Inspection on 26/02/07 for Humfrey Lodge

This inspection was carried out on 26th February 2007.

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

The inspector 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

Humfrey Lodge 18/03/09

Humfrey Lodge 08/01/08

Humfrey Lodge 13/12/05

Humfrey Lodge 13/07/05

Humfrey Lodge 02/03/05

Humfrey Lodge 21/07/04

Humfrey Lodge 22/03/04

Humfrey Lodge 13/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Humfrey Lodge Rochelle Close Thaxted Dunmow Essex CM6 2PX Lead Inspector Jane Offord Key Unannounced Inspection 10:40 26th February 2007 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 Humfrey Lodge DS0000017855.V324507.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. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Humfrey Lodge Address Rochelle Close Thaxted Dunmow Essex CM6 2PX 01371 830878 01371 831187 humfrey.lodge@runwoodhomes.co.uk runwoodhomes.co.uk Runwood Homes Plc 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) Mrs Estelle Gordon Ballard Care Home 48 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (48) of places Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 48 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 24 persons) The total number of service users accommodated in the home must not exceed 48 persons The registered person must not admit persons subject to the Mental Health Act 1983 or the Patients in the Community (Amendment) Act 1995 25th April 2006 Date of last inspection Brief Description of the Service: Humfrey Lodge is a care home for older people over the age of 65 years. The home is registered to care for 48 people, 24 of whom may have dementia. The accommodation is all single rooms and is situated all on the ground floor. The home is divided into four units which each have communal rooms. There are a number of informal seating areas around the home and several garden and patio areas that are wheelchair accessible and secure. The home is situated in the attractive village of Thaxted in a residential area but close to shops and other amenities. The home is owned by Runwood Homes PLC. Fees for accommodation in the home are £440.72 per week and do not include hairdressing, chiropody, newspapers, transport, toiletries or clothing. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection looking at the core standards for care of older people took place on a weekday between 10.40 and 15.30. The acting manager was available during the day and assisted with the inspection process. This report has been compiled using information available and evidence found during the inspection. On the day of inspection a tour of the home was undertaken with a member of staff but all areas were re-visited again later. The files, care plans and daily records of three residents were inspected as were the files of three new staff members, the policy folder, some maintenance records, the complaints log and the minutes of residents’ and staff meetings. A number of staff and residents were spoken with and part of the lunchtime medication administration round was followed. Residents looked comfortable and relaxed using all areas of the home. The home was tidy and clean but two places had poor odour control. Staff were offering residents choice about where they wanted to be and interactions were friendly between staff and residents. People spoken with said they had enjoyed their lunch. What the service does well: Records of assessment of residents’ needs were full and informative. Care plans were completed based on individual need and daily records were well written giving information about the experience of the resident not just the physical care. The activities co-ordinator plans something for each weekday and residents can choose to join the activities or not. The meals are well prepared and there is always a choice of the main dish and dessert. All the cakes and pastry are home made. There is a commitment to maintaining staff training up to date and identifying training needs during staff supervision. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Humfrey Lodge DS0000017855.V324507.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 Humfrey Lodge DS0000017855.V324507.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6. Quality in this outcome area is good. People who use this service can expect to have an assessment of needs undertaken prior to being offered a place but they cannot be assured that all the information available will be fully up to date. The home does not offer intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose and a service users guide. Both documents contain a lot of information about the home and the services it offers. However some details about the personnel in post in Runwood Homes PLC have not been updated, information about CSCI inspections has not been changed to reflect the new pattern of inspecting and one organisation in the useful contacts list is no longer in existence. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 9 The files of three new residents were seen and each contained documentary evidence that a pre-admission assessment of need had been undertaken. The assessment had covered areas of need such as personal hygiene, continence, communication, nutrition, skin integrity and dressing and undressing. Further areas included mobility, behaviour, interests and hobbies and sleep pattern. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is good. People who use this service can expect to have a plan of care in place and their health needs met but they cannot be assured that all medication administration practice will protect them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans and daily records for three new residents were seen and showed the care plans were individual with interventions relevant to each resident. The care plans were generated following an assessment of need undertaken when the resident was first admitted and based on the activities of daily living. Independence was encouraged so one entry said, ‘Encourage XXXX to participate in menus choices. They will need support due to their communication problems’. One resident had a long-term urinary catheter in situ that had caused some problems of retention but the care plan had no Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 11 interventions to help in the management of the catheter or any triggers for when the community nurse needed to be contacted for advice or treatment. Each file had details of any health professional involved in the care of the resident including the GP, chiropodist and community nurse. Records were kept of visits to or by any health professional and the