Inspection on 02/03/06 for Sydmar Lodge

This inspection was carried out on 2nd March 2006.

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

Other inspections for this house

Sydmar Lodge 11/06/07

Sydmar Lodge 23/01/07

Sydmar Lodge 06/06/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Sydmar Lodge 201-205 Hale Lane Edgware Middlesex HA8 9QH Lead Inspector Daniel Lim Unannounced Inspection 09:00 2 March 2006 nd 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 Sydmar Lodge DS0000065700.V272222.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. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Sydmar Lodge Address 201-205 Hale Lane Edgware Middlesex HA8 9QH 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) 020 8931 8001 020 8931 8003 European Care (GB) Ltd Mrs Jill Forder Care Home 54 Category(ies) of Dementia - over 65 years of age (54), Old age, registration, with number not falling within any other category (54) of places Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25 July 2005 & 20 September 2005 Brief Description of the Service: Sydmar Lodge is a purpose built care home which is registered to provide personal care for a maximum of fifty four service users over the age of sixty five. Service users with either dementia or physical frailty may be accommodated. The home was previously owned by Suburban & County Care Limited. It is now owned and managed by European Care. The company also owns numerous other care homes in this country. The aims and objectives of the home are to offer a personalised, individual care to individuals who live there and to assist them to live as they wish within any constraints placed on them by their physical or mental frailty. The home is a three storey detached house. There are forty four single bedrooms and five shared bedrooms located across all three floors. All bedrooms have en-suite facilities (a shower, toilet and wash hand basin). There is a lift which provides access to all floors.On the ground floor, there is an office, a large lounge, diner, bathrooms, toilets and service users’ bedrooms.On the first floor, there is a kitchenette, large lounge, bathrooms, toilets and service users’ bedrooms. The layout on the second floor is similar to that of the first floor.The kitchen and laundry room are located in the basement. There is a small parking area at the front of the building and a large garden at the rear with wheelchair access. The home is situated in a residential area of Edgware with easy access to public transport, shops, restaurants and other community services. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out on 2 March 2006 and took a total of 3 ½ hours to complete. This is the first inspection of the home since the change of ownership. The inspector found that many of the National Minimum Standards assessed had been met and the feedback from residents was positive. During this inspection, the inspector was accompanied by the manager of the home (Mrs Jill Forder). The inspector was able to interview four residents and two visitors. The feedback received from them indicated that they were generally satisfied with the care provided. Thank you cards and compliments were also examined. Statutory records including four residents’ case records, the maintenance records, accident records, complaints’ record and fire records of the home were examined. The premises including bedrooms, bathrooms, laundry, main kitchen, gardens and communal areas were inspected. Five staff on duty were interviewed on a range of topics associated with their work and staff training records were examined. In addition, some staff records and the minutes of residents’ meetings were examined. What the service does well: The home was clean, well maintained and well furnished. The garden was attractive. Residents interviewed were satisfied with the care provided and indicated that they were happy with the quality of meals provided The manager and her deputy were knowledgeable regarding their responsibilities and co-operated fully with the inspector. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Improvements are required in the statement of purpose. The registered person must update the statement of purpose. Improvements are also required in care documentation. The registered person must ensure that service users are admitted only following comprehensive preadmission assessments as specified in Standard 3 of the NMS. The care of the resident identified in the section on “Choice of Home” (who has challenging behaviour) must be reviewed and transferred to appropriate accommodation if necessary. Improvements are required to ensure that all residents / service users are well cared for. The registered person must ensure that the responsible doctor is informed / or medical advice sought, after a service user(s) has had a fall or an injury. The registered person must ensure that all staff are provided with instruction on how to respond to complaints made and ensure that staff are instructed to treat all residents and their representatives with respect and dignity. Staffing levels at the home must be reviewed with staff, residents and their representatives to ensure that the needs of residents are met during the day and night. A report of this review together with any action taken or planned must be forwarded to CSCI. Care staff must be provided with training in the care of residents with dementia. Care staff in charge of shifts must receive training in: • • First Aid to be provided when a resident has a wound which is bleeding. The registered person must ensure that the staff records contain all items required in Schedule 2 of the Care Home Regulations (Regulation 19(4)(b)). The registered provider must review the management arrangements of the home to ensure that the needs of residents are met. This must include the role and working arrangements of the manager and her deputy and the adequate supervision of staff and residents. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 7 A report following this review together with any action to be taken must be forwarded to CSCI. 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. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 The manager and her staff had a good understanding of the needs of residents and were able to ensure that the needs of most of the residents are met. Improvements are however, needed in the statement of purpose, preadmission assessments and the care of a resident with challenging behaviour would need to be reviewed. EVIDENCE: Four residents who were interviewed indicated that their care needs had been met at the home and they were generally satisfied with the care and services provided. Comments made included, “well cared for”, “alright here” and “they do as much as they can”. The inspector was also provided with letters and cards expressing gratitude for the care provided. The inspector observed that residents in the home were clean and appropriately dressed. