Inspection on 01/12/05 for Poppy Lodge

This inspection was carried out on 1st December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Poppy Lodge 29/05/07

Poppy Lodge 07/11/06

Poppy Lodge 23/06/05

Poppy Lodge 04/11/04

Poppy Lodge 13/07/04

Poppy Lodge 30/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Poppy Lodge 633 Church Road Yardley Birmingham West Midlands B33 8HA Lead Inspector Alison Stone Unannounced Inspection 1st December 2005 09:00 Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 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 Poppy Lodge DS0000017128.V267241.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Poppy Lodge Address 633 Church Road Yardley Birmingham West Midlands B33 8HA 0121 628 3718 0121 628 3718 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Saeeda Younus Mrs Saeeda Younus Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 23rd June 2005 Brief Description of the Service: Poppy Lodge is currently registered to provide accommodation, care and support for 4 people with learning disabilities. The Registered Manager is also the owner of the Home. An application to increase the number of places to 4 has recently been agreed by CSCI. The property is a large detached house situated in the residential district of Yardley in Birmingham. A range of local amenities and community facilities are available close by, and the house is well served by public transport. On the ground floor there is a through lounge / dining room which gives access to the rear garden through patio doors. There is a large kitchen: adjacent to this is a sizeable lean to, which houses the laundry facilities. There is a downstairs bedroom with en-suite bathroom, and a further w.c, occupied by a new resident that has just moved into the home. Upstairs there are three single bedrooms occupied by the current residents. All have wash hand basins, but none have en-suite facilities. There is a small bathroom with over-bath shower, and a separate w.c. The office and staff sleep-in room are also on this floor. At the front of the house is a good-sized drive offering off-road parking. To the rear of the property is a large private garden. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this visit over the morning of one day. The inspection was unannounced. Information used in the report was collected by talking with people who live in the home, the manager and staff and observing the care and support the people received. The inspector looked at records about care, activities, staffing and some health and safety records were inspected. This was not a full inspection and this report should be read alongside the report of the previous inspection of 23rd June 2005. The inspector would like to extend thanks to everyone who helped with this inspection. What the service does well: What has improved since the last inspection? The home has continued to evolve and develop; some of the requirements from the last inspection have been met. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 6 Staff are being supported to undertake qualifications in the NVQ 2 and 3 awards. The manager has introduced a care planning system around Person Centred Approaches. 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. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5 Information is available to support prospective service users with making a decision about a future placement. Prospective service users needs are assessed prior to them moving in. EVIDENCE: The standards looked at are listed above. The Service User Guide and Statement of Purpose had been up dated and now included detail of local facilities and amenities and the complaints procedure. The Statement of Purpose still needed to include detailed up to date staff information. A new service user moved into the home two weeks ago. They moved in under emergency circumstances and did not have the opportunity to have a series of introductory visits prior to moving in. The manager said she and the senior care staff went to visit the service user in their old home. The manager said they had spoken with the service users social worker, before the service user moved in. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 9 The manager said because of the emergency nature of the admission, they have had some difficulty in getting information about the service user who has moved in. There was no community care assessment and care plan from the social services department on file. The manager and care staff had worked really hard to find out about this service user needs, particularly his health needs. The service user has been registered with a GP, Optician and Dentist. He had been supported to receive the correct glasses for his sight problem and were in the process of supporting him to get new dentures. The staff had started completing a person centred care plan for the service user, and had a review arranged with his social worker to review the placement in early December 05. Careful consideration must be given over the next month, to how well the needs of this service user can be met; extra training in new areas of need must be undertaken if necessary. When reviewing the placement in early December, consideration must be given to the views of the other service users. During the inspection this service users was spoken to, and he said he had settled in well, and liked living here better than his old home, the staff were nice and he liked the food. Resident’s contracts, as a matter of good practice still need to be signed by the service user concerned, or the option of a counter signatory by a relative or appropriately independent person, where service users are unable to sign for themselves. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8, 9, 10 Service users are supported, consulted and encouraged to participate in all aspects of life with in the home. Service users know that information about them is handled appropriately. EVIDENCE: On the day of the inspection service user information was noted to be kept securely, and the service user records were treated appropriately and kept confidentially. Staff, were observed to interact with the service users appropriately and all observed staff service user interactions were done in a positive and respectful manner. The staff had worked hard to include the service users in all aspects of individual support planning. Each service user had an individual Person Centred file, detailing their personal needs, including sections that said ‘Things I would like to do with my life and how I am going to achieve them’. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 11 On the two files sampled only one file had this section completed. The manager said this was a relatively new system and they were still in the process of developing it. Some of the files sampled, had sections where the service users had signed these, demonstrating choices the service users wanted to make, like the section about ‘having a key to the front door and my bedroom door.’ This area needs further work, to ensure all areas of service users Person Centred Plans are agreed with individuals and signed up to. The home had started to undertake some work in ensuring, care plans are goal focused enabling them to review care plans in line with individual service users development. Health Action Plans need to be undertaken by the home for individual service users, in line with The Governments White Paper ‘Valuing people’. More work is required to put in place and develop care planning and risk assessment. There needs to be more care plans and risk assessments in place for individual service users, ensuring all the service users needs are planned for. The practice of mentioning by name other service users, in individual service users risk assessments must stop. More thought needs to be given to the way in which care plan information is worded. Statements like ‘All staff are trained in risk assessment and individual service weakness as a part of care planning activities’ is not appropriate. The risk assessments need to be cross-referenced to the components of the care plans to which they relate, and vice versa. These require reviewing at least every six months. There is evidence of the service users being supported to take risks appropriately. A risk assessment must be put in place as a matter of urgency for the new service user who smokes. On the day of the inspection staff were observed offering choices appropriately to residents and encouraging them to make their own decisions. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not looked at during this inspection. EVIDENCE: Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 21 Service users receive support in a positive and respectful manner. Their physical and emotional needs, are not fully met and failure to provide further support will leave service users at risk. EVIDENCE: The plans in place for service users are based on a Person Centred model. Two of the service users are generally independent in most aspects of their personal care requiring support in the form of verbal prompts. Two of the service users are not independent and require lots of support with their personal care. On one file sampled, there was evidence of a meeting with a service user to discuss their individual needs and agree a plan of support. The service users files sampled had a section called, ‘My needs and how I like to be supported’. These sections were only partially completed for one service user. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 14 The Manager said the Person Centred support plans were relatively new development and were still being worked on. On two of the files sampled there was detailed evidence of health appointments and records of outcomes. The staff had been working hard with multi-disciplinary professionals to look at meeting the changing emotional and physical health needs of that individual. Including support from the district nurse, psychology, psychiatry and the GP. The staff had also been liaising with other involved parties, like the college to ensure the activities he undertook still interested him and could meet his needs. There was evidence that the changing needs of the service users mental health are kept under close review. Service users need to be weighed monthly; records sampled indicated the service users were last weighed in March this year. Health Action plans need to be developed for each individual service user, to ensure all the health needs of the each service user are met There is now one service user who takes prescribed medication. Medication was not looked at on this inspection. One service user was observed being given his medication; this was done in a satisfactory manner. Medication was discussed with the manager and the staff during the inspection. Arrangements need to be made to ensure staff complete required medication training, and that medication is stored securely in a lockable drug cabinet fixed to the wall. On the two files sampled, there were no arrangements in place to support individual service user with changes in their lives associated with the aging process, or evidence of consultation with service users about their wishes in the event if their death. The importance of this was discussed with the manager and staff, and they agreed that this was something they would look at with the service users. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 It was not clear that service users felt their views are listened to or acted upon. Improving their understanding of the complaints procedure will ensure greater protection to service users. EVIDENCE: A copy of the complaints procedure needs to be held on each individual service users file, and where possible service users need to sign this document to support the fact it has been fully explained to them and they understand how to make a complaint. It is recommended that the complaints procedure could be discussed at a service users meeting and this would be a good venue to encourage an open discussion with service users about what to do if they were unhappy with anything within the home. The complaints log was looked at as part of the inspection and there have been no complaints since the last inspection. All the staff team are still to undertake Vulnerable Adults training in the area of abuse and protection, currently only three staff have completed a course in this area. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, 29, 30 The service users who live at Poppy Lodge are supported to live in a house that is spacious, homely and safe. An excellent standard of hygiene is maintained, the house is kept clean and tidy. EVIDENCE: The service users at Poppy Lodge enjoy a home that is comfortable, homely, roomy and adequately furnished. The décor, fixtures and furnishing still require up dating. This is outstanding from previous inspections. The home is kept clean and tidy and a good standard of hygiene is maintained. The manager said that they had recently employed a domestic, who is a positive addition to the staff team; this has released the staff from domestic chores and allowed them to concentrate on supporting the service users. One service user has mobility needs; the staff ensure he has access to a wheelchair for mobilising outdoors, and a walking frame inside the house. It Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 17 was also noted on the inspection he uses specialist cutlery to support his independence with eating. It is recommended the home involves an Occupational Therapist to assess all the service users needs and provide the home with a base line assessment, to enable staff to develop care plans and risk assessments to support his independence. Staff will need to ensure the service users is supported to have the equipment maintained at least annually to ensure his wheelchair and walking frame remain in good order. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 The home’s recruitment policy and practice, supports an adequate level of protection for the residents. The manager still needs to produce an annual staff training and development assessment, to ensure that service users are supported by competent and qualified staff. Service users benefit from a staff team that is well supervised and supported EVIDENCE: Two staff files were looked at during the inspection, one file was for the most recently appointed staff member. CRB checks and POVA checks were present. Staff files need to include details of an employees right to work in this country. The requirement from the last inspection, for the manager to submit to CSCI a detailed analysis of staff training needs remains outstanding. This schedule needs to also indicate when refresher courses are due, and should include a timetable of when training is arranged and who will deliver this. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 19 Many of the statuary training courses like Manual Handling, certain First Aid courses, working with Challenging behaviour, COSHH and H& S. Fire training and Adult Abuse are annual courses, requiring refreshers. As information on these courses are constantly changing, and staff need to regularly update their knowledge base with the latest information, to ensure they practice safely. The manager said two staff leaving and new staff starting had hampered completing this work. The small size of the staff team supports a close team, able to be supported by the Manager and senior care staff on a daily basis. The staff said that they have regular staff meetings and have a formal supervision every three months. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42, 43 The service users are supported by a manager who is suitably qualified and whose style of management is open and inclusive supports the service users. The service users are supported by staff whose general practice protects and promotes the safety and well-being of the service users who live there. Some areas of health and safety need further development to fully ensure the safety of the service users. EVIDENCE: Some of the Health and safety record were looked at during this inspection. Including Portable Appliance testing, Annual Landlord Gas Safety Check, Five Year Hard Wiring and annual fire equipment check. All of the above were found to be in good order. The manager said that the fire risk assessment is now reviewed and this was dated and signed when completed. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 21 This was not seen during the inspection and a copy of these needs to be forwarded to CSCI. The staff say that they do not use restraint to support the service users who live there with the challenges they present. The manager says that two staff have undertaken training in this area, however their knowledge base is used to support service users with distraction techniques and calming down when faced with situation that make them anxious. The manager had a care plan in place to demonstrate that this approach was used. It is important whilst service users present behaviour that challenges, staff are trained and regular refresh their knowledge base in Challenging Behaviour, to ensure the service users are adequately supported. The atmosphere in the home is welcoming and the service users met on the day of the inspection, appeared well cared for, appearing to get on well with the staff on duty. The manager was approachable during the inspection, keen to meet the standards and had worked hard to take on board the previous requirements. It was positive to see the hard work the manager and staff team had undertaken to introduce a ‘real’ Person Centred Approach to the care planning systems. Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 X 2 1 Standard No 22 23 Score 2 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X 2 X 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X 2 2 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Poppy Lodge Score 2 1 X 1 Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 2 DS0000017128.V267241.R01.S.doc Version 5.0 Page 23 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 YA1 Regulation 4 (1c) Sch 1 Timescale for action Update the Statement of Purpose 01/01/06 to include current staff information. Outstanding from the previous inspection. Cross-reference care plans and 01/01/06 risk assessment, and ensure that they are reviewed at least every six months. Reviews should be recorded in writing, indicating who takes part and how decisions are made. Outstanding from the previous inspection. Complete an immediate risk 02/12/05 assessment re-smoking in the home, to support the health and safety of all the service users who live there. Urgent requirement. Ensure that all staff receive 01/01/06 training in medication training annually, to ensure the staff team is constantly updated. Produce a schedule for planned 01/01/06 maintenance and refurbishment of the home and forward to CSCI. Outstanding from the previous inspection. DS0000017128.V267241.R01.S.doc Version 5.0 Page 24 Requirement 2. YA6YA9 12(1a)15 13(4a-c) 3. YA6YA9 12(1a)15 13(4a-c) 4. YA23 13(6) 5. YA24 23(2b) Poppy Lodge 5. YA29 23(2) 6. YA33 18(1a) 7. YA35 12(1a) 18(1a) 9. YA42 13(4a-c) A maintenance contract is put in place to ensure the specialist equipment in the home is checked at least annually. Review staffing levels offered to the service users, in light of the new admission and to support the changing needs of a service user who lives in the home Submit a detailed staff training and development assessment to CSCI, as indicated in the main body of this report. Outstanding from the previous inspection. Send CSCI a copy of the fire risk assessment. This should be signed and dated at the time of the review. 01/01/06 01/01/06 01/01/06 01/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA5 Good Practice Recommendations Provide facility in residents’ contracts for countersignature by relative or other independent person, where resident is unable to sign. Outstanding from the previous inspection Implement a system to introduce Individual Health Action plans for each service users Ensure a copy of the complaints procedure is given to each service users and a copy is held on the file. At a service users meeting discuss the complaints procedure with the service users to ensure they fully understand their rights. Develop and implement a Quality Assurance system for the home. 2. 3. YA19 YA22 4. YA39 Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Poppy Lodge DS0000017128.V267241.R01.S.doc Version 5.0 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!