Inspection on 08/09/05 for Rosemary Lodge

This inspection was carried out on 8th September 2005.

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

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

Other inspections for this house

Rosemary Lodge 05/06/08

Rosemary Lodge 07/09/07

Rosemary Lodge 03/05/07

Rosemary Lodge 30/09/06

Rosemary Lodge 05/05/06

Rosemary Lodge 08/04/05

Rosemary Lodge 21/12/04

Rosemary Lodge 27/07/04

Rosemary Lodge 14/11/03

Similar services:

Maple Lodge

Heathlands

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Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Rosemary Lodge 154 Alcester Road South Kings Heath Birmingham West Midlands B14 6AA Lead Inspector Mrs Zeta Joseph Unannounced Inspection 8th September 2005 09:35 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 Rosemary Lodge DS0000017019.V254804.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. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rosemary Lodge Address 154 Alcester Road South Kings Heath Birmingham West Midlands B14 6AA 0121 43 1166 0121 442 6454 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) Mr S.V. Chundoo Elizabeth Campbell Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home adheres to a laundry policy which ensures that soiled laundry is not transported through the dining area when meals are served or consumed. 8 April 2005 Date of last inspection Brief Description of the Service: Rosemary Lodge is situated on the Alcester Road, Kings Heath; it is a short distance away from the main Kings Heath shopping centre where there is a good range of local facilities. Another smaller local shopping centre is in the opposite direction towards The Maypole. The home was originally two large Victorian houses, has retained many of its original features and is set back behind a parking area for up to 5 cars. Trees and shrubs that have been well maintained surround this area. The main entrance to the home is via some steps up to the front door; this access is unsuitable for wheelchair users. There is another front door, located to the front of the property where people with mobility difficulties can access the home at ground level where access is gained into the dinning area. The home has a passenger lift to where the first floor bedrooms can be accessed; the second floor is office space. There is a pleasant garden to the rear of the property; a patio area was being completed at the time of the inspection. Egress from the home into the rear garden is conducive for wheelchair users and people with mobility difficulties. The home caters for up to thirty older people. The bedrooms vary in size and all are decorated in individual colours. There is a large dining/sitting room, a smaller lounge, a ‘Victorian’ themed sitting room, a large quiet sitting room and a conservatory. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspector conducted an unannounced inspection to monitor outstanding requirements from the previous inspection visit. A serous concerns letter had been forwarded to the home because of failings to address previous requirements. A brief response to how the home would meet the individual requirements had been forwarded to the Commission. On the day of inspection there were twenty-four residents’ living at the home. The home was toured, residents’ were spoken to and their care plans examined. Staff were spoken to and staff records were examined. A tour of the building took place and resident and staff were spoken to. A factual correction to the last report is that a smoke alarm was fitted to the ceiling in Room 24. What the service does well: What has improved since the last inspection? The Registered Manager has enrolled on a medication management training course; records relating to this course were not available for examination. This course will improve her skills to work within the scope of her duties and the medication policies of the home so that medication management is more robust and that residents’ are not at risk of harm. Residents’ Medication Administration Records and copies of their prescriptions are filed individually. Complaints records were examined and these were managed well. Equipment used at the home is no longer stored in residents’ bedrooms and there are plans to build adequate storage space for this. This means that residents using wheelchairs have more space to mobilise. Footrests and safety belts have been purchased and fitted to wheelchairs. Lighting, Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 6 decorating and fire exits signs are improved. A variety of improvements has taken place in residents’ and residents say they are very pleased with these. The dinning area has been re-arranged so that residents requiring a wheelchair mobilise safely. 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. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 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 Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 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): 2, 3, 4, 5 Service users contracts or terms of conditions do not comply with the Minimum Standards. All service users are assessed by the home during their trial period so that they know whether the home can meet their needs. People can visit the home prior to the trial period. EVIDENCE: Service users contracts do not contain information as listed in the Minimum Standards and this must be re written to accord with the standards. Service users are assessed during their trial period with records maintained by the home. Prior to selecting whether to live at the home, people can visit to look at the facilities on offer, there is a signing in and out record book of various visitors; the layout of this book will need to be improved. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 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 Progress has been made on improving health care management arrangements so that the health care needs of residents are identified and met, and that residents’ health is not put at risk. Resident’s needs are described in their individual care plans so that a comprehensive record is maintained of how health care needs are met. The Registered Manager has applied to study a certificated course in Safe Handling of Medicines. MAR charts are filed within residents’ files. EVIDENCE: Residents individual care plans are available and progress has been made to ensure care plans are representative of the residents’ needs and are kept up to date. There were records relating to discussions with health care practitioners especially where residents had sustained a fall or injury that resulted in a Regulation 37 report to the Commission. When residents’ had returned to the home from a stay in hospital, their multidisciplinary records, risk and manual handling records were updated and referral to a specialist. The Manager will be studying a certificated Safe Handling of Medicines course by long distance and will provide the Commission with a copy of the certificate upon completion. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 10 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): 13, 14 Residents are encouraged to maintain contact with their family. Residents were given a choice to upgrade their bedrooms which reduces the extent to which residents can exercise and control over their lives. EVIDENCE: Relatives were visiting the home and welcomed the unannounced inspection. Residents said they were pleased with the improvements in their bedrooms and liked the furniture and furnishings chosen for them. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 11 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 Complaints are managed more robustly and the complaints policy followed. EVIDENCE: Complaints are taken seriously and are recorded in the complaints book as a numerical log; this can be tracked back to the complainant. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 12 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, 22, 23, 24, 26 There are noticeable improvements to maintain resident’s safety and to manage cleanliness. Service users would benefit from improved safety and comfort by the provision of lockable facilities in all bedrooms and screening in the shared bedrooms. The Manager liaises with residents’ Doctors, District Nurses, Dietician and Nutritional Specialist. Toilets are too small to allow safe access for wheelchair users. There is no evidence to show that equipment and furniture purchased and planned adaptations meet residents’ needs. Infection control audits have been implemented to ensure residents’ live in a safe and hygienic home. EVIDENCE: Chairs, wardrobes and headboards have been replaced and fitted throughout the home. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 13 Fitting of magnetic door closures where these were missing previously from bedroom doors. Residents’ who share a bedroom must be provided with a screen to assure privacy when personal care is being carried out. The home is being reviewed with regard to signage of exits, decorating, lighting and labels on residents’ bedrooms. The signage relating to exits meets the fire regulations; electric bulbs and lampshades have been replaced where theses were missing previously. Residents’ bedrooms have been re painted or decorated. The Manager will be contacting the Dementia Society for advice about appropriate signs for residents’ bedroom doors. Work has started in the garden, there are notices displayed about this. The toilets throughout the home are inadequate in size to safely manual handle wheelchair users; the owner confirmed that residents in wheelchairs were being toileted safely in the larger upstairs bathroom. The proprietor has applied to Birmingham City Council for planning permission and a copy of the draft plans have been provided to the Commission in regard to an extension to the ground floor to include a shower, toilet, kitchen and conservatory. There are no details in these to show how the adaptations will meet residents’ needs. Equipment is stored elsewhere in the home so that residents’ private bedrooms and shared communal spaces are no longer used for storage. Residents’ old furniture has been removed, their