Inspection on 25/01/07 for Lorna House

This inspection was carried out on 25th January 2007.

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

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

Other inspections for this house

Lorna House 15/01/09

Lorna House 15/02/06

Lorna House 09/08/05

Lorna House 17/12/04

Lorna House 27/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Lorna House Devons Road Torquay Devon TQ1 3PR Lead Inspector Stella Lindsay Key Inspection (unannounced) 25th January 2007 9:15 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 Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lorna House Address Devons Road Torquay Devon TQ1 3PR 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) 01803 329908 01803 606532 clare@crocoscare.co.uk Crocus Care Limited Ms Linda Christine Vans-Colina Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24), of places Physical disability over 65 years of age (24) Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 2006 Brief Description of the Service: Lorna House provides residential care for up to 24 older people who may have physical disabilities, and who may have mild levels of mental confusion. The house is a large detached property with a level garden in the Babbacombe area of Torquay, by Cary Park. There are 20 single rooms, 9 of which have en suite facilities, and two double rooms, both en suite. There are three bathrooms, two of which have Aquatec powered bath seats. Accommodation is on two floors, with a stair lift. Access around the ground floor is level, with a ramp to the garden via the front door, and another from the conservatory. There is a dining room and a large lounge which leads to an attractive conservatory. The Crocus Care car is freely available for local journeys, with a charge for petrol for longer journeys, and a minibus has been provided. The service is not aimed at people with advanced dementia or severe physical disabilities, though best efforts are made to continue caring for residents whose health deteriorates after moving in to the home. Current fees range from £320 to £350 per week. The most recent CSCI inspection report was available in the entrance hall. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place between 9.15 and 5pm on a Thursday in January 2007. The Registered Manager had provided supporting information about the home, its staff and service users, and health and safety procedures and checks prior to the inspection. Comment cards were received from five relatives, and surveys were returned to the CSCI from a randomly selected sample of staff. Views expressed are represented in the text. The inspection involved a partial tour of the premises, and examination of care records, staff files, and health and safety records. The inspector met with the Manager, twelve residents, four staff on duty and two visiting relatives. All core standards were inspected. What the service does well: What has improved since the last inspection? A copy of the Residents’ Guide is now kept in the entrance hall, so that any resident or visitor may refer to it. A gazebo had been provided in the garden, to provide a shady area in hot weather. Residents had been out more, on trips and in the garden. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 6 The bathrooms and the laundry had been decorated, and were looking much better, though still awaiting new flooring. Staff lockers had been moved out of the laundry, in the interests of good hygiene. Surfaces in the kitchen and the cleaning routines had been improved, following an inspection by the Environmental Health inspector. Fly screens had been provided for the kitchen windows, so that staff could have ventilation, while flies are kept out. Temperatures of fridges and freezers were being logged, to make sure that food is stored at the right temperature. Staff files now have the documents required to assure the safety of residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear and up to date information is produced, and residents are offered care appropriately, after careful assessment. Intermediate care is not offered at Lorna House. 1,3 EVIDENCE: Lorna House has produced a Statement of Purpose and a Residents’ Guide which are clear and concise, and kept up. The ethos of the home in promoting positive choices and a stimulating social life is presented. Crocus Care also has a website – www.crocuscare.co.uk. The home’s Residents’ Charter, the Complaints procedure, and the Residents’ Guide were available in the entrance hall, as well as the most recent CSCI inspection report. Advice on ‘Choosing the right service’ printed from the CSCI’s own web site was also on display. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 9 Two residents had been recently admitted to the home. Both had attended for day care previously, so they were familiar with the staff, facilities and other residents, and the Manager was able to carry out the assessment of care needs over a period of time. The home has a standard letter sent to applicants on positive completion of the assessment, to let them know that Lorna House is suitable for meeting their needs. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was evidence of care staff working with health professionals for the good health and well being of residents, and the medication system was sound. 7,8,9,10 EVIDENCE: Personal fact files are compiled for each resident, including some social history. The person’s preferred daily routine was recorded. Service Users’ satisfaction questionnaires were kept on file, so their opinions were recorded. Care tasks are listed on a chart which is renewed weekly for each resident. Staff initial when they have accomplished each task each day. This is good for clarity and accountability. They could constitute a weekly check of care needs, but complete accuracy had not been maintained. Some tasks were not signed for, and it was explained to the inspector that the resident had chosen to do this for themselves. It was recommended that care task lists be produced individually, and that staff should write on them any differences observed or required. District Nurses visit daily to treat and monitor a resident who is an insulin dependent diabetic. Risk assessments were on file in respect of diabetes and Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 11 danger of falls. Another resident was monitored by the Parkinsons clinic, and had attended the previous day. ‘The staff do all they can’, said one visitor. Two residents needed to be fed. A complete record of food and fluid taken was kept in the room of a seriously ill resident, which showed the