests that at this point in time this has fallen down. EVIDENCE: Observation of staff interacting with service users indicated that they were accessible, approachable and comfortable in the presence of service users; they appeared to be good listeners and appeared interested in service users. Staff appeared to have a good knowledge and understanding of the disabilities and specific conditions of the service users in their care. The home does not employ any trainees under the age of eighteen. Discussion with the home manager indicated that nineteen care staff hold N.V.Q Level 2 or better. This represents the home meeting the standard that 50 of the care team being N.V.Q qualified. A further one staff is working towards their Level 3 award, with a further six working towards their Level 2. Both the home managers have N.V.Q Level 4 in care. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 20 Discussion with the assistant home manager and staff, and later the home manager, indicated that staffing levels have recently been reduced to a manager and two carers on duty from 07.00-22.00 hours. Nights are covered by two waking night staff. Cooking at the home is covered by external contract staff. A 24/7 on-call is available to staff in the absence of managers. This is made up of an initial contact person designated the key holder (night staff) who may then if required refer to the manager on-call. The staffing levels seen/cited are not sufficient to support the involvement of service users in activities and other community based activities. However, as mentioned previously, overtime has been made available to facilitate this. Discussion with the home manager indicated that in their opinion the current staffing levels are adequate to meet service users’ basic needs, but do not take into allowance crisis situations or facilitate skills acquisition. Discussion with the home manager indicated that there is a formal supervision process in place. However, current demands on time have meant that formal supervision has currently fallen behind, although the home manager was keen to point out that access to informal supervision is readily available. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38 and 42. Service users are supported by a management team who are experienced and qualified to a good standard. The management ethos of the home could be improved to be more open and transparent, particularly during this period of extreme change. The home needs to further improve its records to ensure that service users’ health, safety and welfare are promoted. EVIDENCE: Although the registered manager/general manager has significant previous experience of working in the care sector, they are not qualified in N.V.Q Level 4 in management or care. This was discussed at the previous inspection when the registered manager spoke of their proximity to retirement. Bearing this point in mind, the Disabilities Trust has adopted the following: the registered manager is supported by two home managers, both of whom are qualified at N.V.Q level 4 in care, with three units remaining to achieve their full Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 22 Registered Manager Awards, although the registered manager retains overall responsibility/accountability. The day-to-day running of the home is devolved to the respective home managers who report back directly to the registered manager. Discussion with staff indicated that the management approach of the home is generally open and inclusive, the general view being that the manager makes every reasonable effort to communicate a clear sense of leadership and direction in what staff currently describe as a difficult climate of change. There was, however, an underlying suggestion from staff that during this period of change that the home is not perhaps running as openly and transparently as perhaps it could. The home’s safe working practices were inspected through the viewing of the following safety certificates, which were seen to be in order: • • • • • Certificate of water chlorification Emergency lighting inspection test certificate Fire alarms system inspection certificate Portable appliance test Gas safety inspection certificate. The electrical installation safety certificate was out of date and requires renewal. . Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 1 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 x ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 X 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 X 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X 3 2 X X X 2 X Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14 Requirement The registered person must develop a policy/procedure for the home for admitting new service users. The registered person must ensure that service users have a contract of residency which meets with regulatory requirements. The previous timescale of 31/12/05 was not met. The registered person must ensure that there is an identifiable individual service user’s plan which is based upon assessed need. The previous timescale of 31/12/05 was not met. Timescale for action 31/05/06 2. YA5 5,14 31/05/06 3. YA6 15 31/05/06 4. YA9 13 (4b) The registered person must 31/05/06 ensure that service users have risk assessments in place which support service users’ development, and which are kept periodically under review. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 25 5. YA24 16,23 The registered person must address the environmental issues and ensure that the premises are safe and well maintained. 31/05/06 6. YA33 18 (a) The registered person must 31/05/06 ensure that at all times staff are provided in the care home in appropriate numbers to meet the health and welfare needs of service users. The previous timescale of the 31/12/05 was not met. The registered person must ensure that all staff receive formal supervision. The previous timescale of 31/12/05 was not meet. The registered person must ensure that all reasonable actions are taken to ensure service users’ health and welfare. This relates to the need to ensure that the home has a current certificate for its electrical installation. 31/05/06 8. YA36 18 (2) 9. YA42 23 (b) 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA12 OP17 Good Practice Recommendations It is recommended that opportunities for service users to access educational and occupational activities be further developed. It is recommended that the service continue to look at ways in which this Standard maybe further developed whilst the re-provision programme runs its course. DS0000017841.V283237.R01.S.doc Version 5.1 Page 26 Hamilton Lodge 3. YA38 It is recommended that during the period of re-provision the manager does everything they can to maintain a culture of openness and transparency at the home. Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Hamilton Lodge DS0000017841.V283237.R01.S.doc Version 5.1 Page 28 - 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!