lockable facilities have not been replaced; these will need to be implemented. Residents are provided with specialist equipment where required such as wheelchairs purchased with the correct attachments such as footrests and safety belt. The hoist in the ground floor bathroom was recently serviced and the safety belt is used; the Manager confirmed that she consults with suitably qualified persons at the healthcare centre; records were examined on service users’ personal files in relation to this. The Manager confirmed her intention to contact the Dementia Society for advice about appropriate signage for residents’ bedroom doors. Fire exit signs within the home comply with statutory requirements. An Environmental Health inspection was conducted in August 2005; there were requirements and recommendations for the home to comply with. The Manager has implemented an infection control checklist based on the infection control audit conducted in the home January 2004. There are notices displayed in the bathrooms and toilets for staff not to leave residents personal items in bathrooms and toilets. There are paper towels, liquid soap that cannot be refilled in the bathrooms and toilets. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 14 Care assistants were observed wearing health and safety clothing when carrying out personal care tasks for residents. A cleaner has been employed to ensure the home is kept clean at all times. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 15 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, 29, 30 The staff on duty meet residents’ needs. Residents are not fully protected due to incomplete recruitment processes and not all staff being fully trained to the level of foundation standards; this was raised by the Inspector at the last inspection. A comprehensive training matrix has been produced to identify staff training needs and where some staff have received training, which demonstrate the development towards staff being fully competent to do their jobs. EVIDENCE: There were three care staff on duty to meet the minimum staffing requirements to care for twenty four residents at peak times; this excluded the Manager, cook, cleaner and administrator. The Inspector examined staff files and saw that the home had not implemented robust recruiting methods to protect service users from potential harm. An up to date Criminal Records Bureau check must be applied for, there are gaps in employment records and appropriate references had not been applied for. The training matrix lists gaps in staff training and training programmes have been organised so that staff are provided with mandatory training. The Manager will need to confirm whether the induction and training course meet the Skills for Care foundation standards. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 16 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): 31, 32, 33, 38 The Manager is being supervised more robustly by the Responsible Individual so that the health, safety and welfare of residents’ is continuously promoted Staff supervision including the Registered Manager takes place and meets the standards in terms of frequency. Residents must be assessed when using the hoist equipment that belonged to a resident who is no longer living at the home; or arrangements must be made to return the hoist to the supplier. Newly acquired furniture meet the Fire Regulations. EVIDENCE: Due to improved supervision, agreed actions and setting of targets for the Registered Manager, the risks and hazards occurring within the home are being managed satisfactory with records available for inspection. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 17 The Registered Manager must provide a copy of her qualification to NVQ Level 4 in Management and of recent training courses attended. Records relating to staff supervision were examined and meet the minimum standards terms of frequency. The hoist in the downstairs bathroom has been fitted with a safety belt; however this hoist was loaned to the home from the Health Authority for use by a resident no longer living at the home; the hoist must be returned. Residents requiring hoisting must be assessed and a hoist purchased to suit their assessed needs. Furniture recently purchased meets Fire Regulations. The unused shower room is kept locked and there is a smoke detector fitted in Room 24; this is a factual correction to the last inspection report. There are outstanding requirements and timescales for compliance from the inspection undertaken by the Environmental Health Officer in August 2005. There are outstanding requirements from the last inspection that must be addressed by the Responsible Individual and Registered Manager so that the home is managed with sufficient skill and competence. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 18 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 1 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 2 2 2 3 STAFFING2 Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 2 2 2 2 Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 19 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 OP1 Regulation 4(c), 5(c) Requirement Timescale for action 01/12/04 2 OP4 3 OP9 4 OP14 The Registered Person shall ensure the Statement of Purpose and Service Use Guide includes how refurbishments has improves service delivery. THIS REQUIREMENT REMAINS OUTSTANDING. 