Inspection on 09/05/06 for Kestrel House Lodge Care Home

This inspection was carried out on 9th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kestrel House Lodge Care Home 20/04/07

Kestrel House Lodge Care Home 01/12/05

Kestrel House Lodge Care Home 22/08/05

Kestrel House Lodge Care Home 21/03/05

Kestrel House Lodge Care Home 01/03/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Kestrel House Lodge Care Home St Thomas` Avenue Kirkby In Ashfield Nottingham NG17 7DX Lead Inspector Meryl Bailey Key Unannounced Inspection 9th May 2006 09:45 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 Kestrel House Lodge Care Home DS0000008705.V293726.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 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. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Kestrel House Lodge Care Home Address St Thomas` Avenue Kirkby In Ashfield Nottingham NG17 7DX 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) 01623 757 204 01623 750 512 Keslaw Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Manager post vacant Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st December 2005 Brief Description of the Service: Kestrel House Lodge is a purpose-built home close to Kirkby town centre and is located on a quiet residential avenue. Most of the bedrooms are single, although two doubles are available for those who choose to share. Accommodation is on two floors and there is a passenger lift to the first floor, as well as a staircase for those who are able and prefer to use this. There are pleasant gardens to the rear, which are enclosed, and there are car parking spaces to the front of the property. The home is close to Kirkby town centre and is located on a quiet residential avenue. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information from people who use services aswell as staff and providers. Records of information received since the last inspection have been used together with an unannounced inspection visit to the home, which lasted just over eight hours. Discussions were held with service users and staff about their views of the service provided. Further discussions were held with the manager and administrator. A sample of care records were examined to assess how care is planned. There was also a tour of the building and some direct observation of care practices. There were 27 service users in residence. What the service does well: What has improved since the last inspection? What they could do better: Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 6 Needs are usually assessed, but full clear assessment must always be carried out prior to admission and new service users should be assured that their needs can be met by staff at the home. Care is planned, but the manager does not check that all needs are covered in the action plans. Staff do not always follow the safe procedures with medication and the manager needs to make regular checks on practise and records. Some chairs in the new quiet room were worn and stained and should be replaced. Greater care should be taken to clean commode bowls immediately and all pads should be kept in their packets until needed. There were local alarms on the fire exits and other external doors, but staff could not hear these alarms. To ensure safety and security, an appropriate system needs to be fitted with alarm buzzers that staff can hear. Staff are trained in some essential areas, but further training is needed. 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. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 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 Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Needs are usually assessed, but any omission of a full clear assessment prior to admission could lead to an inappropriate placement. The registration does not cover the range of current service users and this is being addressed to ensure needs are appropriately met within the home. EVIDENCE: The files of four service users were viewed and three contained appropriate assessment material. The fourth contained brief background information from a Community Psychiatric Nurse, and a brief assessment carried out by a senior care assistant. The background information did not provide a clear assessment of the need for care within this home. In discussion during this inspection the service user expressed a wish to return home, since the agreement was for a short stay, which had so far lasted 7 weeks. From the four files selected two service users were under 65 years and had a history of mental health conditions. These were identified during the last inspection in December 2005 and no further service users under 65 years had Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 9 been admitted since that point, but on checking the admissions register at this inspection visit, a further two service users were found to be under 65 years. The acting manager stated that she was unaware of their ages. There was no evidence of service users receiving written confirmation that their needs could be met at the home. Staff were developing their experience in working with people with various mental health conditions and specific training was planned to be provided by the local community mental health team. Telephone contact was made with the area manager who stated that the providers were currently applying to vary the registration to include the category of Mental Disorder. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care is planned, but the manager does not check that all needs are covered in the action plans. Health needs are given priority and health professionals are consulted appropriately. Medication is dealt with in an organised way, but practice does not always follow procedures and the manager needs to make regular checks on practise and records. Service users are treated with respect and privacy is given. EVIDENCE: Each of the service users files contained some essential information for staff including a photograph for ease of identification. Care plans examined gave some clear directions to staff about how to meet needs. However, not all needs were addressed. From conversation with one service user there were clearly needs relating to communication, but these were not identified in assessment and there were no corresponding action plans. Existing plans had been written by senior staff and reviewed on a monthly basis. There were signatures of service users showing their agreement to the plans. The manager was not aware of all aspects of each. