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Inspection on 08/03/07 for St Andrews Lodge Care Home

Also see our care home review for St Andrews Lodge Care Home for more information

This inspection was carried out on 8th March 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

A warm and welcoming atmosphere was evident on entering the home. Good relations were seen between staff, service users and visitors. Staff spoken with showed a good understanding of service users needs. Service users spoken with said that staff were kind and caring and they listened to them. The relative spoken with spoke highly of the home, staff and care received. Plans of care in place were of a good standard and were relevant to service users needs. Specialist services are accessed as required. The environment is structured and opportunities for service users to socialise are available. A range of activities are in place and service users spoken with said that they enjoyed these. The staff team have the skills and experience necessary to provide suitable care and assessment of the service users. There is a quality assurance system that actively encourages participation from relatives and comments are acted upon to improve the service.

What has improved since the last inspection?

There have been a number of improvements within the environment since the previous inspection. An artist has recreated old time themes around the home and themes to match the unit name to enable service users to rememinise and recognise their areas more easily. Decoration has also taken place with the use of primary colours, such as bright blues and reds to enable service users to recognise their surroundings. Three bathrooms have also been redecorated using muriel scenes. A number of new hoists and beds have been purchased and the acting manager said there are plans to contiue to acquire more. The homes quality assurance system continues to ensure ongoing improvements in the home.

What the care home could do better:

As there were a number of gaps in signing for medication administered the responsible person is required to ensure the safe administration and recording of medication to ensure service users are fully protected.