17(1) The Registered Person is required to ensure there are sufficient trained and competent staff working in the care home that are trained in dementia and care planning to meet residents’ needs. THIS REQUIREMENT REMAINS OUTSTANDING. 18(1)(a)(c The Registered Person shall ) ensure the Registered Manager completes an accredited medication training course; a certificate of completion must be available for inspection. 12(2) The Registered Manager shall demonstrate how residents’ are empowered to exercise their choices and preferences within the home. THIS REQUIREMENT REMAINS OUTSTANDING. DS0000017019.V254804.R01.S.doc 30/08/04 30/11/05 25/04/05 Rosemary Lodge Version 5.0 Page 20 5 OP19 23(2)(b) 6 OP21 23(2)(n) 7 OP22 23(2)(a) 8 OP22 23(2)(n) 9 OP24 23(2)(g) 10 OP24 23(2)(g) 11 OP28 18(1) The Registered Person must ensure that the care home is kept in a good state of repair as per the schedule provided to the Commission. THIS REQUIREMENT REMAINS OUTSTANDING. The Registered Person must ensure that a review of washing and bathing facilities is carried out including appropriate plans to meet the assessed needs of residents’. The plans, when submitted to the Commission must have time scales indicating when the work is to be carried out. THIS REQUIREMENT REMAINS OUTSTANDING. The Registered Person must review the signage and labels on bedroom doors for residents’ suffering from dementia. THIS REQUIREMENT REMAINS OUTSTANDING. The Registered Person must provide evidence that the recommended adaptations to the home will meet residents’ needs. THIS REQUIREMENT REMAINS OUTSTANDING. The Registered Person must ensure where residents are sharing a room that screening is provided to ensure privacy for personal care. The Registered Person shall ensure each resident is provided with lockable facilities and a key, which he or she can retain unless the reason for not doing so is detailed in the care plan. The Registered Person shall ensure staff induction and mandatory training complies with Skills for Care (previously TOPSS) foundation standards. THIS REQUIREMENT REMAINS DS0000017019.V254804.R01.S.doc 31/08/05 01/12/04 30/09/04 30/09/04 30/09/05 30/09/05 01/12/04 Rosemary Lodge Version 5.0 Page 21 12 OP29 19, Sch 2 13 OP30 19(1), 10(3) 14 OP31 10(1) 15 OP31 18(1) 16 OP32 18 OUTSTANDING. The Registered Person must ensure that staff recruitment records comply with Schedule 2 of the above regulations and a more robust recruitment process is implemented to protect residents. Two references must by pursued, one from the previous employer and all gaps in employment history must be explored with comprehensive records maintained. THIS REQUIREMENT REMAINS OUTSTANDING. The Registered Person shall ensure all staff including the Manager are provided with accredited mandatory training in safe manual handling techniques, including wheelchair training. Training must be reviewed and updated annually. THIS REQUIREMENT REMAINS OUTSTANDING. The Registered Person and Manager shall, having regard to the health and safety of residents, manage the home with sufficient skill and competence and that all outstanding requirements from previous inspections are acknowledged and an action plan submitted to the Commission. THIS REQUIREMENT REMAINS OUTSTANDING The Registered Manager must provide evidence to the Commission of qualification to NVQ Level 4 in Management or equivalent. An extension to the date required has been re negotiated with the Manager. The Registered Person shall ensure the Manager manages the home in an open and transparent manner and DS0000017019.V254804.R01.S.doc 01/12/04 01/07/05 27/07/04 31/12/05 30/11/05 Rosemary Lodge Version 5.0 Page 22 17 OP38 23(2)(a)( b) 18 OP38 18(1) 19 OP38 23 communicates clear direction and leadership for staff and residents. The Responsible Individual must demonstrate to the Commission the support provided to the Manager to enable her to carry out her duties. The Manager shall ensure the unused shower room is kept locked; the shower tray constitutes a trip hazard for any resident who has access to it. The Registered Person must ensure that supervision processes includes employment policies and procedures adopted by the home and its induction and training arrangements are put into practice within supervision. The Registered Person must ensure that hoist equipment loaned to the home is returned promptly to the Stores Department. The home must purchase its own handling equipment. 31/12/05 30/11/05 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP37 Good Practice Recommendations That the layout of the signing in/out record book is improved. Rosemary Lodge DS0000017019.V254804.R01.S.doc Version 5.0 Page 23 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 Rosemary Lodge DS0000017019.V254804.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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