frequent care and monitoring that was being given. Professional advice had been requested, and specialist equipment had been obtained to meet the needs of residents with vulnerability to pressure areas. One resident was taken to physiotherapy on the day of the inspection. Another, who was recovering form an injury, was very appreciative of the care she had received – ‘they have pulled out all the stops’. There is a policy and procedure for administering medication. Residents are enabled to self-medicate if they are able. An assessment with regards to a resident’s competence to understand, deal with and store their own medication was seen to have been reviewed recently. There is appropriate storage and recording of Controlled drugs. Authorisation had been received for the homely remedies in use. The home should have a separate and secure fridge, now that insulin is stored regularly, as advised by the Royal Pharmaceutical Society in their advice on the Administration and Control of Medicines in Care Homes. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is choice and variety in the social activities and meals provided, and relatives are involved and kept well informed. 12,13,14,15 EVIDENCE: The day starts with breakfast being served in peoples’ rooms. Residents have a regular weekly time for their bath and bed changing. Those who spoke to the inspector were satisfied with these arrangements, though one resident was looking forward to being able to have a shower. Residents may have a fridge, kettle and microwave cooker in their room, subject to risk assessment. A little ‘shop’ is kept, so that residents can buy toiletries and stationery without delay. Residents’ privacy is respected, but they are encouraged to be sociable. Social activities are provided every day, and the activities planned for the month are written on a whiteboard in the entrance hall. On the day of the inspection some residents were taken out for a drive. A visiting activities provider did word games in the lounge with residents who had not wanted to go out, and later an exercise group was held in the lounge. Staff keep a record of social activities, and who joined in. They can see how popular different providers have been, and book accordingly. Staff lead activities, including memory games and discussion groups. A harpist gives monthly Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 13 performances. The weekly bingo is very popular, tempting downstairs some residents who otherwise choose to stay in their room. Residents had enjoyed seeing the Christmas lights, and some had been to a pantomime – ‘it was wonderful’, said one. A ninetieth birthday party had been held the previous week, including family members and other residents who joined in singing and dancing. Families had joined in social events over the Christmas period. Relatives who spoke to the inspector or returned comment cards said that they were happy with the home and service provided. The Manager sends newsletters to relatives every two months, informing them of developments planned for the home, as well as a list of forthcoming events, with an invitation to join in. On the day of the inspection fifteen of the twenty residents came to the dining room for lunch. There was choice in all three courses. For starters there was fruit juice or Florida fruit cocktail, main course a delicious home made chicken pie, with mashed suede, peas and potatoes or omelette with salad. Dessert was brought in so that residents could see what was offered, and choose any combination of jelly, fruit and cream. There is a vegetarian option every day. Choice is also offered at tea-time. On this day there was gala pie or sardines on toast, and a beautiful home made chocolate cake. Fresh vegetables are included in the diet on most days, and fruit salad is prepared at least once a week. Menus had been discussed at residents’ meetings, and suggestions included in the new menus that had been provided. All residents who spoke to the inspector were happy with the quality and variety of their meals. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management at Lorna House listen to and respond to residents’ concerns and suggestions, and procedures and staff awareness protect them from abuse. 16,18 EVIDENCE: The complaints procedure is available on the desk in the entrance hall. Records kept show that no complaints had been received since June 2005. Residents told the inspector they would tell the Manager if they were worried about anything, and minutes of Residents’ Meetings bear this out. There was a policy and procedure on the Protection of Vulnerable Adults from Abuse, which was clearly written and included the local arrangements about reporting any allegation. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The house is comfortable and attractive, and the Registered Provider has plans to carry out the work that is still required to make the building safe and hygienic throughout, and provide a choice of bathing facilities for residents. 19,20,21,24,25,26 EVIDENCE: Lorna House is an attractive and comfortable home. It has a spacious level garden, which was much enjoyed by residents over the summer. A gazebo was provided to give shelter on sunny days. There is a large and comfortable lounge, and a light and attractive conservatory, giving residents and their visitors a choice of sociable spaces. There is also a quiet corner, where the payphone is situated, with an easy chair. The dining room is pleasant and light, but people should avoid using it as a corridor while residents are eating their meals. Not all residents were comfortable in the dining chairs, and none of these chairs had arms to aid safety and independence. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 16 The bedrooms are varied and were seen to include many residents’ personal possessions. Four new bedroom carpets had been laid during the year. Electric sockets had been installed at waist height, for easy access. The home is light and warm. There had been problems with heating during the autumn and these had been dealt with. There are three bathrooms, two with battery-powered seats. The other bath is used only for sterilising commode pots. A sluicing facility is included in the improvement plans. The main plan is to provide an accessible shower and a toilet instead of the ground floor bath, and the Manager was pleased to inform the inspector that financial arrangements have been made, and this work is expected to progress. This will be a benefit for residents, and one resident particularly said that they are looking forward to having a shower. At present there is only one ground floor communal toilet. A sliding door has been provided for it, to enable residents with walking aids to use it and maintain privacy. The laundry had been redecorated, and was awaiting re-flooring which was to be included in the other works planned. Staff lockers had been moved out. Flaking walls were seen on the way to the back door where the staff lockers had been relocated. Paper towels and liquid soap had been provided in communal toilets, and disposable gloves and aprons were available where needed for personal care. Improvements had been made to the cleaning and checking of temperatures in the kitchen, following an inspection by the Environmental Health officer in August 2006. Fly screens had been provided for the kitchen windows, so that the staff could have fresh air without jeopardising food safety. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 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. 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. There is a stable group of staff, with good teamwork, continued training, and a variety of skills and attributes. 27,28,29,30 EVIDENCE: Lorna House is a busy home, with many family and health professionals visiting. Residents are increasingly frail, and currently two are bed-bound, with others also having extensive and complex care needs. Staff were seen to be meeting these needs, but would have met them better if there had been four care staff on duty, which is normal for week days. It had been reduced to three because no-one was attending for day care. However, although the workload was therefore reduced later in the day, the period from 8-11am would have benefited from having the full complement of staff. Of the five relatives who returned comment cards, two said that they did not think there were always enough staff (and one felt unable to answer that question). The Registered Manager is additional and works Monday to Friday. A Cook and a Kitchen Assistant and two domestic staff are also employed. The home has a handyman/driver, who also works for another Crocus Care home. During the afternoons staff are able to be involved in social activities with residents, and said that they enjoyed being able to talk with them. Of the current fifteen care staff employed, seven had achieved NVQ2 in care or equivalent. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 18 Recruitment had taken place, with all checks carried out for the protection of residents. The Manager encourages the staff in their NVQ achievement, and aims to provide training input every month. Other training provided during the year included a course in dementia care, and in-house training in food hygiene, control of infection, and in loss and bereavement. More staff had received training to become competent to administer medication. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 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. 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. The Registered Manager is well qualified and competent to lead the team with the support of the Senior Care staff. Good communication is actively promoted, between staff and management and with residents and families. Systems are in place to maintain safe methods of working in the home. 31,33,35,38 EVIDENCE: The Registered Manager, Linda Vans-Colina, has achieved the Registered Managers’ Award, and a Front Line Management certificate. She has threemonthly meetings with the other Crocus Care managers, and gives herself monthly goals to assure the home of continuous improvement. The Registered Provider, Clare Hunter, visits the home regularly, and sends monthly reports to the CSCI. Residents meetings are held, and minutes show that residents feel able to voice any concerns, and the Manager gives them an answer. Staff meetings Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 20 are also held. Staff were pleased to say that they felt they could speak out, and that everyone had their turn. All staff who returned surveys to the CSCI said that they felt they receive enough support to do their job well. A Quality Report for the previous year had been produced, and the Manager stated that she would supply a copy of the 2006 Report to the CSCI. Small amounts of cash are kept for six residents, at their wish. Records were checked and found to be accurate. The Registered Provider had stated that a risk assessment was included in the fire risk assessment for the home, abut this was not apparent at the time of the inspection. Professional fire safety training had been provided for staff at six monthly intervals, which is good practice. However, there was no evidence that night staff had an up-date at three monthly intervals, as is recommended for the best protection of residents in the event of an emergency. The fire precaution system had been serviced on 25/07/06. Training and up-dates in Moving and Handling, control of infection, food hygiene, and first aid had been provided. Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X X 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations The care task sheets should be written accurately reflecting individuals’ needs, with updates included as observed by staff or requested by residents, to ensure that all staff are aware of current care needs. A separate and secure fridge should be provided for the safe storage of insulin, to protect residents from potential harm. The Registered Person should ensure that all residents are comfortable while sitting at the dining tables. There should be a choice of bathing facilities for residents, and another communal toilet on the ground floor, for their enhanced choice and comfort. The laundry and bathroom floors should be sealed and easily cleanable throughout, in order to avoid risk of cross DS0000018390.V324419.R01.S.doc Version 5.2 Page 23 2. 3. 4. 5. OP9 OP20 OP21 OP26 Lorna House 6. OP27 7. OP38 8. OP38 contamination. Previous timescale 31/03/05. The weekday care staff levels should be maintained throughout the week between 8 and 11am, regardless of day care attendance, in order to meet residents’ care needs in the way they expect. Night Care staff’s up-dates in fire training every three months should be recorded, to ensure a safe response in the event of an emergency. Previous time scale 30/06/06. Staff and management should be aware of the risk assessment regarding the storage of oxygen, in order to maintain safety in the home. Previous time scale 31/03/06 Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lorna House DS0000018390.V324419.R01.S.doc Version 5.2 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. 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