CARE HOMES FOR OLDER PEOPLE
Extwistle Lodge 34 Scarisbrick New Road Southport Merseyside PR8 6QE Lead Inspector
Mike Perry Unannounced Inspection 8th November 2005 09:30 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 Extwistle Lodge DS0000065950.V265477.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. Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Extwistle Lodge Address 34 Scarisbrick New Road Southport Merseyside PR8 6QE 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) 01704 532173 01704 532172 Ramos Healthcare Limited Ms Janet Marshall Care Home 20 Category(ies) of Dementia - over 65 years of age (20) registration, with number of places Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to a maximum of 20 DE(E). The Service should employ a suitably qualified and experienced manager who is registered with the Commission For Social Care Inspection. 24th February 2005 Date of last inspection Brief Description of the Service: Extwhistle Lodge is a large detached building, which has undergone conversion to provide residential care for up to 20 older people who have a degree of Mental health need. The Home was originally a Victorian house. It is set in its own grounds and occupies a corner position situated very near to Southport Town centre (1/2 mile). The accommodation is divided over 3 floors with the day facilities on the ground floor and bedrooms above. There is office accommodation on the lower ground floor as well as the laundry and kitchen facilities. Externally the grounds are contained. Ramos Healthcare Ltd owns the Home and the Responsible Person is Mr Roland Mangahas Ramos. Janet Marshall is the Registered Manager. Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted over a period of 8 hours on two separate days. All day and recreation areas were seen and many but not all of the residents bedrooms. Care records and other records kept in the home were also viewed. In total the inspector spent time with some of the residents and the staff on duty [3 care staff and the cook]. A series of comment cards were also left in the home for relatives, professionals and visitors to complete. Representatives of the Registered Providers [owners] were also present for some of the inspection. 4 relatives were also interviewed by phone 14 of the 20 Core standards were covered on the inspection. There were many positive aspects to the inspection and the staff and manager were responsive and open to comments made. The feedback from both resident [including observed behaviour as verbal feed back is difficult due to some residents level of confusion] and relative interviews was generally positive and supported the notion of a caring home. The one theme that emerged from the interviews was that although staff were very caring there was a lack of stimulus and activity for residents on a daily basis and this should now be the focus for improving the quality of the lives of the people in the home. Extwhistle Lodge continues to develop with strong support and input from the ownership that have spent some resources on improving the environment and creating a more homely atmosphere. What the service does well:
The home provides some useful information for prospective and existing residents and relatives in the form of the Statement of Purpose’ and ‘Service Users Guide’. The latter is available in the entrance to the home and gives information that can assist in making an informed choice. A member of the management team ensures that a preadmission assessment is carried out so that there is some assurance that the needs of the resident can be met by the home. Copies of assessments by community care professionals and discussion with them is also evident from the records seen. Once admitted there is a care plan drawn up and staff try and ensure that residents [if possible] and relatives share in this process. The care plans show that there is appropriate referral to health care professionals on most occasions. For example one resident who has had regular support from the district nurses for the treatment of a leg ulcer. Another relative commented
Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 6 that the staff had been very careful to ensure that a particular resident had attended for all hospital appointments arranged. The personal care conducted in the home was commented on as being very good with care staff being both kind and respectful. Comments received were: ‘Staff are very kind’ ‘ Staff keep us informed about the care’ ‘ It’s a very friendly home’ ‘Staff are very kind and treat the residents well’. The health and safety management in the home is satisfactory. There is evidence that the manager conducts regular risk assessments of the general environment. Also the various safety checks and certificates such as gas and electricity where up to date. What has improved since the last inspection? What they could do better:
One opinion received was that some of the senior care staff were not always willing to make decisions about referring residents for medical opinion on occasions without recourse to the manager who might be off duty at the time. Therefore delays could occur and residents might not receive interventions at the time needed. Some activities are organised for residents and the home is generally relaxed and sociable. There is a need however to ensure a more structured approach to the organisation of social activities so that residents are better stimulated on a daily basis. Attention here will assist in improving the quality of life for residents in the home.
Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 7 The home provides a safe environment and staff are caring and understanding of the residents needs. Staff were however unaware of the procedures for the reporting of any concerns around mistreatment of vulnerable adults and there needs to be some in-house training around the local procedures so that staff are more aware. Staff records indicate that not all care staff are receiving the necessary checks to ensure fitness to work with vulnerable elderly people such as written references, Criminal Records [CRB] checks and checks of the Protection of Vulnerable Adults [POVA] Register. These must be completed for all new staff and staff employed since April 2005. The provision of staff for the afternoon shift is not always consistent and can fall below the minimum agreed level of 3 care staff. This presents particular difficulties, as there is also no current provision of kitchen staff at this time. Relatives commented that ‘staff work hard and are very caring but sometimes there is not enough staff’. This was discussed on the previous inspection and requirements were made at that time. There was also some discussion with the manager around the need to ensure that the duty rota is reflected of the times staff are on duty and that this is accurate. The management of residents’ monies is monitored well. There are however some recommendations in the report around the provision of locked facilities for some residents and maintaining clearer records. 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. Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 The homes Statement of Purpose and Service User Guide provide useful guides so that prospective residents have information in order to make an informed choice. The assessments carried out by the home are good and help ensure that the home can meet the needs of residents admitted. EVIDENCE: The homes written information is included in the ‘Statement of Purpose’ and the ‘service uses guide’. Copies of these are available and the service user guide is available in the entrance to the home. Both documents have been updated following recommendations in the last inspection report and form useful documents that assist prospective residents making a choice about the home. Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 10 Three residents files were seen. All residents had been assessed prior to admission and there was reference to community assessments from professionals [social workers and hospital and community nurses]. The preadmission assessment form is not completed in its entirety and also not always signed and dated. [There was some discussion as to the suitability of the preadmission assessment, which may better be used following admission as the necessary detail required can be better assimilated]. The homes assessments cover all aspects of the care standards including history of falls. Assessments also include mental state, risk and nutrition. The assessments provide information so that the home can make a decision as to whether they can meet the care needs adequately. They also form the base from which a care plan can be drawn up. Extwistle Lodge DS0000065950.V265477.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 Individual care plans are drawn up with the relative’s involvement if possible and reflect changing needs so that both personal and health care needs are met. Relatives canvassed felt that staff were supportative and appropriate in their care so that respect and dignity is maintained. The management of the medicines in the home is satisfactory so that residents are protected by a safe policy. EVIDENCE: Care plans were seen and reviewed in detail for 3 service users. Care plans were descriptive of the care offered and are easy to follow. There is evidence of good liaison with district nurses, for example one resident who has a leg ulcer, and how this was being monitored. Risk of falls is assessed under ‘mobility’ and highlighted under ‘maintaining a safe environment’. The care plans are very long and detailed and cover all aspects of the care including reference to dementia and mental health issues. There is however summaries of the longer care plan kept in daily ‘work logs’ for staff. It would be a good idea to offer a copy of this plan to service users or relatives. Staff
Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 12 interviewed did not access these on a regular basis although it was clear that changes to the care plans are discussed at the staff handovers. There is evidence of resident and relative involvement with some of the care plans having been signed accordingly. Relatives interviewed felt that they were generally kept informed about the care in the home and the manager in particular was very communicative in this respect. The manager has followed recommendations from the previous inspection in that the care plans are now written and coordinated by 2 other senior carers as well as the manager. This process can be further shared and developed. The care notes contain good records of medical appointments [GP’s visits etc] as well as more routine chiropody, optician and dental appointments. One relative interviewed said that the home had been very good at arranging and ensuring attendance at hospital appointments for one of the residents in the home. One opinion was that some of the senior care staff were not always willing to make decisions about referring residents for medical opinion on occasions without recourse to the manager who might be off duty at the time. Therefore delays could occur and residents might not receive interventions at the time needed. The medicines were reviewed and the recording of medicines administered was satisfactory with clear records maintained. Care staff who administer medicines undergo some training from the supplying pharmacist and the details of the training are very appropriate. Residents able to express an opinion and relatives were off the opinion that staff were very respectful and carried out personal care appropriately. Those residents seen were clean and appropriately dressed. Comments received were: ‘Staff are very kind’ ‘ Staff keep us informed about the care’ ‘ It’s a very friendly home’ ‘Staff are very kind and treat the residents well’ Extwistle Lodge DS0000065950.V265477.