treatment prescribed by them. There were risk assessments for moving and handling, falls, nutrition and skin integrity. The Norton score was used for assessing pressure area risk and there was evidence that if the scoring put a resident in a risk category action was taken, such as the use of a pro-pad mattress, and the score reviewed. Records were kept of the food and fluid intake of residents and regular weight checks were made and recorded. Daily records seen were informative and gave a feel for the experience of the resident during the day. There were comments about mood and behaviour not just physical care. Staff observed spoke to the residents in a respectful and friendly manner. They were seen to offer choices and assist residents with patience and care. Staff were observed knocking on doors before entering rooms. Residents spoken with said the staff were reliable and nothing was too much trouble. The medication policy was looked at and showed there was guidance on ordering, storing, administering and disposing of medicines. It included guidance on a resident’s refusal of medication, covert administration of medication and the use of ‘homely’ remedies. The medication administration records (MAR sheets) were seen and showed that the signature boxes were correctly completed and ‘as required’ medication that has a choice of dose had the amount administered recorded each time. The home uses a monitored dose system (MDS) so tablets are dispensed from blister packs prepared by the local pharmacy. All medication is stored in a locked clinic room together with the medicine trolleys. The MAR sheets all had identification photographs of the resident with them. The carer doing the lunchtime round said they had an annual competency check to ensure they could administer medication safely. During the round residents were asked if they wanted painkillers and helped with their medicines sensitively. It was noted that on some occasions tablets were dispensed from the blister pack directly into the carer’s hand before being transferred to a medicine pot to be taken to the resident. One prescription for chloremphenicol eye drops was for a five-day course. It had been commenced on the 7th February but was still being administered on the day of inspection 26th February. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. People who use this service can expect to be encouraged to maintain contact with family and friends, be offered meaningful pastimes and a well-balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents’ files seen all contained details and contacts for the next of kin. Two files were for very recently admitted residents but the third file for a person who had been in the home a little longer contained evidence of some life history work with details of family relationships. Visitors were seen coming and going during the day and spending time with residents in the communal areas or their own rooms. Information about the residents’ preferred activities and religion were recorded. One file said, ‘Likes flower arranging so let them arrange any general flowers that arrive in their unit’. Another said, ‘Would like to attend the monthly church service’. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 13 The home has an activities co-ordinator who arranges a programme of activities for each week and ensures it is on the notice board so residents can choose the activities they wish to participate in. The pastimes include keep fit, carpet bowls, bingo, reminiscence and board games. External entertainers are booked sometimes and regular clothes sales are held. Sometimes a group of residents go to a local teashop for afternoon tea. One resident said their spouse visits frequently and they go out to the shops together. The kitchen was visited and the food stores inspected. There was a wide variety of dry stores and fresh fruit and vegetables. Refrigerators and freezers had their temperatures recorded and showed they were all functioning within safe limits for food storage. Left over food was covered, labelled and dated. The cook said they make all the cakes and pastry used in the menus. The menus showed that a cooked breakfast was available three mornings a week and there was a choice of dishes for the main meal every day for example, fish pie or corned beef hash, chicken and mushroom pie or beef stew. Teatime had a choice of sandwiches or a hot snack such as jacket potatoes or sardines on toast. Desserts included baked jam sponge, lemon sorbet and cheesecake with fresh fruit and yoghurts always available. Residents spoken with on the day of inspection said they had enjoyed their lunch, that the food is always nice and they were pleased the regular cook had returned. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. People who use this service can expect to have any concerns taken seriously and investigated and be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy was seen and meets the required standard offering investigation of any complaint and a written response within a given timescale. Like the statement of purpose some details of Runwood Homes PLC personnel need updating. The complaints log showed a number of complaints had been received since the last inspection. Several were about the behaviour of one resident and the effect it was having on other residents, one was about a staff shortage and two were from relatives who had not been kept fully up to date about the health and behaviour of a resident. There was evidence the complaints were all fully investigated and the complainants received a written response that included any changes in practice or actions taken as a result of the learning from the complaint. The protection of vulnerable adults (POVA) policy was up to date and crossreferenced to the county guidelines. The home also has a whistle blowing policy to protect any staff who exercise their duty of care to protect residents. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 15 In the staff files seen there was documentary evidence that POVA training was included in the induction for all new staff. Staff spoken with said POVA training was one of the mandatory courses that were regularly updated for all staff including ancillary staff. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is adequate. People who use this service can expect to live in comfortable surroundings but cannot be assured that all paintwork and carpeting is of a high standard, that there is always good odour control or that staff correctly follow the infection control guidelines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection a tour of the home was undertaken and it was found to be warm and tidy. There was a feeling of space as corridors are wide and there are large windows giving a lot of natural light. There were some odours of urine in two parts of the home that were identified to the acting manager for action during feedback. A piece of carpet at the entrance to unit three had Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 17 been taped down with gaffer tape but the tape had become scuffed and it posed a trip hazard. Although only painted just over a year ago wheelchairs have chipped the gloss on a lot of the doors and one door in unit 1 has a large strip of paint missing from top to bottom. The acting manager said there were plans to re-paint the doors and put protectors on them. The laundry was visited and was tidy. One washing machine has a sluicing cycle for use with soiled linen. Staff spoken with said that soiled linen was placed in red alginate bags that were put directly into the machine on the sluicing wash programme. Minutes seen of a staff meeting held recently indicated that staff had been asked to hand-sluice soiled linen before placing it in an alginate bag. This practice is not safe or necessary, given the equipment available, and was discussed with the acting manager who will raise it with staff and reinforce the infection control policy. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. People who use this service can expect to be supported by adequate numbers of correctly recruited and trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rotas were seen and showed that there is a team leader on duty throughout the twenty four hours supported by seven carers in the morning, six carers in the evening and four carers during the night. In addition there is a cook and kitchen assistant each day, three domestic staff, a maintenance person, an administrator and an activities co-ordinator who work on weekdays. The manager or acting manager is supernumerary. The files for three new staff members were seen and contained evidence of the recruitment checks that had been made before staff commenced in post. Each one had a POVA 1st check and a criminal record bureau (CRB) check, evidence of identification checks such as passport and birth certificate and a full work history. There were two references in each file and the notes made at interview. Records of the induction programmes showed that it covered health and safety, infection control, moving and handling, fire awareness, food hygiene and protection of vulnerable adults (POVA). Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 19 The training matrix seen showed staff are given regular mandatory updates for health and safety, moving and handling, POVA, first aid, dementia awareness, infection control and fire safety. Notices seen on the day of inspection announced training planned in March 2007 for dementia and health and safety. Staff confirmed they receive training updates and those responsible for medication administration have annual competency assessments. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38. Quality in this outcome area is good. People who use this service can expect to be consulted and have their personal monies safeguarded but they cannot be assured that their welfare or confidential information will always be protected by the practices in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been on sick leave for a period of time and is now making a gradual planned return to work. The acting manager has been at the home for many years and has wide experience in care management. Staff spoken with said there was good leadership and the management team were approachable. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 21 There was evidence that residents’ meetings take place regularly. The most recent one had been in December 2006. The minutes showed that a wideranging discussion had taken place. Staff meetings also happen and cover areas of care practice, home’s policy and staff issues. In the staff files seen here were supervision records that indicated staff are supervised every couple of months and performance and training were discussed. The system used for managing residents’ personal monies was explained and showed that individual transactions are recorded, receipts kept and a running balance available. Two wallets at random were checked and found to tally with the records. Some maintenance records were inspected and showed regular daily, weekly, monthly and six monthly checks were carried out for all areas from fire panels and nurse call bells to the boiler, the lift, the water system and external building checks. As noted earlier in this report there was some concern that staff were not following the infection control policy correctly in relation to soiled linen. Some products that fall under the control of substances hazardous to health (COSHH) regulations were found in an unsecured cupboard on the day of inspection. The cupboard also contained some archived records relating to residents. Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 2 Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 OP1 Regulation 4 (1) (c) 6 (a) Requirement The registered persons must update all relevant information and policies of the home to reflect changes in the personnel of Runwood Homes PLC and other changed information. The registered persons must ensure that assessed needs are addressed by appropriate interventions on a resident’s care plan. The registered persons must ensure that medication is dispensed using a non-touch technique. The registered persons must ensure that instructions for a short course of medication are complied with correctly. The registered persons must take steps to secure the torn carpet in unit three and repaint the door to the resident’s room in unit one that was identified during the inspection. The registered persons must take steps to eradicate unpleasant odours from the home. DS0000017855.V324507.R01.S.doc Timescale for action 31/03/07 2. OP7 15 (1) 26/02/07 3. OP9 13 (2) (3) 26/02/07 4. OP9 13 (2) 13 (4) (c) 23 (2) (b) (d) 13 (4) (a) 26/02/07 5. OP19 31/03/07 6. OP26 16 (2) (k) 26/02/07 Humfrey Lodge Version 5.2 Page 24 7. OP37 17 (1) (b) 8. OP38 13 (3) 9. OP38 13 (4) (c) The registered persons must ensure that all documentary information in relation to residents is kept securely. The registered persons must ensure that staff comply with the infection control policy in relation to the management of soiled linen. The registered persons must comply with the COSHH regulations. 26/02/07 26/02/07 26/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Humfrey Lodge DS0000017855.V324507.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!