Inspection on 23/11/06 for Maple Lodge Care Centre

This inspection was carried out on 23rd November 2006.

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

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

Other inspections for this house

Maple Lodge Care Centre 30/04/08

Maple Lodge Care Centre 02/05/07

Maple Lodge Care Centre 06/07/06

Maple Lodge Care Centre 14/02/06

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Maple Lodge Care Centre (Scotton Gardens) Scotton Richmond North Yorkshire DL9 4LZ Lead Inspector Jo Bell Key Unannounced Inspection 23rd November 2006 09:30 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 Maple Lodge Care Centre DS0000066447.V313852.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. Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maple Lodge Care Centre Address (Scotton Gardens) Scotton Richmond North Yorkshire DL9 4LZ 01748 834029 01748 831008 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) www.fshc.co.uk Four Seasons (DFK) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Susan Margaret Alderson Care Home 60 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (10), Old age, not falling within any other category (50) Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users to include up to 50 (OP), up to 10 (DE(E)) and up to 10 (MD(E)) up to a maximum of 60 Service Users The Category MD refers to one named Service User Date of last inspection 6th July 2006 Brief Description of the Service: Maple Lodge is a large care home providing nursing and Social care for up to 60 elderly people. There is a separate 10-bedded unit providing nursing care for people suffering from dementia. The home was purpose built in 1991 and comprises three single storey wings with level access by wheelchair users throughout. The fees vary from £430 upwards. There are additional charges for chiropody, hairdressing, papers and toiletries. The home is located near the Garrison base of Catterick and has extensive grounds to the rear with car parking at the front. Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A second key inspection of the year took place on Thursday 23rd November 2006. In July pre-inspection information was collected for the previous site visit. At this inspection one inspector spent over four hours at the home. The manager and administrator were not available and therefore some standards could not be assessed, though overall outcomes in each area were considered and decided upon. Service users, relatives and staff were spoken with. Observations of care practices, mealtimes, medication and interactions between service users and staff took place. Documentation regarding health and safety (including fire safety), care planning, training and staffing levels were checked. The deputy manager was available to assist when needed. The home has an environment where activities are enjoyed in large communal areas. However, some of the outcomes for service users were poor, these included privacy and dignity, nutritional care and aspects of fire safety. These were discussed with the deputy manager. What the service does well: What has improved since the last inspection? Fire doors have been installed on service users rooms. The sluice room and medication rooms have locks which ensures these areas are kept safe. Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 6 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. Maple Lodge Care Centre DS0000066447.V313852.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 Maple Lodge Care Centre DS0000066447.V313852.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable) Quality in this outcome area is adequate. Service users have their needs fully assessment though this is not consistently documented. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Initial assessments are undertaken by either the manager or deputy manager of the home. Information is also received through the care manager if the service user is funded through social services. The residents assessment relates to activities of daily living. Social, physical and health needs are discussed, the assessments checked were variable. All needs had been discussed though the information was not always kept in the same place. For example, one service user had incomplete documentation for meals, hobbies, religion, social history, and therefore the initial assessment had many blanks on it. However, further into the records details regarding social activities could be found. This needs to be addressed to ensure all needs are discussed, documented and can be met. Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is poor. Service users receive an unsatisfactory standard of care, their privacy and dignity is not maintained and safety issues regarding medication need to be addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit observations of care practices took place Two service users were case tracked, relatives were spoken with and discussions took place regarding the home with service users in the lounge, dining room and bedrooms. Overall care practices were unsatisfactory. On one occasion, a service user was found in the bathroom in a wheelchair on her own, even though she requires assistance. The care plan for this person was inspected and it was recorded that this person was registered blind, had hearing difficulties and often becomes agitated. The service user was already in an agitated stated being left on her own, and no action was taken to reduce this anxiety. During the time this service user was having a bath, staff kept coming in and out of the bathroom for a variety of reasons, none of which were urgent. This was observed on five occasions. This was discussed with the Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 10 deputy who said that this is where the hoist is stored, and staff need to go into the bathroom (even though there is an engaged sign on the door). However, there was a lack of understanding regarding privacy and dignity from the deputy and the staff on duty. This was evident later in the morning when another service user was having a bath. Again, because the bathroom door opens straight into the bathroom, service users can be observed having a bath which is extremely undignified for the person, and every time the door is opened a draft is then created making the whole bathing experience less than enjoyable. This must be addressed as a matter of urgency. One service user had a diagnosis of dementia, however it was felt these needs could be best met on the nursing/residential unit. Comments in the daily record said ‘rude to staff and residents’, other records confirmed this person was agitated and could be aggressive. However, whilst there was a care plan for being ‘wandersome and confused’ there was no specific plan to manage this type of behaviour. Some risk assessments were in place regarding