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 11 Up to date daily notes were kept in one file in respect of all service users, but on separate pages. Examination of this file showed the involvement of health professionals, including members of the community mental health team. There was a visit from a general practitioner during this inspection visit. Medication was held securely and two staff were observed to be following correct procedures for administering and recording medication given during lunch and teatime. However, one tablet was found on the floor in one bedroom during the inspection and staff reported that others had been found. Within the Medicine Administration Record sheets there were several handwritten items and instructions with no authorised signatures. On examination of controlled drugs, the register was found to have loose leaves and there were some inaccuracies in recording the times and doses of drugs given. The name and strength of one drug was not recorded in the controlled drugs register. The manager immediately checked the original prescription and inserted the information into the register. More regular checks need to be made to ensure correct procedures are followed. There had been a recent change of pharmacy used by the home and some old stocks of medicines were still to be returned. There was no British National Formulary (BNF) with the drugs trolley for immediate staff reference. The only copy found was out of date. The company’s own procedures stated that an up to date BNF is kept with the drugs trolley. Service users spoken with were complimentary about the staff and manager and said they were treated with respect. Staff were observed interacting well with individual service users, encouraging independence as much as possible. Two bedrooms were being shared and this was from choice. Curtain screening was available for privacy. Staff were observed to knock and ask before entering rooms where they were occupied and all rooms were lockable. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities are well planned and contacts with families and the community are maintained. Service users exercise choice and a variety of food is provided. EVIDENCE: An activities worker was employed on four mornings each week. Additional entertainers and therapists visited from time to time. Most service users were involved with a “parachute” exercise during the afternoon of the inspection visit. The activities worker was also observed talking individually with service users. The visitors’ book showed regular visits from family and friends and there was a pay phone available for service users to contact relatives. One of the staff was observed giving appropriate assistance with a telephone call. One service user went out to the local Chat group meeting during the day and another was visiting friends. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 13 Service users spoken with said they could choose what they do each day and some chose to stay in their own rooms for the greater part of the day. Others said they could get up and go to bed at whatever time they liked. Lunch and tea were served during the inspection visit and there were varying responses to the food provided. For lunch there was a choice of corned beef pie or processed breaded lamb cutlet and vegetables. Some people said the food was always hot and welcome. Others said they did not always like the lunches, but enjoyed tea. There was a choice at teatime of soup sandwiches or beans on toast. There were planned menus that were rotated over four weeks. These showed a great deal of choice and variety. Roast dinners were provided each Wednesday and Sunday. Alternative cutlery was provided and people were encouraged to be as independent as possible with eating. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users know how to make complaints and they are protected from abuse. EVIDENCE: The complaints procedure was given to service users and their families as part of the Service User Guide and was also on the main notice board. There had been complaints recorded since the last inspection. The Acting Manager stated that concerns were sometimes raised with staff on duty or the Acting Manager regarding misplaced items of clothing. It is recommended that these concerns be written down clearly with final outcomes. The Acting Manager had planned to give refresher training in adult protection to all staff. Appropriate preparation papers were seen. The Nottinghamshire Committee for the Protection of Vulnerable Adults policy and procedures were readily available to staff and had been appropriately used. Service users spoken with said that they felt very safe in the home and that carers were kind and caring. Some small amounts of money for each service user held securely, with procedures that offered protection from financial abuse, but see further comments under standard 35. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises generally suit the needs of the service users, but some actions need to be taken to ensure health and safety and to improve furnishing. Service users are satisfied with their own bedrooms and bathrooms facilities are appropriate to meet needs. EVIDENCE: The inspection visit included a full tour of the premises. The premises were purpose built for uses as a care home. A four-foot wall separated the main lounge and dining room. The lounge had four distinct sitting areas so that people could sit in small groups. There was also a newly constructed quiet room. All areas were well decorated, but some chairs were worn and stained. The fire exits and other external doors were alarmed, but each alarm was local to the exit and could not be heard by staff in other parts of the home. (See further comments under standard 38). The fire exit doors had been repaired since the last inspection. There was a dedicated hairdressing room on the first floor, which was well equipped. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 16 Two bedrooms were being shared and this was from choice. Another had two beds, but only one was occupied. Curtain screening was available for privacy. Those spoken with said they liked their bedrooms. Each had a lockable space, suitable lighting and radiators that could be individually adjusted. Some bedrooms had been recently decorated and one was being decorated during the inspection visit. Most, but not all bedrooms had ensuite toilets and washbasins. Where a toilet was not ensuite, there was one nearby outside the room. Bathrooms and toilets were well equipped with seat raisers and hand rails. There was a level floor shower and baths with adjustable seats. All communal areas were found clean and bedrooms were being cleaned during the morning. Commodes were available for those who needed them and the commode bowl was left unclean in a washbasin within one bedroom. This should always be cleaned immediately and replaced. The laundry room was well equipped. There was a separate store for pads and some pads were loose on the shelf. All packets of pads appeared to be shared between those that needed them as none were named. There were also some pads loose on a shelf in a bathroom cupboard. All pads should be kept in their packets until required. