Inspection on 22/05/06 for Linton Lodge

This inspection was carried out on 22nd 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Linton Lodge 09/10/07

Linton Lodge 22/02/06

Linton Lodge 30/09/05

Linton Lodge 11/01/05

Linton Lodge 21/10/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Linton Lodge 97 Forburg Road Hackney London N16 6HR Lead Inspector Kristen Judd Unannounced Inspection 22nd May 2006 10:20 Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Linton Lodge Address 97 Forburg Road Hackney London N16 6HR 020 8806 5343 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 Florelda Willis-Barnes Mrs Florelda Willis-Barnes Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 2006 Brief Description of the Service: Linton Lodge provides 24-hour residential care for six people with learning disabilities. Linton Lodge is located in a quiet residential road off Clapton High Road. It is easily accessible to Clapton, Stamford Hill and Stoke Newington British Rail links and shopping areas. The home is well served by bus routes on Clapton Road. Unrestricted on street parking is available. The property is a large, comfortable, homely Victorian terraced house with many original features. All service users have their own rooms with hand washbasin On the day of the inspection the home was fully occupied by 6 service users. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection followed up the requirements made at the unannounced visit held on 22nd February 2006. The registered manager was unavailable for the inspection. As a result not all of the key standard could be assessed, as the inspector could not gain access to relevant records. This has resulted in some of the previous requirements to be reinstated with new timescales so that they can be assessed at the next inspection. Samples of the homes records were examined. Service users and staff were spoken to during the inspection. There were six service users placed at the time of inspection. There have been 12 requirements and 1 recommendation made following this inspection. An unannounced inspection gives the Commission an opportunity to assess the home against the National Minimum Standards applicable to the service without the home having notice of the visit. Verbal feedback was given to the staff on duty. The inspector wishes to thank the staff and service users for facilitating this unannounced inspection. What the service does well: 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. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 &5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are clear about the service provision and what assistance is expected to be provided to service users. However the new contracts must be agreed and signed. EVIDENCE: The Statement of Purpose in place that covers the aims and objectives services provided, accommodation how referrals should be made and information regarding complaints. A copy of the service users guide was accessible and is in a suitable format. There is an admissions policy in place, which clearly states the referral process, initial assessment stage; trail visits and introductory period for service users. The policy also provides guidance for staff stating what is expected on the initial visits in place. There have been no new admissions since the previous inspection. There is a new contract/statement of terms and conditions however there was no evidence of it being issued to the residents. This therefore remains an outstanding requirement. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans cover basic needs and require further improvement to provide a comprehensive document, which is reviewed regularly. EVIDENCE: Individual service user plans were examined during the inspection. Each file examined contained a service user profile that contained all the basic personal information as required. There was some evidence to show that the plans had been updated since the previous inspection. The inspector tracked individual service users needs, such as personal care needs, which was still lacking in detail. For example one service user needs particular skin care products to be used due to allergies and assistance from particular equipment such information must be transferred to the individual plans. Plan of action and assistance from staff remains confusing due to the format of the individual plans. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 9 The inspector acknowledges that staff are clearly knowledgeable about the individual needs of the service users and how those needs are met. Such information must be included in the individual care plans. It remains an outstanding requirement that the registered manager must ensure that individual service plans clearly identifies the all of the assessed needs, how those needs are to be met and clearly describes any restrictions. The individual care plans lack evidence of how the plans are reviewed and evaluated. There has been improvement in some of the risk assessments now in place. However through cross-tracking between the risk assessment and the service users plans it was noted that the not all risks had been assessed. For example a service user does at times display inappropriate behaviour which has not been risk assessed. This was highlighted in the previous inspection. Service users are involved in the day-to-day running of the home, participation in activities of daily living and involvement in choice of daily activities. Service users are encouraged to maintain their personal space, preparation of drinks dependent on their ability. Service users have weekly plans and staff support them is needed to complete daily living tasks around the home. The inspector continues to be satisfied that service users are involved in the day to day running of the care home where possible given the dependency of each service user. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, 15,16 &17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to make choices and are provided the opportunity to access the community and take part in activities in the home, which provides variation and interest for service users. EVIDENCE: The inspector continues to be satisfied through observations made during the inspection that staff encourage service users to be involved with many activities and organisations outside the home. Service user assist with tasks around the home in line with their individual abilities. All the service users attend some form of day services such as day centre and community groups. This continues to be one of the homes strengths. One the day of inspection three service uses attended some form of day provision. Two went into the community independently. The sixth service user was provided one to one support to access the community in the afternoon. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 11 Records seen reflected trips to the cinema or service users being taken to the local pub. There is a weekly art club at the home and many of the art projects that service users have been involved in are on display. The staff spoken to showed the inspector a piece of art work completed by the most recent service user which shown the improvement over a period of six months. This piece of work is on display in the dinning area. The registered manager arranges an annual holiday for service users. The inspector was informed by staff that this will be in July this year the destination is yet to be agreed. Service users were seen to move around the home without any restrictions. Through discussions with staff it was clear that service user are able to get up and go to bed as and when they wish to. Daily recording supported this information, sometimes recording detail of the television programmes that the service users like to stay up to watch. Records indicated family involvement and contact arrangements. One service user goes home regularly at weekends. Another service user is escorted to visit his father fortnightly who is also in a care home locally. Family are encouraged to visit the service users at the home. There are three meals offered daily when service users are present in the home, with additional drinks and snacks. Meals are recorded in a daily diary; these records were evidenced during the inspection. Kitchen and food storage premises were inspected, these were found clean and hygienic. It was noted that fresh foods such as chicken drumsticks, cakes and croissants had been frozen but not dated. Additionally there was salad cream and a jar of jam in the fridge that was not dated when opened however instruction clearly stated ‘ consume within six weeks’. Therefore it remains an outstanding requirement that all foods are appropriately stored. Fridge and freezer temperatures were checked however there was no entry noted for the 21/5/06. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. It was the inspectors view was that medication was not being accurately administered; the current practise and lack of adequate recording puts service users at risk. EVIDENCE: Service users’ require a range of support with personal care from prompting supervision to assistance with regards to bathing and assistance with toileting. Service users are fairly independent and are able to make day-to-day decisions such as what time to get up and what activities they wish to undertake. The daily routine is managed around the service users on a daily basis. The inspector was satisfied that appropriate referrals are made with regard to service user health when required. Service users files contained documented medical appointments to GPs, dentist, the local hospital and occupational therapist. The inspector saw evidence of Health Action plans for individual service users, these were detailed and contained relevant guidance for staff with regard to health issues. The inspector recommends that these also clearly indicate actual dates of when service users have annual checks for ease of reference. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 13 The inspector completed five spot checks on generic packaged medication all of which were deemed incorrect. Of particular concern one service user had been newly prescribed a medication and was issued fourteen doses. The Medication sheets reflected that ten doses had been given which meant that there should be four doses remaining however the inspector noted that there were seven doses available. On the day of inspection the medication had been given to service users, two of which had left the home at 9.00am. At the time of the medication being checked 12.15 am the staff member had not completed the medication sheets. This is deemed poor practise. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Clear guidance must be available for staff to respond to allegations of abuse effectively and efficiently in order that service users are protected. EVIDENCE: The complaint procedure is in place. A pictorial format is available for service users. The complaints log indicated that there have been no complaints since the previous inspection. The inspector spoke with the registered manager by telephone and was informed that the Adult Protection policy was in the process of being developed. As such it remains an outstanding requirement that the home must further develop an adult protection policy and procedure, including whistle blowing. The adult protection procedures must link and refer to the adult protection procedures of London Borough of Hackney. Staff have attended an abuse awareness course. The inspector spoke with staff with regard to responding to allegations. Staff appeared confident with regard to how to respond and if in the absence of the registered manager correctly reporting to the local authority. There have been no incidents since the previous inspection. Service users have their finances managed by staff. Records seen were accurate at the time of inspection. A spot check on monies in the home was undertaken which was correct at the time of inspection. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. It is the inspector view that at present the environment is suitable for purpose. EVIDENCE: The home is situated in a quite residential area and is in keeping with the local community. It offers easy access to local amenities and transport links. A tour of the premises was conducted. The inspector was satisfied that the premises are suitable for the stated purpose, and it is accessible to service users. There is no lift however there is a chair lift fitted to the staircase, which is not operational. The registered manager states that this would be in use if a service users required the facility. The office is situated on the first floor. There is no separate visitors room available. The home has a small garden with patio area is available. Parking in the area is unrestricted. The premises are comfortable, bright, and airy. There is sufficient light, heat and ventilation. Furnishings and fittings are of adequate standard. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 16 The staff share the cleaning within the care home, service users are supported by staff to maintain their own rooms if required. All of the communal areas and service users bedrooms were very clean and hygiene. There is a small laundry facility in the basement. The registered manager confirmed with the inspector by telephone that she is still hoping to make some improvements to the outside of the home in the coming year. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Issues around previously raised with regard to training and supervision must be addressed to ensure care provision to service users is of the highest standard. EVIDENCE: Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 18 The home always has at least 2 members of staff on duty during the day when all service users are in the home. At night there is one sleep in night. This is deemed appropriate to meet service users needs. The inspector saw evidence of this on the staff rotas, which accurately reflected staff on duty at the time of inspection. It was noted that staffing is increased to accommodate service users to undertaken activities. One of the service users spoken to was satisfied with the care provided. The inspector spoke with staff on duty during the inspection and was satisfied that they were fully aware of their individual roles and what was expected of them The registered manager was not present at the inspection; as a result the inspector could not access supervision, recruitment and training records. These standards will be inspected at the next statutory inspection. These standards were scored as a ‘2’ at the previous inspection. As such the previous requirements in these areas that will carry forward to the next inspection, one of these requirements was still within timescale. Minutes for staff meetings were seen for February 2006 the content of the meeting was good. The registered manager uses this forum for informing staff of issues in the home. Items that were discussed were as follows: Concerns regarding service users. Inspection Day to day issues. Outings Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42&43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager must formalise the business plan for the care home. EVIDENCE: The inspector acknowledges that the registered manager was not present at this inspection however assured the inspector by telephone that many of the requirements that are regarding documentation have been completed or are in the process of being completed. The inspector has reinstated unchecked requirements with new timescales and these will be inspected at the next statutory inspection. Staff spoke to spoke highly of the registered manager stating that she was always contactable when not in the home. It is recommended that the registered manager formalise feedback from professionals, service users and families with regard to their satisfaction by implementing a system to record feedback with regard to the service provision. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 20 The inspector acknowledges that there continue to be improvements in the homes recording however improvements are needed in the following areas to keep records up to date and valid: Risk assessments. Care plans. Medication Requirements have been made against individual standards. Service users’ finances were seen which were being recorded accurately and were deemed correct. The inspector spoke with the registered manager by telephone and was informed that the business plan was still being worked on. The inspector was informed that some external works will be completed this year. It remains an outstanding requirement that the registered manager must ensure that business and financial plans of the home are available for inspection. The inspector saw evidence of certificates and other documentation that was in place to ensure health, safety and welfare of service users and staff. Linton Lodge DS0000010275.V292258.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x x 3 3 x x 3 2 Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 17 Requirement The registered manager must ensure that all service users have signed contracts in place. (Timescale of 30/04/06 not met) The registered manger must ensure that care plans clearly identifies the all of the assessed needs, how those needs are to be met and clearly describes any restrictions and agreed with service users. (Timescale of 31.12.04 not met) The registered manager must ensure that individual care plans had are reviewed and evaluated at least six monthly and updated to reflect changing needs. The registered manager must ensure that individual risk assessments for service users are carried out and recorded. (Timescale of 28.2.05 not met) The registered manager must ensure that all foods are appropriately stored. The registered manager must ensure that all medication is stored and recorded accurately. (Timescale of 30/11/04 not met) Timescale for action 31/08/06 2. YA6 15.1.2 31/08/06 3. YA6 15.2 31/08/06 4. YA9 13.4 31/08/06 5. 6. YA17 YA20 16.2(i) 13.2 30/06/06 30/06/06 Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 23 7. YA23 13.6 8. YA34 19.1 9. YA36 18.2 10. YA34 19 11. 12 YA35 YA43 18.1 25 The registered manager must ensure that the Adult Protection Policy be developed to include actions taken by the home and ways of reporting adult protection issues to relevant authorities. (Timescale of 31.12.04 not met) The registered manager must ensure that records for all employees comply with Regulation 17 and the accompanying Schedule of The Care Homes Regulations 2001. (Timescale of 31.12.04 not met) The registered manager must ensure that persons working in the care home are appropriately supervised and records are available. (Timescale of 31.12.04 not met) The registered manager must ensure that staff work in line with any visa restrictions in place. The registered manager must ensure that all staff completed mandatory training. The registered manager must ensure that business and financial plans of the home are available for inspection. (Timescale of 31.12.04 not met) 31/07/06 31/07/06 31/07/06 31/07/06 31/05/06 31/07/06 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 Refer to Standard YA19 Good Practice Recommendations It is recommended that Health Action plans be updated with the actual dates of annual checks completed/due. Linton Lodge DS0000010275.V292258.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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 Linton Lodge DS0000010275.V292258.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. 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