moving and handling, nutritional assessments and prevention of pressure sores. Nutrition needs are not fully understood by the catering team (see Standard 15). Service users confirmed they had received visits from the GP, Chiropodist and dentist, this was clearly documented. The home also complete Regulation 37 notifications when an issue arises which adversely affects service users. Observations of service users showed that further improvements to personal care are needed. Some service users had stains on their clothes, on occasions hair was untidy and nails were not cleaned. One relative discussed care practices and felt this area needed to be improved. Attention to detail is needed. One service user before coming into the home always was immaculately dressed and wore make up according to her relative. Observations showed this person had been left without make up and poorly dressed. A jug of orange and a plastic glass had been left in her room, next to a vase of dead flowers. The jug was not accessible to her. However the deputy said it was not meant to be close to the service user because she would not be able to manage it herself, therefore staff would need to assist her. Improved communication is needed between the staff, service users and relatives. The medication system was checked, and it was evident that some improvements had been made since the last inspection. A lock has been fitted to the medication room door along with window restrictors. Medication charts were examined and found to be up to date, controlled drugs are stored correctly and medications are disposed of appropriately. The home has two medication trolleys, though when they are both in use only one member of staff has a key, Therefore for example on the dementia unit, if the member of Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 11 staff needs to leave the trolley unattended it cannot be locked. It is sometimes left in a room with a ‘stable door’ on full view of service users with dementia, or visitors. It cannot be secured to a wall. The rationale for this is that there is another key which is kept at the home and only used if the key in use goes missing. This is not satisfactory, a system whereby both trolleys can be locked and kept safe needs to be implemented. Maple Lodge Care Centre DS0000066447.V313852.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. Service users can enjoy activities, and some autonomy is encouraged though nutritional needs are not fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a large lounge, conservatory and activity area. There is a designated activity organiser who facilitates a range of activities. Evidence of games on offer included dominoes, board games, books, television and newspapers. Service users spoke with said they have a choice on whether they participate in activities. Service users can decide when they get up and go to bed and their daily routine. Visitors are encouraged and evidence of them entering and leaving the home was available in the visitors book. The rapport between staff and visitors could be improved, staff were not especially welcoming, and on one occasion the deputy spoke quite sharply to two relatives. The food was discussed with the cook, and the kitchen assistant and the kitchen area was examined (See Standard 38). The kitchen assistant did confirm that the dietician had previously visited. A cook confirmed he had received food hygiene training, though he is not a qualified chef. No other Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 13 training regarding how to meet nutritional needs has been undertaken. A discussion took place regarding how to cater for service users who are underweight or overweight, the cook did not understand how to meet these needs. His communication skills were poor, and he felt he needed to increase portion size or he would add cream to the porridge and mashed potato if anyone is underweight. However, he confirmed this would be for everyone and not just for those who are underweight, which would then have a detrimental effect on those who were overweight. This area needs to be addressed. The content of the menu has improved since the last inspection, there are normally two main courses to choose from. At the site visit lunch was a chicken stir fry with frozen vegetables, and a homemade pudding and custard. The content of the fridge was checked and it was confirmed that ham salad would be on the menu for tea. This was made with reformed ham. The dining room was examined, this was spacious with material cloths and napkins. Service users were observed being assisted in a dignified manner, and many people ate all their food. Maple Lodge Care Centre DS0000066447.V313852.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. Service users need to be communicated with more effectively regarding their concerns, and they need to be treated in a more respectful manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home have a complaints procedure in place. One previous complaint has been dealt with by the provider previous to this visit. A further issue was raised by a relative regarding items of jewellery going missing, although the manager was aware of this, the complainant did not feel she had received a satisfactory outcome. This was discussed with the deputy manager who appeared to dismiss this issue. Communication needs to improve and the home needs to be more pro-active in dealing with concerns. Staff receive adult protection training, and whilst this was confirmed it was evident through observations that staff did not respect service users or consistently treat them in a professional and courteous manner. This was evident when service users were being bathed. Four Seasons have an adult protection procedure in place and a designated Whistle Blowing telephone line, and therefore there is no reason for staff to behave in this manner towards service users. Maple Lodge Care Centre DS0000066447.V313852.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is poor. Service users live in an environment that is not consistently clean, and they have access to a limited amount of bathing facilities one of which needs refurbishing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is set in a pleasant location with views across the fields available. Routine maintenance takes place, and observations showed that areas of the home were nicely decorated. The home have a large communal space which is well used. It was evident that the bathroom on Laurel Wing is still in need of refurbishment, this has been outstanding for a number of months and needs addressing. The bath has rust marks, the room is very small making it difficult to use a hoist or wheelchair in this area and the floor and bath need repairing. The shower room is inaccessible as it is filled with continence products. These issues need to be addressed. Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 16 The dining room needs a thorough clean, the domestic mopped the floor though many crumbs were evident and the tables and chairs had stains and worn marks on them. Service users rooms were inspected and again it was evident that surfaces are not cleaned properly and areas remain dirty. It would be beneficial having an audit of the cleanliness of the home to gain a better understanding of this issue. Staff do receive infection control training, the laundry was examined and found to be satisfactory, different coloured skips and bags are used for normal or soiled clothes, and there is a designated member of staff for domestic duties. Maple Lodge Care Centre DS0000066447.V313852.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 & 30 Quality in this outcome area is adequate. Service users are cared for by a sufficient number of staff, though aspects of care needs improving to ensure service users are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An adequate number of staff were on duty to care for the thirty seven service users. A senior sister was on duty on the dementia unit with carers and the deputy of the home was in charge of the nursing/residential area. Service users in the lounge said that generally staff come and attend to their needs when they press the call bell. This was also observed throughout the visit. Some staff have completed an NVQ Level 2, though the home has a high turnover of staff due to its location which makes it difficult to increase the level of staff with these qualifications. The recruitment files were not available which the manager has responsibility for. Induction training takes place when staff are initially employed, this covers care practices, health and safety and issues relating to the role of carers. This is equivalent to skills for care (formerly TOPSS). Staff need to have a greater understanding of privacy and dignity and generally how to care for people to a higher standard. Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 38 Quality in this outcome area is poor. Service users do not have the opportunity to formalise their views and opinions. The home does not adhere to fire safety and therefore this puts service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some service users spoken with said they could discuss their concerns with members of staff, and whilst Four Seasons are developing a quality assurance system this has not be fully implemented. Some audits have started to take place though needs should be carried out routinely. Staff meetings take place though service users could not confirm that they had attended a residents meeting. The manager was not available to discuss in detail. Health and safety was discussed, previous certificate information has been provided regarding electrical wiring, gas safety, contracts for equipment, Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 19 environmental health and fire safety. The maintenance person is fully aware of the systems which need to be checked, this includes COSHH, water temperatures, kitchen checks and fire training. Risk assessments have been undertaken in many areas. The home must provide adequate storage areas for equipment. A fire drill took place during the visit which all staff responded to well. Staff have attended fire training and this was well documented. Since the last inspection, fire doors have been fitted to service users room doors which has minimised the risk of harm should a fire occur. However, it was evident at the visit that aspects of fire safety remain outstanding which have been raised by the fire officer. These include lack of fire doors to the lounge and insufficient fire doors within certain compartments. A fire risk assessment must be undertaken and action needs to be taken to address these issues. A discussion has taken place with the fire officer who confirmed this information, a request has been made for a visit to the home to take place by CSCI. Staff and records confirmed that moving and handling training, infection control and COSHH take place on a regular basis. The kitchen area was examined, the store room contained food which had expired, and many containers storing food were dirty. The preparation area, surfaces and fridge freezers all need a thorough clean. Staff must ensure a good standard of hygiene is maintained. Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 1 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 N/A 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A x 2 x N/A x x 1 Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP7 OP9 Regulation 15 13 Requirement Service users with dementia must have specific care plans in place regarding their behaviour. The ability to lock both medication trolleys when not in use must be made available. Staff must not leave the drugs trolley unlocked or unsecured. Service users must not be left unattended in the bathroom when carers should be assisting them. Service users when having a bath must not be interrupted by other staff coming in and out of the bathroom (unless there is an urgent reason to do so). The cook must be aware of how to make meals suitable for those service users who are underweight or overweight. The bathroom in Laurel Wing should be refurbished with the aim of providing a safer environment for the residents and staff (Previous timescales of 01/04/06, 07/09/06 not met). Timescale for action 07/12/06 07/12/06 3. OP10 12 23/11/06 4. OP10 12 23/11/06 5. OP15 16 23/12/06 6. OP19 23 23/01/07 Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 22 7. OP38 23 8. OP38 23 9. OP38 16 Recommendations from the 23/01/07 previous fire risk assessment must be acted upon, these include having fire doors to the lounge and having no more than nine bedrooms in one zoned area without a fire door (verbal/written information). A fire risk assessment must be carried out. Hoists, wheelchairs, commodes 23/01/07 and chairs must not be stored in service users toilets. A storage area must be provided. The kitchen area must be 07/12/06 thoroughly cleaned, this includes all the store room, preparation area, and all shelves, and cupboards. Any items of food which have expired must be destroyed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP3 OP16 OP26 OP28 OP33 Good Practice Recommendations The initial assessment should be completed in full, without blank spaces. A review of how complaints are dealt with should take place. An audit regarding the cleanliness of the home should take place. More staff should try to complete an NVQ Level 2 in care The quality assurance system needs to be fully implemented. Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Maple Lodge Care Centre DS0000066447.V313852.R01.S.doc Version 5.2 Page 24 - 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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