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 10 The statement of purpose was not sufficiently comprehensive, as it did not specify that nursing is not provided at the home and the criteria for admission was not sufficiently informative. Two pre-admission assessments were examined. The inspector noted that one of them did not contain a completed lifting and handling risk assessment. This is required to ensure that staff are fully informed of the care to be provided and residents are fully assessed prior to admission. A requirement is made accordingly. There was documented evidence that residents had the opportunity to view the home prior to moving in. This was also confirmed by a relative. The inspector noted that a resident had challenging behaviour and staff had experienced difficulty managing this resident. A complaint had also been received by the home regarding this resident. In view of this, a requirement is made for this resident’s care to be reviewed and the resident transferred to more appropriate accommodation. Complaints had also been made regarding the quality of care provided at the home. These are commented upon in the relevant sections. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Residents were generally well treated by staff and their personal and arrangements were in place to ensure that their healthcare needs are attended to. Further improvements are however, required to ensure that all residents are well-treated and provided appropriate care. EVIDENCE: Residents interviewed informed the inspector that their healthcare needs had on the whole, been attended to and staff treated them with respect and dignity. Staff interviewed were polite, co-operative and knowledgeable regarding the care to be provided to residents. The sample of four case records examined were up to date and plans of care had been regularly reviewed. Records of medical and healthcare treatment were available for inspection. These included appointments made with the GP, chiropodist and community nurse. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 12 The medication administration charts examined were up to date and had been appropriately signed. A daily record of medication storage temperatures had been kept. These were satisfactory. Residents who were able to express an opinion stated that they had been given their medication. Photographs of residents were available in the medication charts examined. One resident and one of the visitors could not fully confirm that all staff were respectful. In addition, two complaints had also been received (prior to this inspection) which indicated that some staff were insensitive and not respectful. In view of this, a requirement is made for staff to be instructed to treat residents with respect and dignity. A third complaint was received by the inspector (prior to this inspection) that a wound sustained by a resident was not properly dressed by care staff and adequate medical attention sought. These were found to be substantiated by the investigating social worker and a requirement is made for staff to be given appropriate instruction and training on first aid to be given when attending to wounds. A further requirement is made for staff to be provided with guidance on action to be taken after a resident has had a fall or has sustained an injury. Three complaints had been made by relatives alleging that residents were not appropriately dressed and were sometimes not dressed in their own clothes and shoes. Although these could not be substantiated due to the lapse of time, a requirement is made for the registered person to ensure that personal care is closely monitored to ensure that residents are appropriately dressed. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 The daily life and routines of residents were well organised and arrangements were in place to ensure that residents social and cultural needs are met. EVIDENCE: Residents who were interviewed informed the inspector that they were satisfied with the activities provided and these activities were appropriate for them. The home’s programme of weekly social and therapeutic activities was displayed on the ground floor. This was varied and included exercise sessions, entertainments sessions, art and crafts, music and bingo. The activities coordinator was enthusiastic and knowledgeable regarding the social needs of residents. Meetings had been organised in which residents were consulted regarding their preferences. The minutes of one of these residents’ meetings was available for inspection. Residents who were interviewed stated that they were satisfied with the meals provided. The menu was examined and noted to be varied and balanced. Choice of main dish was available at meal times. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 14 The kitchen and dry food store were inspected and found to be clean. Daily records of fridge and freezer temperatures had been documented. These were satisfactory. The chef who was interviewed was knowledgeable regarding her responsibilities. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 15 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): 16,18 Systems were in place to ensure that residents are protected from abuse and ill treatment. However, there is a need for further improvements to ensure the welfare of residents. EVIDENCE: The home had policies and procedures for adult protection and for responding to complaints. Staff on duty who were interviewed were aware of the procedure to follow when responding to allegations of abuse received. The complaints book was examined. Complaints recorded had been responded to. The inspector had however, received complaints from two relatives alleging that the home had not responded promptly to their complaints and certain staff had been insensitive and unsympathetic when concerns were brought to their attention. Three complaints had been brought to the attention of CSCI since October 2005. These had been brought to the attention of the home manager and company officers. They had responded promptly and co-operated with those involved in the investigations. Requirements are being made in this report in response to the findings of investigations. These are commented on under the relevant sections. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 16 In response to complaints made regarding by relatives a requirement is made for the registered person to ensure that all staff are provided with instruction on how to respond to complaints made. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 17 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): 19,20,21,23,24,25,26 The home was clean and maintained to a high standard, therefore providing a pleasant environment to live in. The facilities were adequate. EVIDENCE: The premises including bedrooms and communal areas were inspected and found to be clean and hygienic. The required maintenance and safety certificates for the gas installations and lifts were available for inspection. Residents’ bedrooms were inspected and found to be well furnished. Residents interviewed stated that they were happy with the accommodation provided and their bedrooms had been kept clean. The gardens were attractive and seating had been provided. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Staff on duty were knowledgeable and aware of their responsibilities and the needs of residents were generally met at the home. However some deficiencies were noted in the staffing arrangements. EVIDENCE: The staff rota was examined. This indicated that there was a minimum of 9 staff on the morning shifts and 6 on the afternoon and evening shifts. There were 4 staff on the night shifts. The manager and her deputy were supernumerary. Two of the staff interviewed informed the inspector that the staffing levels were not always adequate. They explained that this was the case when staff were off sick, as replacements were not always provided. In view of the comments made, the registered person must review staffing levels at the home with staff, residents and their representatives to ensure that the needs of residents are met during the day and night. A report of this review together with an action taken or planned must be forwarded to CSCI. Staff who were interviewed on a range of topics (such as health and safety, fire procedures and adult protection) were knowledgeable regarding their roles Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 19 and responsibilities. The inspector however, noted that not all staff had been provided with training in the care of residents with dementia. This is required. The sample of three staff records examined contained most of the required documentation such as two references, satisfactory CRB disclosures, contracts and evidence of identity. One of the records (of a recently recruited staff) examined did not contain a reference from the previous employer of the staff member concerned. This reference is required (unless a satisfactory explanation is provided and documented) and a requirement is made accordingly. One of the visitors stated that staff did not always respond promptly to the emergency buzzer. The emergency buzzer was activated in one of the bedrooms. Staff responded promptly (within one minute). Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 20 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): 31,33,36,38 The manager was knowledgeable regarding her role and responsibilities. However, some deficiencies were noted in the management of the home and Systems were in place to ensure the safety of residents. requirements are made for improvements to be made in the management of the home. EVIDENCE: Weekly fire alarm checks, fire drills and fire training had been documented. Window restrictors were in place in the bedrooms inspected. The portable appliances and electrical installations had been inspected. There was a record of accidents. These were well maintained. When interviewed, the manager was found to be knowledgeable regarding the needs of residents and residents were of the opinion that the home was Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 21 generally well managed. Five staff were interviewed. Three indicated that they were happy with the management of the home while two indicated that they were not satisfied. Three complaints had been made regarding the care and management of the home. Some of the allegations made were substantiated while others were not substantiated. The allegations indicated that improvements are required in the monitoring of staff, personal care and supervision of residents, staff training, guidance to staff regarding action to take following accidents and injuries. The manager informed the inspector that she is aware of the complaints made and prompt action had been taken to improve care and management of the home. She further added that she had ensured that there was adequate management cover at weekends. A requirement is made in this report for the management arrangements of the home to be reviewed to ensure that the needs of residents are met. The registered provider must review the management arrangements of the home to ensure that the needs of residents are met. This must include the role and working arrangements of the manager and her deputy. A report following this review together with any action to be taken must be forwarded to CSCI. A further requirement is made for the registered person to provide the inspector with an action plan in response to the findings of it’s own investigations and in response to recommendations made in the strategy meeting held at the home on 1st March 2006. Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 X 2 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 2 Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? 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 2 Standard OP1 OP3 Regulation 6(a)(b) 13(4)(c) 14(2)(b) Requirement The registered person must update the statement of purpose. The registered person must ensure that service users are admitted only following comprehensive pre-admission assessments as specified in Standard 3 of the NMS. This must include lifting and handling assessments. The registered person must ensure that the care of the resident identified in the section on “Choice of Home” (who has challenging behaviour) is reviewed and transferred to appropriate accommodation if necessary. The registered person must ensure that staff are instructed to treat residents and their representatives with respect and dignity. The registered person must ensure that the responsible doctor is informed/or medical advice sought, after a service user(s) has had a fall or injury. DS0000065700.V272222.R01.S.doc Timescale for action 01/05/06 13/04/06 3 OP4 10(10) 12(1) 13/04/06 4 OP10 12, 13(6) 13/04/06 5 OP8 12(1) 13(1)(4) 20/03/06 Sydmar Lodge Version 5.0 Page 24 6 OP16 22(3)(4) 12(1) 18(1)(a) 7 OP27 8 OP30 18(1)(c) (i) 18(1)(c) (i) 9 OP30 10 OP29 19(1)(5) 19(4)(b) 11 OP31OP33 OP36 10(1) 12(1) The registered person must ensure that all staff are provided with instruction on how to respond to complaints made. The registered person must review staffing levels at the home with staff, residents and their representatives to ensure that the needs of the residents are met during the day and night. A report of this review together with any action taken or planned must be forwarded to the CSCI. The registered person must ensure that care staff receive training in the care of residents with dementia. The registered person must ensure that care staff in charge of shifts receive training in: • First Aid to be provided when a resident has a wound, which is bleeding. The registered person must ensure that the staff records contain all items required in Schedule 2 of the Care Home Regulations (Regulation 19(4)(b)). The registered person must review the management arrangements of the home to ensure that the needs of residents are met. This must include the role of working arrangements of the manager and her deputy and the adequate supervision of staff and residents. A report following this review together with any action to be taken must be forwarded to the CSCI. 20/04/06 30/04/06 01/05/06 01/05/06 30/05/06 30/04/06 Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 25 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 Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Sydmar Lodge DS0000065700.V272222.R01.S.doc Version 5.0 Page 27 - 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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