Inspection on 07/06/05 for Lammas Lodge

This inspection was carried out on 7th June 2005.

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

Lammas Lodge 25/09/08

Lammas Lodge 25/09/07

Lammas Lodge 24/04/06

Lammas Lodge 01/12/05

Lammas Lodge 20/03/05

Lammas Lodge 14/10/03

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Lammas Lodge Lugwardine Hereford HR1 4DS Lead Inspector Jean Littler Announced 7 June 2005 11:00 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Lammas Lodge Address Lugwardine Hereford Herefordshire HR1 4DS 01432 853185 01432 851468 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Parkcare Homes (No 2) Ltd Mrs R E Wooderson Care Home only. 6 Category(ies) of Learning Disability (6) registration, with number of places Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: In addition to the information on the previous page the following Conditions of Registration apply. 1) In addition to Learning Disability, service users will have needs associated with autism spectrum disorder. 2) For each assessment indicating the need for professional services, a statement is provided to the funding authority, in advance of the admission, showing the agreed contractual arrangements for its delivery. A copy of the statement must be retained at the home and be available for inspection by the Commission. 3) A designated senior in charge of the service, who is suitably trained and experienced, must be on duty at all times. 4) All staff must receive training in autism spectrum disorder and appropriate behaviour management techniques within 12 weeks of starting work at the home. 5) The Care Manager must be provided with formal recorded one to one supervision sessions with a line manager every month for the first 12 months of her registration in respect of the service provided at Lammas Lodge. 6) Service users abilities to manipulate bedroom door locks must be assessed at the point of admission. A written record of this assessment must be included in the care plan with details of action taken for any service user who is unable to manage the existing style of fitted lock. Date of last inspection 20/3/05 Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Lammas Lodge offers 6 places to younger adults of either sex who are between the ages of 18 and 24 years at the point of admission. Personal care needs arise from a learning disability and will include needs associated with Autism Spectrum Disorder. The service offers a transitional period of residence rather than a home for life. Where a stay is expected to last longer than five years there will be negotiation with the Commission, purchasing authority, service user and next of kin. The Statement of Purpose describes a therapeutic atmosphere and a full social/recreational and educational programme will be identified prior to admission. The providers state that a high staffing ratio will be provided to meet the assessed support and supervision needs of residents with complax needs. The Home is situated on the outskirts of Lugwardine village which is three miles from Hereford. The house is set in a large grounds with an area for activities and a sensory garden. The house is large and is divided into two areas. There is a self contained one bedroom flat, and the main house that provides one ground floor and four first floor en-suite bedrooms. An unmarked vehicle is provided to facilitate community access. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This routine announced inspection was carried out on a weekday between 11am and 4pm. The manager completed an inspection questionnaire prior to the visit to provide additional information. The residents and their representatives were provided with feedback questionnaires some of which were returned. The providers monthly visit reports to the Commission, and other communication with the Home since the last inspection were all considered as part of the assessment process. The inspector spent some time with both residents and one was able to express his positive opinions about the service. The manager assisted with the inspection process and a support worker and team leader were interviewed. What the service does well: What has improved since the last inspection? What they could do better: The assessment process needs to be comprehensive to ensure all admissions are appropriate. This process needs to include clear written agreements with funding authorities for health care services e.g. psychiatric support. Staffing levels need to be increased to ensure there is sufficient flexibility for the manager to have time for administration tasks and so staff can be freed up to attend essential training. The monthly monitoring visits, by a representative of the provider, need to be carried out without giving the Home advance notice. Recorded supervision sessions between the manager and the provider’s representative need to be held monthly. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 7 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. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4. Suitable arrangements were in place to provide interested parties and residents’ representatives with information about the service. Ways of informing residents or potential residents about the service in a meaningful way need to be further developed. An assessment process was in place that included trial visits. How assessment information is collated and admission agreements made need to be further developed. EVIDENCE: A Statement of Purpose and Service User’s Guide were produced when the service was redeveloped. These documents had been made available to those interested in accessing the service and copies of the Guide were seen on both residents’ files. The manager was aware that the information about the service still has to be developed into a format suitable for each resident’s individual needs. The usefulness of a short video should be considered. There were four vacancies in the main house, however one person was due to begin a transition period. The manager had received assessment information from the placing authorities for the two residents who had been admitted since the Home reopened. Further information about their needs had been obtained from assessment sessions with relatives and professionals involved in their care, and through direct observations. The transition period had included visits, outings and trial short stays. A trial period is built into each contract with the funding authority. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 10 In one case the assessment process had failed to highlight some risks regarding the resident’s known behaviour patterns. The manager acknowledged that the admission process in this case was not effective. In response to this the manager had adapted the assessment form and seemed clear about how any future assessments needed to be carried out. A Condition was placed on the Home’s Registration arrangements that for each assessment indicating the need for professional services, a statement would be provided to the funding authority, in advance of the admission, showing the agreed contractual arrangements for there delivery. This Condition had not been fully complied with. Although the providers have now arranged to provide monthly imput from a phychiatrist and phychologist, all future admissions must have written specialist health support agreements in place prior to the resident moving in to ensure their needs will be met. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9. Appropriate care planning systems and records were in place that included arrangements for managing any risks. The residents were being consulted regarding daily choices. There was an awareness that too much information and choices could overwhelm a resident during the start of their placement, therefore the Person Centred Planning approach was going to be introduced slowly. EVIDENCE: Both residents had care plan folders that contained their assessment information, risk assessments and clear care and support plans. The staff spoken with reported that they had read and contributed to the plans and found them very useful and accurate. Risk assessments showed a balanced view was being taken between providing normal life experiences for the residents, whilst managing potential risks to them and others. The plans had been kept under review and updated, as the residents’ needs were becoming better known. Daily records showed that suitable support was being given to assist the residents with personal hygiene, activities, communication and general life skills. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 12 Formal Person Centred Planning had not taken place with the residents, however the residents’ personal preferences and wishes regarding activities and routines were clearly being considered e.g. one resident was offered the choice of what afternoon sporting activity he wished to attend. Residents’ involvement in their care planning was going to be reviewed once the transition periods were over and individuals’ abilities better known. The manager agreed to consider how arrangements to review the care and support at least every six months could be put into place even though social workers may only wish to attend annual reviews once the residents they have placed in the Home have settled in. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13,14, 15, 17 Positive arrangements were in place to provide residents with active and enjoyable experiences each day that they had some choice and control over. Good efforts were being made to maintain links with families and to support residents to go out into the community. Mealtime arrangements offered choice whilst encouraging a healthy diet. EVIDENCE: Both residents had clear activity plans and were being supported to access the community regularly e.g. for shopping, college or sports activities. They were being encouraged to be as independent as possible and to undertake valued tasks e.g. cooking, erecting a green house to grow vegetables. Existing hobbies were being encouraged e.g. indoor plants, video collections. Both residents were being supported to stay in regular contact with their families and to visit them. Relatives had been involved in supporting the residents to move in and in personalising their bedrooms and living areas. One resident’s family felt communications about how the service was developing Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 14 could be improved during this transition phase of the Home reopening. The manager should consider a newsletter or relatives meetings. Food was being purchased locally and a healthy diet encouraged. One resident prepares some meals in his own kitchen with staff support. One resident had lost a significant amount of weight since his admission through healthy eating and regular exercise. This was benefiting his health and lifestyle greatly, and it was hoped that he would soon be able to retry horse riding. The meal record could be improved by noting when five portions of fresh fruit and vegetables were being provided daily, as was reported. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) - EVIDENCE: These standard were not fully assessed, however there was evidence that health care was being made a priority. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23. Suitable arrangements were in place to provide a framework to protect residents from abuse. EVIDENCE: No vulnerable adult concerns have been raised since the last inspection. The staff spoken with were clear they would report any concerns promptly and felt the standards of care and staff conduct in the Home were high. Staff training was available in Adult Protection and in managing challenging behaviours. An Abuse and Whistle Blowing policy were in place and protection was also being covered in induction and during supervision sessions. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) - EVIDENCE: These standards were not assessed, however the Home was attractive, clean and was being well maintained. The manager agreed to ensure the grounds were clear from unnecessary hazards after a resident found easy access to left over building materials when he was upset. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,36. The residents were benefiting from the staff team who were being supported by effective management to work in a professional and consistent manner. Staffing arrangements still need to be further strengthened with new recruits and through the provision of essential training. EVIDENCE: The team leader and support worker were spoken with. They were positive about the residents and were enthusiastic about the range of valuable and enjoyable activities offered. They had a good understanding of the residents’ needs and how a consistent approach benefits them. They reported they were receiving regular supervision with a line manager and found staff meetings useful. All staff on duty were seen to interact with residents in a sensitive and friendly manner. Job descriptions were in place for each role and staff were also taking on keyworking duties. A sample of four weeks rotas seen showed that sufficient staff had been on duty at all times, including a senior. The original night staffing arrangements of one waking and one sleeping in had been increased to two waking staff following a reassessment of one resident’s needs. Providing the high staffing levels required had been difficult at times and the manager reported she had had to spend a significant amount of time over the last three months working on care shifts to cover gaps. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 19 New staff were in the process of being recruited to improve the current arrangements and in preparation for more residents to be admitted. Some agency senior staff had been needed to cover senior cover on at all times. The organisation had recently agreed to create another senior post to provide some flexibility to cover sickness, leave etc. The staff team are new and therefore arranging for each worker to attend all core, specialised and NVQ training has had to be staggered over several months. Progress was being made with a good range of courses being on offer, and three staff had achieved a relevant NVQ Award. A significant amount of training is still required, but the manager reported that staffing shortages had prevented staff attending some available courses. She felt that this situation would improve when the staff currently being recruited start work. The Condition of registration stating that all staff must attend training in Autistic Spectrum Disorder within the first twelve weeks of their employment had not been fully complied with. Six staff had attended this training but another four, who had been in post since April 2004, had not. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,41,43. The Home was being well run by a competent and approachable manager. Appropriate management and record keeping systems were in place. The corporate support and funding arrangements for the premises had led to breaches of the Regulations and of a Condition of the Home’s registration. These will be addressed with the provider. EVIDENCE: The manager holds relevant qualifications and has many years experience of managing services for people with special needs. The staff reported that she was professional, approachable, well organised and focused on residents’ needs. The residents interacted with the manager in an informal manner and also clearly found her approachable. The management systems in place that included daily handovers, regular staff meetings and supervision sessions provided time for the residents’ complex needs and staffs’ ability to respond to these to be kept under close review. The way in which staff discussed issues with the manager during the day indicated that all were well informed about Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 21 Autism and were supporting each resident in an individualised and skilled manner. The organisation has a formal internal Quality Assurance system. This was not assessed as the service and management systems were still being developed. The monthly provider’s visits have been carried out by the Regional Manager, however these were being arranged in advance with the manager and taking place when the manager was on duty. Regulation 26 requires that these visits be carried out unannounced to provide a monitoring system that helps to protect the residents. The Organisation has a corporate set of operational policies and procedures. These were not looked at on this occasion. The manager was advised to develop a policy and procedure to guide staff if they are required to take the role of ‘Appropriate Adult’ if a resident ever had to be interviewed by police. Records were being stored in the office that is locked when not in use. Consideration should be given to storing care plans in a locked cabinet to ensure only authorised persons have access to this information. Health and safety arrangements were not fully assessed however in the preinspection questionnaire the manager provided information showing that equipment had been serviced and fire safety checks and drills had been completed recently. Two areas for action were identified during an Environmental Health inspection in February 2005. The manager had not yet fully complied with the requirements made. Financial management was not fully assessed on this occasion, however a current insurance certificate was on display. It was a concern that two essential pieces of work had been delayed for over a month while the manager waited for funding authorisation from a senior manager. One was for electrical work in a bedroom a new resident was due to move into soon, and the other was for a door alarm that had been assessed as needed to help control a serious risk that had been identified. Authorisation for this work to proceed was received during the inspection. The manager has not been provided with formal and recorded supervision with her line manager every month and therefore this Condition of registration has not been fully complied with. Although the manager reported that she had been supported by her line manager in between supervision sessions through telephone and email contact, formal sessions are essential to ensure that clear communication and accountability is maintained during this transitional period. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 1 2 3 x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score 3 2 2 x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lammas Lodge Score x x x x Standard No 37 38 39 40 41 42 43 Score 4 4 x x 3 x 2 E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 23 NA. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 39 and 41. 2 and 3. Regulation 26 12, 13, 14. Requirement The monthly providers visits must be unannounced. Assessments must be comprehensive. Where the need for specialist support is identified a formal agreement to provide this must be in place with the funding authority prior to the person being admitted. Support staff who have not attended training in Autistic Spectrum Disorder within the first twelve weeks of their employment must be provided with this training. All other support staff must attend this training within the first twelve weeks of their employment in line with the Condition of registration. Essential repairs and premises works must not be delayed. The instalation of the door alert system and the electrical repair needed in one bedroom must be actioned. The manager must be provided with formal recorded supervision sessions each month by a line manager. Timescale for action 30/6/05 7/6/05 3. 32 and 35. 18 30/8/05 4. 24 and 42. 23 30/6/05 30/6/05 5. 39 and 43. 18. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 24 6. 43 13 Complete the risk assessments and hazard analysis required at the Environmental Health inspection in February 2005. 31/7/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA41 Good Practice Recommendations Further develop formats to provide information about the Home to residents and potential residents in a meaningful way. Develop a policy and procedure regarding staff taking the role of ‘Appropriate Adult’. Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Hereford Area Office 178 Widemarsh Street Hereford HR4 9HN 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 Lammas Lodge E52 E02 S24739 Lammas Lodge V226858 070605 Stage 4.doc Version 1.30 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. 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