CARE HOMES FOR OLDER PEOPLE St Andrews Lodge Care Home Riber Crescent Basford Nottingham NG5 1LP Lead Inspector Karmon Hawley Key Unannounced Inspection 8th March 2007 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 St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Andrews Lodge Care Home Address Riber Crescent Basford Nottingham NG5 1LP 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) 0115 9245467 0115 9245485 Trinity Care Homes Limited Mrs Gillian Margaret Bell Care Home 80 Category(ies) of Dementia - over 65 years of age (80), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (80) St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No person falling under category MD(E) Mental Disorder older people over 65 years (excluding Learning Disability or Dementia) or DE(E) Dementia shall be admitted to St Andrews Lodge when there are already 80 persons of these categories/combined categories accommodated in the home To admit into St Andrews Lodge one named service user aged 45 years under category DE To admit into St Andrews Lodge one named service user aged 40 years under category DE To admit into St Andrews Lodge 10 service users aged between 50 65 years under category DE The maximum number of persons to be accommodated within St Andrews Lodge is 80 21st August 2006 2. 3. 4. 5. Date of last inspection Brief Description of the Service: Trinity Care Ltd, the registered provider, had a contract with the Health Authority to accommodate people that are in need of continuing care. The contract is currently under review. St. Andrews Lodge provides nursing care for 80 older people with Mental Illness and for those with Dementia. The registration allows for up to 10 people between the ages of 50- 65yrs to be accommodated. The home is split into two separate units, Garden and Assisi. Sited in an established residential area the home had sufficient car parking and a well maintained garden. All areas of the home were accessible to service users. The fee range is from £339.00 to £589.00 per week including the nurse determination fee. St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the site visit an analysis of the performance of the home over the previous year took place in line with the key national minimum standards. The evidence gained was assessed and thus the site visit planned in accordance with further evidence required to demonstrate compliance with the national minimum standards. The unannounced site visit took place in four hours and was performed by one inspector. The main method of gaining evidence during the site visit was case tracking, this is a method of sampling the records of six randomly selected service users to ascertain if the needs of service users are appropriately assessed and identified needs are being catered for by the home to maintain optimum health and wellbeing of the service user. Six service users and one relative were spoken with so as to give the inspector an insight into the conditions and standards within the home. Those spoken with were happy with the staff, care received and the standards within the home. The acting manager assisted in the inspection process and two members of staff were spoken with. Staff were able to demonstrate an understanding of service users needs. Due to service users complex needs, some service users were unable to offer clear accounts of their lives within the home, however time was spent with them in the main lounges. What the service does well: A warm and welcoming atmosphere was evident on entering the home. Good relations were seen between staff, service users and visitors. Staff spoken with showed a good understanding of service users needs. Service users spoken with said that staff were kind and caring and they listened to them. The relative spoken with spoke highly of the home, staff and care received. Plans of care in place were of a good standard and were relevant to service users needs. Specialist services are accessed as required. The environment is structured and opportunities for service users to socialise are available. A range of activities are in place and service users spoken with said that they enjoyed these. The staff team have the skills and experience necessary to provide suitable care and assessment of the service users. There is a quality assurance system that actively encourages participation from relatives and comments are acted upon to improve the service. St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users may be assured their needs will be met and assessed prior to entering the home. Intermediate care is not provided. EVIDENCE: Registered nurses visit prospective service users in the community and carry out a preadmission assessment. Preadmission assessments were seen within the plans of care case tracked and covered all the requirements of this standard. The acting manager said that prospective service users may visit the home and spend time there prior to making a decision. Staff spoken with were able to discuss the preadmssion policy and procedure. Intermediate care is not provided. St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health and personal care and social care needs are set out in an individual plan of care. Service users health care needs are fully met. Service users are protected by the homes medication polices and procedures, however minor improvements are required. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: Six service users files were case tracked. There was evidence seen to show that service users undergo various assessments such as manual handling, nutritional needs, pressure area care, mental health needs and the activites of daily living. Information gained forms the basis of the plan of care. Care plans in place were relevant to service users needs, were personalised and reflected service users prefecens and choices. Apporpaite risk assessments were also in place for all identified risks. Daily records and reviews were maintianed to ensure conituity of care. Staff spoken with were able to discuss service users needs and how they are supported in meeting these. Service users spoken with St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 10 expressed that their needs were met. The relative spoken with said that standards of care were good and they felt that all their realtives needs were met. Within service users personal files there was evidence available to show that the multidisciplinary team and specialist services are accessed as required. During the tour of the home specialist equipment was seen such as cushions and mattresses. Appropriate policies and procedures for medication are in place. Those service users cased tracked medication records were seen. These corresponded with the medication record chart. Medication was checked into the building evidence to demonstrate this was available on the medication chart. Records of medication returned to pharmacy were available. There were a number of gaps in signing for medication on the medication record of two service users. Fridge and room temperatures were not always recorded on a daily basis. Staff spoken with discussed how they ensure that service users privacy and dignity are maintained by ensuring that care is offered with respect and choices are acknowledged and upheld. Curtains are in place within shared rooms. Staff were seen to knock on doors prior to entering. Service users spoken with said that staff were kind and respectful. St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are enabled to experience a lifestyle that matches their needs and expectations and satisfies their needs. Service users are enabled to maintain contact with family and relevant others. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome and appealing diet in pleasing surroundings. EVIDENCE: There are two activities coordinators employed who offer a variety of activities for service users such as arts and crafts, games, trips out and reminiscence. Activities are offered on a one to one and group basis. The activities coordinators were seen to take one service user out during the visit and after lunch were seen talking with and entertaining several service users. One relative spoken with said that although their relative was unable to join in many of the activities they were always included as able. They stated that they are always made welcome when they visit and attends events when they are provided. One service user said that they enjoy the activities on offer. Other service users were seen to be entertaining themselves with various personal St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 12 activities. Staff spoken with said that the routine of the home was flexible and service users are enabled to make choices with regard to their daily lives, they stated that as the majority of service users who live at the home have mental health needs staff advocate on behalf of service users. During the visit service users were seen to make their own choices as able and were not restricted when they wished to walk around the home. The acting manager is currently liaising with a local church to arrange further services for service users. There are no restrictions on