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are satisfied that there are sufficient staff to meet their needs. Few staff have received formal training in care practise, but training is given to meet specific needs and carry out essential tasks. Protection is given through the recruitment process. EVIDENCE: The staffing rota showed four care staff during the morning, three in the afternoon and two at night from 7pm to 7am. Staff described the night shift as variable. Some nights were quiet, but others involved constant attention required by some people, particularly those with needs relating to mental health. Service users said that they had sufficient help from staff when they needed it and there was a two way call alarm system. In addition to care staff there were kitchen, laundry and cleaning staff. An administrator works part time and there was an activities worker employed four afternoons each week. The acting manager stated that just two of the staff had achieved a National Vocational Qualification at level 2 in care, though some others had undertaken some training. Those responsible for medication had received training in the past and during this inspection the manager requested further training from Boots pharmacists. Specific training relating to mental health was planned to take place during the following two weeks. There were records of training in Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 18 safe working and one senior care assistant spoken with had qualified in training other staff in moving and handling. Four staff including the manager had undertaken training in Dementia care. A sample of staffing records was inspected and there were clear records of references and checks having been undertaken in respect of these staff. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The acting manager is developing her skills and is supported in her role. The provider company monitors quality. Financial interests are protected by strict management of money held on behalf of service users. Further action is needed to promote health and safety in some areas. EVIDENCE: The acting manager had recently applied for registration with the Commission and the application was in process. The acting manager reported that Four Seasons Health Care had used questionnaires to monitor the quality of the home. Completed questionnaires had been returned directly to the area office. The area manager made regular Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 20 visits to the home and another experienced manager within the company also supported the acting manager. Some service users’ money was looked after and held securely. There were clear records showing how much was held for each person, it was not possible to check the accuracy of any individual person’s amount with records as all money was held together. The records were up to date and maintained by the administrator. There was evidence that some appropriate action was taken to promote health and safety. Records showed that staff had received some training in the safe working topics and fire extinguishes were dated with the last check made in March 2006. As reported under standard 19, the fire exits and other external doors were alarmed for the protection of service users, but each alarm was local to the exit and could not be heard by staff in other parts of the home. Each alarm was reset by a switch close to the exit. Further protection would be provided by each exit being connected to a central system and alarm buzzers that could be heard by staff. An inspection of food stocks found three cans of food that were out of date. These were immediately removed by the manager. There were clear guidelines and instructions on the door of the store about the importance of rotating food stocks. More regular checks are needed to ensure these guidelines are being followed. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 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 2 X 3 X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)(a) and (b) Requirement The Registered Person must ensure full assessments of needs are carried out and copies obtained prior to the admission of any service user including those admitted “on respite” for short term care. The Registered Person shall not provide accommodation to a service user at the care home unless it has been confirmed in writing to the service user that, having regard to the assessment, the care home is suitable for the purpose of meeting the service user’s needs. The Registered Person must ensure Medicine Administration Record Sheets are signed and witnessed where instructions are handwritten. The Registered Person must ensure that staff check that all medication is taken before they initial the Medicine Administration Record Sheets. The Registered Person must ensure that the controlled drugs DS0000008705.V293726.R01.S.doc Timescale for action 10/05/06 2. OP4 14(1)(d) 10/05/06 5. OP9 13(2) 10/05/06 6. OP9 13(2) 10/05/06 7. OP9 13(2) 10/05/06 Kestrel House Lodge Care Home Version 5.1 Page 23 8. OP38 13 register is accurate and appropriately kept. The Registered Person must assess the risks associated with local alarms on the fire exits and other external doors and fit an appropriate central system with alarm buzzers that are audible by staff. 30/06/06 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. 3. 4. 5. 6. 7. 8. Refer to Standard OP7 OP9 OP9 OP19 OP26 OP26 OP28 OP38 Good Practice Recommendations The manager should monitor the quality of care planning to ensure all identified needs are appropriately addressed to meet needs. The manager should make regular checks and observations to ensure staff adhere to correct procedures in the administration of medicines. An up to date British National Formulary should be made available for staff reference regarding medicines. Replace the chairs that are worn and stained in the new quiet room. Commode bowls should always be cleaned immediately and replaced. All pads should be kept in their packets until required. Further staff should be supported to attain the National Vocational Qualification in care at Level 2. Ensure guidelines are being followed to rotate food stocks. Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Kestrel House Lodge Care Home DS0000008705.V293726.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!