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): 12 The home provides a relaxed and sociable environment but the provision of better planned and organised activity on a more regular basis would enhance the quality of life for people living in the home. EVIDENCE: There is recognition that the social interaction between both staff and service users is positive. This was observed on the inspection and commented on by relatives interviewed. Residents were relaxed and interacted well with each other. Relatives felt that more could be done in the area of organising activities for the residents however. The residents do not get out of the home on a regular basis although there are some examples of individuals being escorted locally as well as the occasional trip [lake district trip organised some months ago]. Staff do try and organise some social interaction in the afternoons but again this is sporadic and depends on staff availability. Relatives generally felt that there was not always enough staff available for the ‘extra’ care required with respect to social activities. Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 14 There was some discussion around how things could be further improved. Inviting outside entertainment into the Home is one idea discussed and this has been actioned on some occasions. There is currently no staff member designated, as a key person to organise a programme of activity for residents and this should be addressed. An activity programme circulated and advertised in the Home is a requirement of standard 12.4 Staff have reported on the previous inspection that the owners intend to purchase a mini bus at some stage and this would be an excellent way of improving the quality of life for service users who could enjoy trips out on a regular basis. The standards under this area of care will be inspected in greater detail on the next inspection when the management and staff have had time to reflect and plan care in this area so that the quality of live for residents can be further enhanced. Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 15 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): 18 The home provides a protective and caring environment but there needs to be more awareness amongst the management and staff regarding the local adult protection procedures so that residents are fully protected from abuse. EVIDENCE: The feedback from the residents and relatives in the home was very positive in that there is a feeling of safety and that residents are well cared for. Staff spoken to were clear in there understanding of abuse and what constituted abusive care. They understood for example the right of residents to remain as autonomous as possible and to make their own decisions. Staff were not clear however on the wider picture around local procedures for the protection of vulnerable adults and how the reporting of such instances should be carried through. In one example discussed the home had taken appropriate disciplinary action, which protected residents, but had not accessed the correct procedures at an early enough stage. The local procedures were not available although contact numbers were on the manager’s notice board. The manager is in the process of organising some training for staff on various issues and the raising of awareness regarding the adult protection procedures should be included for all staff. Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 16 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): 19,26,24,26 The environment at Extwhistle Lodge has been improved greatly over the past year and there are clear maintenance and upgrading plans to improve this further so that residents live in a safe, well maintained environment that is also homely. EVIDENCE: The owners of the home have upgraded the environment considerably over the past year and the work is constantly reviewed and ongoing. The requirements and recommendations from the last inspection have been actioned as well as the recommendations following the assessment by the physiotherapist for any environmental adaptations. All residents able to express an opinion were pleased with the cleanliness and the homeliness of the furnishings and fittings. Since the last inspection there has been more general decorating to bedrooms and bathrooms/toilets as well as the provision of new carpeting and soft furnishings in day areas. There are examples of particular care being taken given the resident group. For example
Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 17 lighting on landing is controlled by sensors so that residents can easily find their way if they need to at nighttime. There are some residents identified who would like their own key to their bedroom and this should be assessed accordingly and provision made when required. The laundry and the general environment of the home are maintained in a clean and tidy state. There are no offensive odours. Care staff have received training in basic hygiene. Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 18 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): 27,29 The staffing in the home is inconsistent during the afternoon period and this needs to be addressed by the management so that resident’s needs are met in at all times. The homes recruitment procedures are currently inadequate and do not ensure protection for residents. EVIDENCE: The issue of staffing cover for the afternoon shift was raised on the previous inspection. There are times when there are only 2 care staff on duty for this period. There is also no cover in the kitchen or laundry so this level of staffing is clearly inadequate. Interviews with both staff and relatives evidenced the opinion that ‘there is not always enough staff on duty to observe the residents’. Relatives gave examples of situations when dignity had been compromised with some residents who had, for example, partly undressed without being observed by staff. The provision of social care and activities is also obviously compromised if staffing is so low on occasions. Relatives commented that ‘staff work very hard and are caring but there are times when there is not enough staff’. The duty rota includes the names of the providers who do spend a good deal of time in the home. The times when they are present is not specified however and therefore the duty rota is not an accurate reflection of total staffing
Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 19 numbers. The manager needs to address this and to sign each week’s rota once completed as an accurate record of hours worked. The staff files for 3 staff recently employed where inspected. Not all the required checks had been made to ensure fitness for employment in the home. Staff had not yet received Criminal Records [CRB] clearance and there had been no check made of the Protection of Vulnerable Adult [POVA] register prior to commencement of employment. Not all written references were in place. Residents are therefore not fully protected by the homes recruitment procedures. Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 20 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): 31,35,38 EVIDENCE: Janet Marshall is the Registered Manager of the home. Janet has an NVQ in care and has nearly completed the Registered Managers award. She is supported in her role by input from the ownership of the home who provide a regular presence. Janet has worked well and continues to develop her role. She has carefully delegated more care tasks to senior carers. The residents and relatives spoken to were very positive in their comments regarding her caring nature and ability to communicate and keep them informed regarding any changes. Likewise staff interviews were supportative. Janet is open to any constructive criticism and has worked to meet previous requirements and recommendations following inspections. Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 21 The financial management of the resident’s finances was reviewed. There is a clear policy statement included in the ‘service users guide’. One of the residents manages her own finances and must be offered a locked facility [draw or secure box?] so that she can keep valuables etc. other resident should be assessed regarding this and future replacement of furnishings need to take into account the provision of a lock facility so that residents have the option of using this. The records of expenditure for residents were seen and some recommendations were discussed so that these could be made clearer. Policies and procedures around health and safety were seen and the management displayed a good awareness of the principal’s involved including the need for regular risk assessments. There is a designated person for H&S and he is to undergo some formal training in the future. Safety certificates were inspected for gas, electricity, and lift maintenance and where satisfactory. Fire records were seen. Some of the recording of fire safety checks was unclear and the manager will make amendments to the recording process. Manual handling training for staff is well monitored. Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 22 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 X 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 23 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. Standard Regulation Requirement The manager must address the need for a more planned approach to the provision of social activities in the home which includes the allocation of any necessary resources in terms of staffing and equipment ect. The manager must ensure that the home has a copy of Sefton’s Adult Protection procedures and that this forms the basis of training around awareness raising for staff employed at the home. The Manager and Registered provider must ensure adequate care staff are employed on duty for the afternoon period [a minimum of 3 care staff in total] so that resident needs can be fully met. The home must employ suitable cover for the kitchen during the afternoon and teatime period. [Requirement on previous inspection. Timescale date of 1.4.05 not met] All staff employed must receive
DS0000065950.V265477.R01.S.doc Timescale for action 1 OP12 16 20/02/06 2 OP18 13 20/02/06 3 OP27 18 30/12/05 4 OP27 18 20/02/06 5 OP29 19 30/12/05
Page 24 Extwistle Lodge Version 5.0 the necessary POVA and CRB checks as well as adequate written references prior to full employment in the home. Those staff identified on the inspection employed since April this year must have their records updated as discussed. 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 OP8 Good Practice Recommendations The manager should ensure that senior care staff are empowered and confident to refer residents for medical opinion if required without recourse to the manager who may not be immediately available. The residents identified who require keys for their bedroom doors should be assessed and appropriate action taken in response. The recommendations concerning the recording of the duty rota listed in the report should be actioned by the manager. The resident discussed on the inspection who managers her own finances should be provided with a locked facility in her room. The registered provider should ensure clearer records of expenditure for resident’s monies so that a clear balance is shown in the records. 1 2 3 4 5 OP24 OP27 OP35 OP35 Extwistle Lodge DS0000065950.V265477.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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