visiting and visitors are welcomed at any time. There are numerous seating areas around the home where privacy may be sought if required. One visitor spoken with said that they were able to visit at any time and they were always made welcome. The acting manager is in the process of developing a hospitality suite so visitors may stay at the home should the need arise. There is evidence that relatives are encouraged to remain involved and residents are supported to maintain contact with friends and loved ones. Staff spoken with were able to discuss issues with regards to equality and diversity and how service users are treated as individuals. They had a good understanding of service users needs and also discuss how they supported service users to make choices with regard to their daily lives. Service users spoken with said that staff were kind and listened to them. The acting manager has planned a relatives meeting and one relative spoken with said that they were attending this. Relevent records in the kitchen such as menus, cleaning rotas and temperature records were seen, these were maintained as required. Menus on offer were wholesome and appealing and choices were offered. Staff spoken with agreed with this in general, however they felt that minor changes in the choices offered and liquidised diets would be benefical. The meal served on the day of the visit was nicely presented and staff supported people appropriately. Service users spoken with said that meals were good and plentiful. St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and relevant others may be assured that complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: Relevant policies and procedures for dealing with complaints were in place. 18 complaints have been received since the previous inspection. These had been dealt with appropriately and resolved. The acting manager and staff said they felt that this was due to the lack of a manager during the time these occurred. Staff spoken with were able to discuss how they would deal with a complaint if received. Service users and the relative spoken with expressed no concerns with care received or life within the home. Relevant policies and procedures were in place for the protection of vulnerable adults. Staff spoken with were able to discuss what they would do should they have any concerns. All staff had current Criminal Record Bureau checks in place, these were seen within staff personnel files and staff spoken with were able to confirm this. St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a safe and generally well-maintained environment. The home is clean, pleasant and hygienic. EVIDENCE: The home has three units all locked with key pads to ensure service users safety.The main entrance is staffed by one person during office hours.CCTV operates outside of the home for external security.The home has a routine maintenance programme and the homes handyperson provides daily support. Records of maintanance were seen. There have been a number of improvements within the environment since the previous inspection. An artist has recreated old time themes around the home and themes to match the unit name to enable service users to rememinise and recognise their areas more easily. Decoration has also taken place with the use of primary colours, such as bright blues and reds to enable service users to recognise their surroundings. Three bathrooms have also been redecorated using muriel scenes. The acting manager said that this has already had positive effects on service users as St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 15 comments and observations have been made by service users whilst using these facilties. A number of new hoists and beds have been purchased and the acting manager said there are plans to contiue to acquire more. The acting manager spoke pasionately about the developments he wishes to see in the home and the changes he intends to make with regard to the environment to enhance service users quality of life further. The home was clean and tidy in all areas and appropriate facilities were available within the laundry. Throughout the home hand washing and disinfectant facilties were availiable. The laundry system provides safe washing temperatures that control any infection. There is a clinical waste collection in place in line with legislation. There are systems in place to control infection, staff are provided with training and personal protection to undertake safe practices and control any spread of infection. St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 homes recruitment policy and practices. Staff are trained and competent to do their jobs. EVIDENCE: The duty rota seen showed that sufficient staff are on duty throughout the day and night. Staff spoken with confirmed this, however they stated that the afternoons were very busy at times. The inspector saw that staff were very busy during the afternoon on the residential unit and also on the nursing unit at lunch time as there was a number of service users who required assistance with their meals. The acting manager said that relatives often visit at this time and help their relatives. Service users spoken with said that staff were available to meet their needs. 55 percent of staff at the home have achieved the National Vocational Qualification level 2 or 3 (a nationally recognised work and theory based qualification). The induction programme in use is thorough and relates to all areas of the home and aspects of service users care. evidence of staff undertaking this was available within staff personnel files. St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 17 Six personnel files were seen. All except two longer-term members of staff contained the required documentation. These two members of staff only had one reference in place. There was evidence seen to show that all staff files are undergoing a large audit to ensure all documentation is in place and well organised. Staff spoken with confirmed that they had a Criminal Record Bureau check in place. Staff training records seen showed that staff are trained in all compulsory areas. Staff spoken with were able to confirm this and they said that they felt supported in their training and development. St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The acting manager has yet to apply to become the registered manager. The home is run in the best interests of service users. Service users financial interests are safeguarded. The health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: There is an acting manager in place who has been working at the home since 22nd january 2007. He stated that he feels supported and has settled into his role. He has previously been a registered manager prior to joining St Andrews. He has registered to commence the Registered Managers Award. During the inspection the acting manager discussed many positive changes and St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 19 developments he wishes to bring to the home. Staff spoken with spoke highly of the manager and said that he was approachable. There is an effective quality assurance system in place that actively seeks the views of all those involved in the home and it was evidenced that these views are considered and used to inform the homes development and improving the outcomes for the service users. The acting manager also carries out in house audits to ensure a quality service is maintained. A relatives meeting has been arranged in this coming week. One relative spoken with was aware of this. several staff meetings have also been arranged. Four service users personal allowances were checked. These were all correct with the accounting sheet. The acting manager and administarator ensures the safety of these. If necessary service users money is looked after by the means of the court of protection or power of attorney. All maintanance certificates and servicing sheets such as the hoist, gas, electrics and waste control were seen. A maintance person is employed who carries out routine mainanance in the home. records of this taken place was seen. Accident records were maintained and included significant information. Fire systems were generally tested on a weekly basis, however on two occassions there were gaps of 9 days between tests. Emergencey lights were tested on a monthly basis and staff undergo regular fire drills. Appropriate fire risk assessments were in place. Records seen showed that staff had undertaken relevant training in regard to health and safety, staff spoken with confirmed this. St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13 (2) Requirement The registered person is required to ensure the safe administration and recording of medication. Timescale for action 20/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP38 Good Practice Recommendations Record room and fridge temperatures on a daily basis. Test the fire alarm systems on a weekly basis. St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 St Andrews Lodge Care Home DS0000026472.V331885.R01.S.doc Version 5.2 Page 23 - 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. 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