Inspection on 11/10/05 for Northview Lodge Nursing Home

This inspection was carried out on 11th October 2005.

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

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

Other inspections for this house

Northview Lodge Nursing Home 24/12/09

Northview Lodge Nursing Home 17/11/08

Northview Lodge Nursing Home 15/03/07

Northview Lodge Nursing Home 23/05/05

Northview Lodge Nursing Home 16/11/04

Northview Lodge Nursing Home 08/07/04

Northview Lodge Nursing Home 19/03/04

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

CARE HOMES FOR OLDER PEOPLE Northview Lodge Nursing Home Northview Road Castletown Sunderland SR5 3AF Lead Inspector Mrs Katie Tucker Unannounced Inspection 11th October 2005 10:00 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 Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 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. Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Northview Lodge Nursing Home Address Northview Road Castletown Sunderland SR5 3AF 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) 0191 5168605 0191 5168601 Southern Cross Healthcare Services Limited Mrs Lynn Bell Care Home 45 Category(ies) of Dementia (8), Dementia - over 65 years of age registration, with number (15), Mental disorder, excluding learning of places disability or dementia (30), Physical disability (10), Physical disability over 65 years of age (7) Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th May 2005 Brief Description of the Service: Northview Lodge is a two-storey purpose built nursing home, which was originally designed to provide care for older people with dementiatype illnesses. At the beginning of 2002 the ground floor was converted to provide care for younger adults with acquired brain injury and mental health needs. In July 2004 the upstairs unit was converted to provide a smaller higher staffed unit for older people with a dementia-type illness and a small unit for younger adults with very complex mental health needs. There is a car park and main entrance to Northview Lodge at the front of the building. Access to this entrance is level. Both floors have dining rooms, lounges, bathrooms, toilets and bedrooms. a passenger lift serves both floors. The administration office is located on the first floor with an additional office area on the ground floor. The home is off the Western Way at the Castletown junction. A short walk from the home is an industrial/business estate with food retailers and a range of stores. The local bus routes provide transport to the local estates and the city centre. Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of Northview Lodge and was conducted as part of the routine yearly programme. An inspector visted and spent the day at the home talking with residents, relatives and staff. A sample of assessments, care plans and risk assessments were examined plus staff files and personal allowance recors were discussed. The staff were asked about the service user plans, the complaints procedure, access to training and any changes to working practices, as were the service users. The general maintenance of the building was checked. Northview Lodge provides a service for people with a dementia-type illness (memory loss) and acquired brain injury as well as for people with mental health needs. Some of the people have difficulty making their views known. Therefore staff practice, attitude and approach were observed and judgements were made on how well the approaches that were used were working. This type of observation formed a part of the inspection process as well as what people said and was backed up through the examination of records, comments made by service users, staff, relatives and the manager. During this inspection key standards were focused on but not all were checked. What the service does well: The service is follows the ethos of providing person centred care and this was very evident throughout the visit. The service is well–run and practices are based on up-to-date research. The manager and staff are constantly promoting the rights of the people who live at Northview Lodge. The staff on the dementia care unit worked with people in a sensitive manner and valued people’s choices and decision. By adopting this style of care residents have retained many of their skills. Staff and relatives reported that since moving to Northview Lodge one person communication and skills have greatly improved. Over the last year groups of people from the younger adults units have been on holiday to Spain, Turkey and at the end of the week were going to Portugal. The manager is in the process of organising a weekend a way in England for people from the dementia care unit. Northview lodge is divided into three units and staffing levels in all three units is beyond that seen elsewhere. Southern Cross Healthcare has instructed the Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 6 manager that she must staff at sufficient levels to meet all the needs of the people using the service. At the last inspection the manager said she felt Southern Cross Healthcare would heavily criticise her if the home were found not to be meeting people’s needs. The manager works in partnership with a local hospital trust. This has led to an occupational therapist working full-time at the home. Also Southern Cross employs a team of specialists including a psychiatrist, a neuro-rehab psychologist and clinical psychologist who specialises in dementia care. This level of healthcare support has greatly enhanced the care that people receive and allowed staff to develop their skills and ability to meet people’s needs. The resident’s on all three units have access to a wide range of activities. Staff have started to take resident’s on the dementia care unit out for a meal every Tuesday. Plus other activities are provided on the unit such as art and craft sessions, which have included texture boards and a tree of life. Residents were very eager to tell the inspector how they had put photos and made the leaves for the tree. Staff also use resident’s memorabilia as reminiscence tools and were sitting with people discussing their photos. Staff skilfully assisted resident’s recall recent and distant events and people. Thus residents’ were proactively assisted to find ways to remember their loved ones including great grandchildren. Staff have completed all of the life histories for people who have dementia. This information has been written in a sensitive and informative way. The life histories reflect clearly how staff greatly value people. What has improved since the last inspection? The staff are continuing to develop their record keeping. They are aware that they need to change some of the way that they record information so care plans and also up-date some care plans. During her audit process the manager has identified this as an area that needs to be concentrated upon. The assessment records that the manager developed for people with dementia have been completed. With this being a new tool staff are in the process of reviewing writing styles. It was suggested that staff write in the same style as the life histories and add the skills people retain onto this document. Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 7 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. Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 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 the following standard(s): 3 and 6 The manager adopts a pro-active approach to admissions and this ensures that the needs people have can be met at Northview Lodge. Staff have worked hard over the last six months to complete all of the new assessment tools and these provide a wider range of informative and pertinent information. EVIDENCE: The manager ensures that a lot of detail is recorded when assessment of people’s needs are undertaken prior to admission being agreed. She is adept at ensuring that agreements are reached, around meeting people’s complex physical and mental healthcare needs and conditions of residency, prior to admission. She appropriately contacts CSCI to discuss the complex needs people may have and the impact this may pose for other service users prior to their admission to Northview Lodge. The manager developed a specific assessment tool for the younger adults units when this service was opened in 2002. The tool is very comprehensive and provides space for a wide range of information to be recorded. At the last inspection it was noted that at times some important information was not Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 10 recorded. Staff have continued to develop the way they record information so the incidence of the occurring is reduced and hopefully eradicated. The manager has collaborated with a neuro-rehab psychologist and elderly psychologist to design an appropriate and comprehensive assessment tool for the dementia care unit. This tool was seen to be very useful and has now been completely introduced. Staff have been working hard to complete the assessment for everyone. Staff are recognising shortfalls in their style of writing and with the completion of each one have increased the amount of information to be included. One gap was noticed in the information recorded, which was the recording of skills individuals retained. Without this sort of information an unclear picture of a person can be generated and the resident may appear less able than they actually are. Staff undertook to add into the assessments this information and reflect when people’s memory fluctuated. When people have a dementia-type illness the generation of life histories is crucial for assisting staff to work with these people. People with dementia tend to revert to previous routines and patterns of behaviour. By understanding how people have lived and their lifestyles, what often seems to be unusual behaviour when seen in the context of what people previously did becomes perfectly reasonable. Staff have completed life histories for all of the people with dementia. These are written in a narrative style and give a real sense of the person. Staff have evidently spent a considerable amount of time finding out about people’s lives and preferences. Intermediate care is not provided at Northview Lodge. Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 11 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 and 8 Staff have a wide range of information about how to meet the health and personal care needs of individuals. At times staff need to ensure care plans are up-to-date. The staff practices are in line with current models of good practice. Resident’s have access to a wide range of healthcare including specialist provision organised by Southern Cross Healthcare. EVIDENCE: Staff are developing a wide range of care plans and risk assessments. At times it was found that the care plans had not been reviewed for some time and people behaviour was markedly different now. Inconsistent recording can led to staff missing the important actions that need to be taken, or provide inappropriate care. Staff undertook to review the care plans and risk assessment to ensure they are accurate. The manager works in partnership with a local hospital trust. This has led to an occupational therapist working full-time at the home. Also Southern Cross employs a team of specialists including a psychiatrist, a neuro-rehab psychologist and clinical psychologist who specialises in dementia care. This level of healthcare support has greatly enhanced the care that people receive and allowed staff to develop their skills and ability to meet people’s needs. Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 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, 14 and 15 Residents from all units are given access to a wide range of appropriate and stimulating activities. Staff at Northview Lodge have started to extend the range of risk-taking strategies they use for all three resident groups. This was seen as a positive development since the last inspection. EVIDENCE: During the visit staff on all three units were encouraging people to join in activities. Staff were very adept at engaging people in various activities. People were looking at photos, playing dominoes, and enjoying beauty sessions. Whilst others residents went out to college, for meals or to the local shops. Staff were very aware of the importance of meaningful occupation and how feeling valued contributes to people’s sense of well-being. Limitation and restrictions have to be imposed at times because of the needs of individuals or behaviours they are demonstrating at times. When this occurs staff need to record why these decisions have been. The level of risktaking activities has increased in the dementia care unit and people now have access to tea-making facilities, which was seen as a positive development. Nutritious meals are offered at North View Lodge and people can have snacks outside of the regular mealtimes. People were very complementary about the range of food provided. Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 13 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 The complaints procedure is available and has proved to work effectively. EVIDENCE: Southern Cross Healthcare developed a complaints procedure, which complies with the requirements of both the national minimum standards and Care Home Regulations 2001. This is reproduced in the service user guide and made available to residents or their representative. The manager recognises the importance of dealing with all concerns in a proactive manner. She actively encourages residents and relatives make their views known. Where people have raised concerns she has dealt with these to the satisfaction of all concerned and ensured the actions taken to address an issue have been sustained. Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 14 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 and 26 Southern Cross Healthcare and the manager are constantly reviewing the environment and within the constraints of the design of the building ensure it meets current models of good practice. All areas are maintained to a good standard of cleanliness. EVIDENCE: Northview Lodge unit on the ground floor for younger adults is divided into two sections. This allows service users the option to choose which area of the home they live in but still mix when they want. Tea making facilities are provided on both of these units as well as a range of communal areas and bathing facilities. Major refurbishment works were completed lat year on upstairs to develop a smaller unit for people with a dementia-type illness and create a unit for younger adults upstairs. Throughout the changes the manager has demonstrated a desire to develop a very high standard service for people with Dementia-type illness. The reduction to a smaller sized unit for people with a dementia-type illness was based on research produced by Stirling University. The way the lounges and corridors were altered made them more interesting Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 15 and has allowed service users to use the facilities more productively. The manager has developed a kitchenette upstairs on the dementia care unit so as to allow people to retain their skills around making drinks and snacks. Southern Cross Healthcare has agreed plans to develop a conservatory and provide a range of new furniture. A number of areas around the home have been redecorated recently and new carpets have been provided. The overall maintenance of the building is to a satisfactory standard. Northview employs a handyperson and any minor faults are rectified in prompt manner. Dedicated domestic staff ensure the home is kept clean and free from offensive odours. Also dedicated laundry staff provide a good level of service. Staff have completed infection control training. Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 16 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 and 29 The staffing levels at the home very clearly meet the personal, social and emotional needs of the service users. Training is available for staff and staff are actively encouraged to become life long learners. EVIDENCE: The manager has set minimum staffing levels at 2 qualified nurse and 5 carers on the downstairs unit during the day. On the 15-place unit for dementia care 1 qualified nurse and 3 carers are provided during the day. On the 10-place unit for younger adults 1 qualified nurse and 2 care staff are provided during the day. During the night 3 qualified nurses and 4 care staff are provided. However these staffing levels are routinely exceeded and additional staff will be provided in all units. Recently the manager created a senior care post in the dementia care unit as she felt that as the other two units had this position so the should the dementia care unit. Although some reasons for this are that on the younger adults unit specific placing contracts are in place for particular people this is not the case in the dementia care unit. The manager has been allowed to meet not only the personal care needs of people within the home but also the emotional and social needs. The manager is a great advocate for all people with mental health needs and ensures this is reflected in the practices adopted at Northview lodge. During the inspection 1 nurse were on duty and 4 carers were on duty on the dementia care unit, 1 nurse and 3 carers were on the upstairs unit and 2 Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 17 nurses and 5 carers were on duty downstairs. Residents are due to go on holiday at the end of the week and Southern Cross Healthcare ensure staff are provided in sufficient numbers to meet the needs of these residents. The company pays staff for all of the time they were accompanying people on the holiday, which again is very good practice. Since the last inspection the manager is ensuring that her practice meets the requirements of the Working Time Directive. The manager described how now she makes sure that if she is needed to complete night shift she does not work the following day. All staff starting work at the home have a week long induction prior to starting to work as a team member. The manager said she found this to be very useful and staff said it was helpful. At the last inspection the night staff discussed the range of training that they received. The manager arranges mandatory training in one-day batches so those on their days off do not have to keep coming in for various updates. However it was suggested that for access to other types of training the manager might consider the use of the Internet, which she has done. Now three of the computers have Internet access, one of which is used by residents. All of the care staff hold an NVQ level 2 award. Six staff hold level 3 awards and 4 staff have NVQ level 4. Three staff have recently commenced the registered managers award. Staff from the home have been able to get places on nurse training and one person has just qualified. Also one of the part-time staff members is completing a BSc in psychology whilst another is completing research projects into schizophrenia. The manager has become a member of the older people mental health forum, which a focus group for DoH local initiatives. Residents and relatives were extremely complimentary about the service offered at Northview Lodge. Also people were very complimentary about the staff team and felt that they were skilled and competent at their jobs. Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 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, 35 and 38 The practices adopted at Northview lodge ensure people’s health, welfare and financial matters are not compromised. EVIDENCE: The manager exceeds the standards for the range of qualifications that she needs to hold for this position. She has consistently demonstrated excellent management skills and is constantly up-dating her practice. A robust quality assurance system is in place that meets the needs of Northview Lodge. The computers were down so personal allowances could not be fully checked. But the system in place and administrator remain the same. Mechanisms in place ensure that three signatures are received for every monetary exchange. The manager completes and audit every month and Southern Cross Healthcare ensures an independent account comes and verifies practices every six months. Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 19 Door guards have been purchased for residents who choose to keep their doors open. No other health and safety issues were noted at the time of the inspection. Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 4 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 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 Standard OP3 Regulation 12(2) Sch 3(3)(q) Requirement The assessment process must include individuals’ rights, decision-making skills and outline where they are limited.(reqired at the last inspection -timescale 19/04/05) Care plans must set out in detail the actions that staff need to take to meet service users needs. Timescale for action 14/03/06 2 OP7 15 (2) 14/03/06 3 OP29 19 (5) (b) Care plans must be reviewed and action must be taken to ensure they are up to date. A robust system for CRB 15/01/06 disclosures that come back with a show must be in place, which is not reliant on the good will of the individual to produce their form.(required at the last inspection - timescale 22.03.05) Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 22 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 OP12 Good Practice Recommendations Residents on the dementia care unit would benefit from regular access to cookery sessions. Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 Northview Lodge Nursing Home DS0000018202.V250866.R01.S.doc Version 5.0 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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