Inspection on 13/10/05 for Ludbourne Hall

This inspection was carried out on 13th October 2005.

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

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

Other inspections for this house

Ludbourne Hall 13/10/06

Ludbourne Hall 31/01/06

Ludbourne Hall 19/10/04

Ludbourne Hall 02/04/04

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 Ludbourne Hall South Street Sherborne Dorset DT9 3LT Lead Inspector Rosie Brown Unannounced 13 October 2005 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 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. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ludbourne Hall Address South Street Sherborne Dorset DT9 3LT 01935 816382 01935 815901 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) Scosa Ltd Mrs Denise Bevan CRH PC - Care home only 16 Category(ies) of OP Old age (16) registration, with number of places Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: One of the following bedrooms may be used at any one time for shared occupancy, not exceeding a total of sixteen (16) residents: Bedrooms 7 & 11. Date of last inspection 19 October 2004 Brief Description of the Service: Ludbourne Hall is a registered care home offering both long and short-term places to a maximum of 16 people over the age of 65. The home is owned by Debra and Phillip Scott, under the title of SCOSA Ltd; the registered individual is Debra Scott and the registered manager is Denise Bevan. Ludbourne Hall is situated a short level walk from the centre of Sherborne and is within easy access of the town’s facilities including the railway station, gardens and Abbey. Parts of the building date back to the 18th century. Extensions have been added to create the present accommodation comprising 16 bedrooms, a ground floor lounge and dining room. Service user accommodation is on the ground and first floor. There are bathing and toilet facilities on both floors. The home does not have a passenger lift but a stair lift is fitted on the main staircase.Care staff are on duty at all times and include wakeful night staff. In addition to personal care and support the service provided includes all meals, laundering of clothes etc., and all housekeeping. There is a range of social and leisure activities and the manager and staff provide help to make and attend healthcare appointments as necessary. A variety of professionals visit the home including chiropodists, opticians, GPs and community nurses. The home has an enclosed patio area towards the rear of the building. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 13th October 2005 and was undertaken by inspector Rosie Brown: it was the first of two statutory unannounced inspections planned to take place this year. The inspection commenced at 11:00am and was concluded by approximately 2.05pm: a favourable impression was gained. The inspector assessed 15 of the National Minimum Standards and the requirements and recommendations set out in the report of the previous inspection. The communal areas and nine bedrooms were viewed: residents’ care records, staff recruitment records and certain policies and procedures were also examined. The inspector used observation skills to assess certain findings and also spoke with the manager, five service users and three members of staff. A CSCI leaflet entitled ‘Is the care you get the care you need?’ with the contact details of the inspector was also left in the home for service users information. What the service does well: There is a statement of purpose and service user guide available so that prospective residents can make an informed decision about moving into the home. The manage undertakes a comprehensive pre-admission assessment of care needs to ensure that the home can meet the person’s needs prior to admission. Care plans and care related risk assessments are in place for each resident and contain detailed guidance so that staff can meet identified needs. The residents’ social care provision in the home is central to care provision and forms a very positive part of life in the home. Residents are supplied with a variety of wholesome home baked food that is served in a congenial setting. The home is well maintained pleasantly decorated and furnished and clean throughout. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 6 The inspection revealed that the home actively promotes each resident’s independence, privacy and dignity, that their views are respected and acted upon appropriately. The home has a quality assurance system that includes all stakeholders’ views and it was evident that action had been taken to address findings and necessary improvements. What has improved since the last inspection? What they could do better: The care plans and care related risk assessments must be reviewed each month as well as at times of change. Although there are risk assessments in place concerning mobility they must make reference to the prevention of falls. The medicines storage cabinets should be relocated to a suitable place other than the kitchen. The propping open of the fire door to the ground floor bathroom must cease as it compromises the fire safety precautions in the home. A POVAFirst check must be undertaken for the new member of staff who has commenced working in the home before the return of their CRB/POVA disclosure. The homes policies concerned with recruitment and whistle Blowing must be updated to reflect the POVA guidance and amended Regulations. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 7 The home’s staff induction and training programme should be developed to include a check that each person has up to date training in the five mandatory topics referred to in standard 38 of the National Minimum Standards. New staff must be supplied with fire safety training during the first month of employment. In the longer term, the health and safety of some residents continues to be compromised while some radiators remain unguarded and not protected. The risk assessments relating to hot surface temperatures and likelihood of burns or injury from central heating radiators must be reviewed each month and following a fall. 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. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 Each prospective service user is subject to a pre admission assessment, which is undertaken by the manager to ensure that the home can meet assessed needs. The home does not provide intermediate care. EVIDENCE: The care records for one recently accommodated service user demonstrated that the manager undertakes a pre-admission assessment of care needs before the resident moved into the home. The assessment was comprehensive and a care plan drawn up to ensure that identified needs are met: a letter confirming that the home could met their needs was sent to the prospective resident prior to admission. Information was obtained through the hospital and from the family and was signed by a relative. Terms and conditions of residence agreements are provided and also signed by service users and the manager. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 Individual care plans and care related risk-assessments are in place for all service users but must be subject to monthly review to ensure that staff have up to date guidance to provide consistent care. Care professionals are contacted for advice and guidance appropriately so that residents’ specific health care needs are met. EVIDENCE: The care records and care plans for two residents were examined and noted the actions to be taken by staff in relation personal care needs including skin care, social care, mobility, dressing and daily routines. Care plans and care related risk-assessments in place did not demonstrate monthly review. Neither had risk-assessments concerning the prevention of falls. The home uses an accident record book that complies with Data Protection. The manager reviews each accident that occurs in the home following the occurrence and on a monthly basis to determine any patterns or causes and minimise recurrence. However, the care plan for one resident’s mobility needs was not updated following a fall where they sustained an injury to their head. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 11 One care plan evidenced that an Occupational Therapist had been contacted regarding the nigh time mobility and toileting needs of a recently accommodated resident: this record demonstrated good practice regarding specific health care needs. One resident said they are well cared for and that the staff are really helpful. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 and 15 Residents confirmed that the lifestyle experienced in the home satisfies their expectations and enables them to continue with their independence. Individual care records indicate the social care needs and interests of residents to ensure their individual expectations and preferences are fulfilled. The meals and food supplied by the home are very good offering both choice and variety and catering for special dietary need. EVIDENCE: It was evident from conversation with the residents and through observation that the social care provision in the home is very good. Care records evidence the activities that the service user had participated in and residents’ craftwork is displayed in the dining room and hall are of the home. The residents’ notice board displays a monthly social programme entitled ‘dates for your diary’. In addition, other information supplied includes, the weekly menu, the minutes from the monthly residents forum meetings, the home’s complaints procedure, the findings of the quality assurance survey, Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 13 useful contact numbers of local services including advocacy and the resident’s charter of rights. The table in the entrance hall also provides information including a copy of the home’s latest inspection report, the visitors’ book, quality assurance questionnaires and an Advocacy services leaflet. One resident said, ‘I go out to town in my buggy, because I can’t walk very far now’ and another said, ‘I go out for a walk each day and if not I use my exercise bike’. The menu demonstrated that service users are supplied with a wide variety of healthy food with seasonal variations. A cook is employed to work each day of the week including weekends to cook the main lunchtime meal. There is a separate dining room, which is attractively set out with a selection of dining furniture and comfortable armchairs in one part of the room creating a homely ambience. Residents can also take meals in the privacy of their room but the majority choose to eat in the dining room. The previous inspection report recommended that the medication storage cabinets in the kitchen be relocated and this is repeated in this report. The manager explained that future developments to extend the home are being considered by the owners and therefore the cabinets have not been moved. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 There are appropriate policies and procedures available concerning adult protection and staff are trained in the recognition of abuse so that residents are safe. EVIDENCE: There have been no reports of any form of abuse in the home. Procedures are available for staff reference detailing the action to be taken if abuse is suspected and these include a ‘Whistle Blowing’ policy. A copy of the local ‘No Secrets’ guidelines is also available for staff reference. The manager said that staff have received training in the recognition of abuse and that the home’s policies are discussed at each monthly staff meeting. The ‘POVA’ scheme (introduced on 26th July 2004) was discussed with the manager and the details of how to obtain a copy of the guidance supplied. On 26 July 2004 the Department of Health launched a phased introduction of the Protection of Vulnerable Adults (POVA) scheme. At the heart of the POVA scheme is the POVA list, which is maintained by the Secretary of State. The POVA list will work in a similar way as the existing Protection of Children Act (POCA) list. That is, it will operate as a workforce ban on care workers who have harmed vulnerable adults in their care. The POVA scheme gives significantly greater protection to vulnerable adults than has previously been the case. Care providers now have a statutory duty to check that potential new care workers are not on the POVA list before allowing them to work in a care position. They should do so as part of the CRB Disclosure application process. Staff recruitment is referred to later in this report. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home is clean throughout, attractively decorated and comfortably furnished creating a homely atmosphere for service users to live in. However, some central heating radiators are not guarded placing some service users at risk of injury. EVIDENCE: Residents’ bedrooms are available on the ground and first floor of the home; there is a stair lift for people unable to independently use the stairs. The large welcoming entrance hall has armchairs, the home’s ‘parakeet’ and other occasional furniture. There is a communal lounge where ‘Lily’ the home’s dog has her basket and a separate dining room, which also has an area with armchairs offering an alternative room to sit and relax in. The home is in good decorative order, is well maintained and homely: some original features of the ‘old house’ have been carefully restored. The home employs a maintenance worker and there is an annual development and maintenance plan in place. The manager explained that the ground floor Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 16 corridors are due to be redecorated before Christmas and that in the New Year the dining room will be redecorated. New carpets have been laid in a number of bedrooms and communal rooms: two bedroom carpets were stained and would benefit from cleaning. There were no unpleasant odours noted during the visit but the fire door to the ground floor bathroom and toilet was wedged open. The wedge was removed at the inspector’s request. It is recommended that the Fire Safety Officer be consulted to establish the most suitable alternative door closure to be fitted to this door so that it can be safely left in the open position. The home has invested in a new bath chair to aid assisted bathing in the ground floor bathroom and a portable bath seat is available for use in the first floor bathrooms. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The home is staffed by the manager who is supported by a team of care assistants and domestic staff but the staff induction training programme needs further development to ensure that each employed person has the skills necessary to care for service users. The manager uses a company staff recruitment and employment procedure. However, when new staff commence working in the home without their CRB disclosure satisfactorily returned and no POVAFIRST check this puts service users at potential risk of harm. EVIDENCE: At the time of the inspection the staffing levels provided reflected the registered providers aim to mainly accommodate service users who have low to medium care needs. The rota demonstrated that the manager is on duty each weekday with two care assistants and that senior staff are left in charge in her absence. There are two wakeful on duty during the night. The recruitment records for two recently appointed members of staff were examined and these contained a copy of the application, two references including one from their previous employer, an interview record letters confirming the offer of employment, job descriptions and employment contracts plus identification information for CRB/POVA check. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 18 The CRB disclosure for one member of staff had not been received and they had commenced working in the home without a POVAFIRST check and not in an additional capacity. Although the manager said supervision had taken place there were no records to support this. The staff on duty were observed to be friendly, polite, respectful and patient with service users. One service user said, ‘staff are really kind and helpful’ and another commented, ‘they are kind in here’. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 and 38 The registered manager is trained and experienced and is supported by regular visits from the (Registered Individual) RI of the company to ensure that service users are properly cared for. The home has policies and procedures to ensure that staff are supplied with guidance regarding the expected practices associated with service users care and a quality assurance system is in place. The management have yet to ensure that the health and safety aspects of service users’ care is being promoted by a comprehensive induction and staff training programme. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 20 EVIDENCE: The Registered Individual (RI) now visits the home at least once a month and provides the Commission and the manager with a written report of the support/quality assurance visit. The reports received have made positive comments about the social care provision and residents forum meetings. The staff records showed that they were subject to the home’ induction programme but it was not clear if this meets NTO specifications. For example new staff should be supplied with fire safety training within the first month of their employment. The home must be able to evidence that all staff have received training in First aid, Manual handling, Fire safety, Infection control and Basic food hygiene. The manager has compiled a comprehensive policy and procedures manual for staff practice guidance and this is under annual review. The policy/procedure concerning care of the dying service user has been expanded to include the actions to be taken by staff in the event of the sudden (accidental/unexpected) death of a service user, as recommended in the previous inspection report. The home’s staff recruitment procedures and ‘Whistle Blowing’ policy should be updated to make reference to the POVA guidance. The manager undertakes an annual quality assurance questionnaire and there was ample evidence to show that the findings had been acted upon, e.g. the home has a dog and a parakeet because residents have requested them. In addition, residents forum meetings take place and allows the opportunity for residents to express their views about life in the home, e.g. the food offered and where to go on outings. While radiators remain unprotected in rooms this means some residents are at risk and although risk-assessments are in place they must be reviewed each month and at times of significant change, e.g. following a fall or a deterioration in health or mobility. The home has a comprehensive fire risk assessment which is reviewed each year and contains all the pertinent information and regular in-house fire safety training is supplied by the manager during each monthly staff meeting. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 x 3 x x x x 2 Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 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. 2. 3. 4. Standard OP7 OP8 OP19 OP29 Regulation 14 & 15 13 (4) 13 (4) 18 (1) Requirement Care plans and care related riskassessments must be reviewed each month. Risk-assessments concerned with the prevention of falls must be in place for all service users. The propping open of the fire door to the ground floor bathroom must cease. Each new member of staff must be supplied with fire safety training twice within the first month of starting work in the home. Staff commencing work in the home must have a POVAFirst check in place: they must then be properly supervised, with wrtten records kept, until the return of a satisfactory CRB check. Timescale for action 10/11/05 10/11/05 31/10/05 10/11/05 5. OP29 19 10/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 23 Ludbourne Hall 1. OP 19 2. 3. OP29 OP38 The registered persons should consult with the Firse Safety Officer to identify the most appropriate door closure to be fitted onto the door leading into the ground floor bathroom sothat it can be safetly left in the open position when necessary. The registered persons should ensure that induction for new staff includes the five mandatory health and safety topics. The recruitment and Whistle blowing policies should be updated to make reference to the POVA guidance. Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit 4 New Fields Business Park Stinsford Road Poole Dorset BH17 0NF 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 Ludbourne Hall D55 S26838 Ludbourne Hall V240965 131005 Stage 4.doc Version 1.40 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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