Inspection on 23/10/06 for Stow Lodge

This inspection was carried out on 23rd October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stow Lodge 02/09/08

Stow Lodge 13/02/06

Stow Lodge 18/05/05

Stow Lodge 02/11/04

Stow Lodge 17/06/04

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Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Stow Lodge Oval Way Gerrards Cross Bucks SL9 8QB Lead Inspector Gill Gentles Unannounced Inspection 23 October 2006 09:00 rd Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 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 Stow Lodge DS0000023026.V304095.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 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. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stow Lodge Address Oval Way Gerrards Cross Bucks SL9 8QB 01753 886522 01753 886522 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) admin@fremantletrust.org The Fremantle Trust Care Home 11 Category(ies) of Learning disability (10), Physical disability (1) registration, with number of places Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration of One Service user as Physical Disability (PD) This category of care relates to one specific service user within the home. Should this service user leave the home, this category of care will be rescinded. 13th February 2006 Date of last inspection Brief Description of the Service: Stow Lodge is a home for adults with Learning Disabilities managed by the Fremantle Trust. The home is situated in a quiet residential area of Gerrards Cross, within walking distance of all local amenities; there is a bus route nearby connecting the home with the local towns. The home accommodates eleven adults. The service user group has been predominantly male for several years now. There has been no change to the service user group since 1999. The house is detached and situated in large grounds with parking at the front for several cars and a huge rear garden mainly laid to lawn offering space for the residents to play outdoor sports. The fees for this service range from £234.00 - £540.00 according to the current Pre-Inspection Questionnaire forwarded to the Commission. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by Mrs Gill Gentles unannounced on Monday 23rd October 06 at 09:00am. The inspection consisted of talking to the manager and members of the staff team and a couple of service users. Unfortunately eight service users left for the day centres at the time of arrival. Two service users were completing their breakfast so a brief discussion took place and one service user was at home all day and took part in the inspection. The care of three Service Users was case tracked and care practices during breakfast were observed. Documentation pertinent to the health and welfare of Service Users and health and safety around the home were checked. A tour of the environment pertinent to the three service users being case tracked was carried out; this included bedrooms, bathing and toileting facilities as well as the communal areas. The evidence seen indicates that this service meets the diverse needs [e.g. religious, racial, cultural, disability] of individuals. What the service does well: The home appears to be managed well by the manager giving clear leadership to the team and promoting continuity of care to service users and improving standards all round. Health and safety procedures are carried out appropriately ensuring service users are not placed at any risk. The home’s recruitment policy and practices support and protect service users from potential harm. Staff records identify that staff have the competencies, qualities and training required to meet service users needs. Overall Service users receive the appropriate support from well-supported and supervised staff. Effective complaints procedures are in place to ensure that issues raised by service users and their representatives are listened too. Adult protection is appropriately managed to ensure that service users are not placed at risk. Service users are offered personal, physical and emotional support as and when required and records are clearly maintained. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 6 Medication is managed well, ensuring that service users receive the medicines they require to keep them healthy and well. Service users are enabled to access the community and arrange of activities to support their lifestyle choices and promoting independence. Service users are supported to maintain contact with family and friends, to keep important social contacts. Meals and meal times are dependent on personal choices with staff support to enable service users to prepare a healthy nutritious balanced diet. A robust policy and procedure is in place to certify prospective service users are thoroughly assessed to ensure the home can meet their needs. 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. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 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 Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 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): 2 Quality in this outcome is good: This judgement has been made using available evidence including a visit to this service. A robust policy and procedure is in place to certify prospective service users are thoroughly assessed to ensure the home can meet their needs. EVIDENCE: There have not been any new service users in to this home since at least 1999. Therefore it was not possible to ascertain whether service users are/would be assessed adequately. However, the organisation has policies and procedures in place for the manager that provides guidance on the process of admitting new service users. The procedure includes tea and overnight visits as being essential to observe interactions of existing and prospective service users. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 9 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 7 and 9 Quality in this outcome is adequate: This judgement has been made using available evidence including a visit to this service. Personal care needs of the service users are identified through the Care Plans to ensure individual needs are met. However, there was no documentary evidence to support the fact that service users are involved in the development and that they are not written in a format suitable for individuals. Service users confirmed that they make decisions about their lives leading an independent lifestyle as possible. Risk Assessments are in place to ensure service users are safe. EVIDENCE: Three service users care was cased tracked throughout this inspection – one service user sat and discussed his/her Care Plan, unfortunately it was not in a format suitable for the individual to read. The individual service user was unable to confirm the level of involvement he/she had in its development. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 10 The written plans in situ were found to be fairly detailed, however, it was not easy or always possible to triangulate evidence as documents such as the “daily records” were poor in content e.g. “_____ seemed cool”. A discussion with the manager indicted how disappointed she was with the contents of the daily notes and she verbally confirmed that all staff have been on the relevant report writing training. During the inspection the manager called a team meeting for the following week to rectify this situation immediately. It is required that the manager ensures that the Care Plans are developed with the individual service users and put in a format suitable for the individuals. One of the Care Plans viewed was signed by the service user however, there was no evidence of how this individual understands its content, how the plan was explained etc. The service user involved in the inspection confirmed that they are able to make choices in their lives (and records confirmed) e.g. holidays, day time activities, outings etc. they also take some although minimal responsibility for the household tasks in the home such as hoovering, laying the table, loading the dish washer and taking their clothes to and from the laundry room. Service users are supported and encouraged to maintain their independence to the best of their ability in the home by helping themselves to snacks and drinks etc throughout the day. All service users have a number of Risk Assessments in their personal files that are in place to minimise the risk and still support service users in maintaining an independent lifestyle to the best of their individual abilities. A reminder was issued in relation to some Risk Assessments needing reviewing more frequently than annually. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 11 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): 12, 13, 15, 16 and 17 Quality in this outcome is good: This judgement has been made using available evidence including a visit to this service. Service users are enabled to access the community and arrange of activities to support their lifestyle choices and promoting independence. Service users are supported to maintain contact with family and friends, to keep important social contacts. Meals and meal times are dependent on personal choices with staff support to enable service users to prepare a healthy nutritious balanced diet. EVIDENCE: Two of the three service users whose care was tracked attend day centres for people with a learning disability in the local communities of Burnham, Amersham and Beaconsfield, where service users are encouraged to learn new skills and access educational opportunities to local colleges if they wish too. The manager and staff team support and encourage service users to utilise the facilities in the local community of Gerrards Cross, such as shops, pubs, the Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 12 library and Cinema. The service users spoken with confirmed that they do there personal shopping in local towns and villages and go out for meals evening and lunchtime. One service user spoke about the recent holiday to Devon. All service users are supported and encouraged to maintain regular contact with relatives and friends. One service user goes home to mum every weekend while other parents visit the home periodically. The house has facilities for service users to meet their visitors in private in the quiet room or individuals bedrooms. Visitors are welcomed into the communal areas to mix with all the service users who live in the home. Through observations privacy and dignity of service users is respected, e.g. knocking on doors before entering. When involved in feeding service users, staff were communicating with individuals all the time and sat at the same level face to face and asked questions such as “do you want a drink?” and “ are you ready for some more?” Mealtimes in this home are not fixed, breakfast is as and when required depending on the daytime activities and the time of leaving the house. Lunch is when individuals are hungry and generally is between 12:00 and 14:00 pm. The evening meal is usually about 17:30/18:00 to accommodate service users going out to their clubs etc. The menus were checked and appeared to offer a balanced, nutritious diet. Service users are encouraged to select a meal for the menu and records are held regarding who has chosen what. The service user at home, confirmed involvement in the selection and that his/her favourite meals are “spaghetti bolognaise” or “fish and chips”. These had been included in the previous two weeks menus. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 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 and 20 Quality in this outcome is good: This judgement has been made using available evidence including a visit to this service. Service users are offered personal, physical and emotional support as and when required and records are clearly maintained. Medication is now managed well, ensuring that service users receive the medicines they require to keep them healthy and well. EVIDENCE: All Care Plans of the three-service users case tracked identified their personal support needs and specific action for the staff team to ensure service users needs are being met. Service users confirmed that staff are supportive and in general “let me do what I want”. Service users are encouraged and supported to access medical professionals through either the GP or the Community Learning Disability Team. A record of health care appointments, are maintained for those service users who have attended routine doctors, dental, optical appointments with a brief descriptions of the outcome. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 14 Medication policies and procedures are in place and accessible by all staff. Clear guidelines for each service user are in place for administering all medication including PRN medicines. Medication is stored in a separate locked room in lockable cabinets on the wall. Medication for the three-service users case tracked was found to be stored adequately with appropriate documentation being in place. Medication is ordered by a delegated member of staff, who was able to explain the system for ordering and returning medication. Boots the chemist delivers all medication in a sealed bag and audits the home’s storage and recording systems on a quarterly basis. The home has good relations with the local district nurse team who attend the home daily to ensure one service user receives their insulin injection. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 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): Quality in this outcome is good: This judgement has been made using available evidence including a visit to this service. Effective complaints procedures are in place to ensure that issues raised by service users and their representatives are listened to. Adult protection is appropriately managed to ensure that service users are not placed at risk. EVIDENCE: There is a robust complaints policy and procedure in place known as “feedback”. The agency has received no complaints since the previous inspection. There have been no complaints received from service users or their representatives by the Commission for Social Care Inspection regarding this service. Fremantle Trust has clear policies and procedures for dealing with any incidents of suspected abuse. Nine out of eleven staff have attended training in the Protection of Vulnerable Adults and the remaining few are identified as going on the next course. One of the staff team have trained to train and plans to hold regular updates, which will commence in January 07. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 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 & 30 Quality in this outcome is adequate: This judgement has been made using available evidence including a visit to this service. In general the environment creates a homely, comfortable and safe home for service users. However there are some areas that need rectifying to improve the quality of the home. EVIDENCE: The house is situated in Gerrards Cross on a quiet road. The property spans three floors, the service users live on the ground and the first floors with the staff office/sleep in room being situated on the top floor. Sections of the environment were toured during the course of the inspection. All requirements set at the previous inspection had been completed. Through discussion with the manager it was ascertained that the woodwork in the downstairs halls and corridors through to the laundry were due to be decorated the week after this visit. Also highlighted to be carried out is the external woodwork around the window frames etc. Due to the fact that these Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 17 items have been identified for rectifying with timescales then no requirements have been issued at this time. The home is bright and cheerful, with natural and artificial lighting. The heating and electrical systems are ones of a domestic kind and are serviced regularly as required. The rooms pertinent to the service users case tracked were inspected and found to be nicely decorated and very personalised. The home in the most part was found to be free from offensive odours apart from the downstairs toilet that appears to have been an issue for sometime as it has been mentioned in previous reports. It is required that the cause of the odour is located and rectified. The bathrooms décor has been greatly improved as required from the previous inspection, however the flooring in a number of the bath/shower rooms are badly stained and in need of replacing. The overall surface of the home appeared to be clean; however there are signs that the home is in need of a deeper clean. Recently the cleaner left employment placing the onus onto the staff team to carry out. It is strongly advised that the decision not to employ a cleaner be re-evaluated as the home is very large and could prove a difficult task for the care staff to keep on top off. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 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, 34, 35 and 36 Quality in this outcome is good: This judgement has been made using available evidence including a visit to this service. The home’s recruitment policy and practices support and protect service users from potential harm. Staff records identify that staff have the competencies, qualities and training required to meet service users needs. Overall Service users receive the appropriate support from well-supported and supervised staff. EVIDENCE: Staff records identify that staff have the competencies and qualities required to meet service users needs. Personal records were viewed for three permanent staff working in the home. All files contained the appropriate information required to ensure service users are protected from harm. Nine out of eleven staff have completed either NVQ level 2 or 3 or both and the other two staff are in the process of completing level 2. The mandatory training of the permanent staff has improved. Out of eleven permanent staff there are:Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 19 • • • • • • Food Hygiene - 6 Fire Awareness - 10 First Aid - 10 Manual Handling - 10 Infection Control – 7 Medication – 7, 3 do not administer medication so are not trained. Other training is promoted and encouraged, these include challenging behaviour, Person Centre Planning, epilepsy awareness etc. Of the three staff files viewed, two support workers had regular supervision, records indicate between 5 and 8 sessions in the past 12 months. There was a little concern relating to one new employee who has not had formal one to one supervision since commencing in June 06. The manager stated that this was due to her being off sick. However, the three-month probationary meeting took place and records were seen. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 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): 37, 39 and 42 Quality in this outcome is Good: This judgement has been made using available evidence including a visit to this service The home appears to be managed well by the manager giving clear leadership to the team and promoting continuity of care to service users and improving standards all round. Health and safety procedures are carried out appropriately ensuring service users are not placed at any risk. EVIDENCE: Since the last inspection the acting manager Kim Evans has successfully been registered with the Commission, having undertaken her fit person interview and presenting all the appropriate documentation. The manager has been managing the home for eighteen months/two years and has overall responsibility for ensuring the day-to-day running of the home, Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 21 managing budgets etc. She is responsible for ensuring the aims and objectives of the home are maintained in line with the Statement of Purpose of the home. Kim is in the process of completing the Registered Managers Award NVQ level 4. The manager is preparing to go off on maternity leave in the New Year and at present is involved in looking for a temporary manager to run the home in her absence. A quality audit was carried out on the home in June 06 and the results were available during the inspection. An action plan has been developed to meet the homes targets. Regular proprietors unannounced visits take place monthly and records were available for perusal. A selection of health and safety servicing certificates were viewed for: • Hoists • Potable Appliances • Gas safety • Thermostatic valves • Legionella (water) • Fire All were found to be current and up to date, ensuring service users are not placed in any risk. Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X X 3 Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 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 YA6 Regulation 15(1) Requirement It is required that the manager ensures that the Care Plans are developed with the individual service users and put in a format suitable for the individuals. To find the source of the odour in the downstairs bathroom and rectify. To replace the flooring in a number of the bathroom/toilet facilities that are warn or badly stained and unsightly. Timescale for action 15/02/07 2 3 YA30 YA24 16(k) 23(2) 31/12/06 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Burgner House 4630 Kingsgate Cascade Way Oxford Business Park South Cowley Oxford, OX4 2SU 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 Stow Lodge DS0000023026.V304095.R01.S.doc Version 5.2 Page 25 - 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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