Inspection on 12/07/06 for The Lodge

This inspection was carried out on 12th July 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

The Lodge 09/10/08

The Lodge 18/10/07

The Lodge 08/05/07

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE The Lodge 29 Bargate Grimsby North East Lincs. DN34 4SN Lead Inspector Sarah Urding Unannounced Inspection 12th July 2006 09:30 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 The Lodge DS0000067509.V304307.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. The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lodge Address 29 Bargate Grimsby North East Lincs. DN34 4SN 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) 01472 357774 Ramesh Dalton Murugupillai Rabindranath Rommel Selliah Mrs Denise Cullingford Care Home 29 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (29) of places The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2005 Brief Description of the Service: The Lodge is a 29-bedded care home set near the centre of the town of Grimsby. The building is Victorian in style and retains many of its original features, but has a modern extension and large gardens. The home is equipped to provide care for those with dementia and problems of old age. It will also take up to 4-day care places. The home has a variety of sitting rooms and a dining area. The residents, who are able, can wander freely in the home as there is a digital locking system, for which the code is available, to ensure they do not leave the building unescorted, due to the nature of their illness and the very busy main road, through to Grimsby town centre. The home has bathroom and toilets on all floors and also a shower. The first floor is reached via a chair lift. The current scale of charges is £367 per week. Additional charges include hairdressing and chiropody. The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection and the visit to the home was unannounced, taking place over a period of seven hours. The inspector received comments prior to the inspection from two relatives of service users and four service users. One member of staff also chose to comment. This information was used in the inspection and will be reflected in this report. An anonymous letter was also received prior to the inspection outlining several areas of concern about practice in the home. The inspector looked at this during the inspection and has also asked the owners to investigate these concerns. On arrival at the home the building was looked around and a number of records and policies were inspected. The care manager and four members of staff were spoken to. Nine service users and two relatives visiting the home were also spoken to. What the service does well: What has improved since the last inspection? Two written references and POVA first checks are in place before staff start work. This means that the home does everything it can to make sure that service users are looked after by safe people. Owing to the conditions of some of the service users it makes it difficult to seek their views but staff try to overcome this by communicating well with service users relatives. The home has started regular meetings with relatives so that their views on the care offered in the home are sought. The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 6 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 Lodge DS0000067509.V304307.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 The Lodge DS0000067509.V304307.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 at least once during a 12 month period. 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 from evidence gathered both during and before the visit to this service. The home is able to meet the needs of service users owing to a thorough assessment on admission. EVIDENCE: Service users undergo a thorough assessment of needs prior to admission. This demonstrates that the home works in partnership with them, their families and health professionals to glean full information about service users’ lives. The assessment covers all aspects of standard 3.3 and is completed in detail. The assessment links clearly to the care plan. The home is not providing intermediate care at the present time. The Lodge DS0000067509.V304307.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users’ health care needs are met by staff who treat them with respect but a shortage of staff has resulted in some aspects of personal care not being met. EVIDENCE: All Service users have a detailed plan of care that provides staff with the information they need to ensure needs are met. This links in to the home’s assessment on admission and is reviewed on a regular basis and when needs change. Reference to how staff should meet foot care needs has been incorporated in the plan since the last inspection. Five care plans were looked at and were all consistently detailed with the exception of one care plan, which was not fully completed. This must be addressed. Service users’ health care needs are being clearly identified and met by the home. There was evidence in service users’ records that all health care needs were being consistently met. Some aspects of personal care however have been compromised owing to a staffing shortage. The inspector noted that The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 10 some service users’ nails were particularly long and required cleaning. Also during lunch some of the service users clothes were not protected from spillages. This resulted in service users remaining in stained clothes for the rest of the day. The home has a comprehensive medication policy and trained staff administer medication to service users. Overall, records kept were clear and concise. Controlled drugs are being stored and administered appropriately. There was one inconsistency found with regards to the administration record of a service user’s medication. The number of tablets held by the home did not correspond with the administration record. This indicated that medication had been signed for as given on three occasions when it had actually not been given. The care manager could not explain why this was the case but agreed to look in to this and amend the record accordingly so that the correct number of tablets held in the home is recorded. Service users spoken to say that the staff are “ok”, look after them and are polite. Staff were observed to knock on service users doors prior to entering and were aware of the sensitivities involved while carrying out personal care. The Lodge DS0000067509.V304307.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home does not offer all service users the opportunity to experience activities suited to their needs. The lives of services users are enriched by family and friends being able to freely visit the home. Meals are nutritious and balanced and offer a healthy diet for service users but the way in which mealtimes are currently organised and staffed means that not all service users receive the help that they need during this time. EVIDENCE: The shortages in staff has meant that the activity programme is not taking place as specified. The home offers some activities in the form of outside entertainers, however on a day-to-day basis the interests of service users are not being addressed. There was no evidence that activities suitable for people with dementia were taking place. This is disappointing, as some staff in the home have received training about how to engage people with dementia in activities. This needs to be put in to practice. The home does not offer service users the opportunity to take part in religious services of their choice at the present time. Staff said that this was due to The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 12 service users own choice about not wishing to practice their religion. Some care plans indicated that service users had been consulted about this and chose not to practice, which is entirely acceptable. Other care plans, however implied that this information was not known. It was unclear from the care plan of one service user whose first language is not English whether there were any cultural needs that needed to be met. Staff were unclear about this also. The home must carry out a review of the religious and cultural needs of service users and provide access to services and community groups where identified. Contact with service users’ friends and family is promoted well by the home. Two relatives were spoken to during the inspection and they said that they could visit when they wish and that staff are approachable if they have any concerns. They said that they are made to feel welcome by staff when they visit. Owing to the fact that many of the service users have difficulty in communicating, Staff have started to meet regularly with relatives so that they can speak on behalf of the service users where appropriate. This is good practice. Where possible staff said that they encourage service users to maintain their independence and have control over their lives. Staff recognised the difficulties that this presents when working with people with dementia, however they said that they encourage service users to make decisions when appropriate. Care plans identify how staff are best able to communicate with individual service users, however practice could be improved with further training. The home provides healthy and well-balanced meals for service users and some relatives and residents said that the food was good. Some service users and their relatives have said that the sausage meat that the home provides is “awful” and one service user said that they would like to see more fruit available during snack times. Special dietary requirements are catered for. A number of residents are on liquidised diets and one service user is on a gluten free diet. It is recommended that menus are kept for service users on alternative diets. The inspector observed the lunch time period and found it to be chaotic and rushed. There are a large number of service users who require assistance with their feeding. Owing to the lack of staff it is difficult to meet all their needs during this period. Staff were observed to be feeding two service users at one time and one member of staff picked up a chip in her fingers and handed this to the service user. The need to ensure that all residents receive food means that some service users are rushed to finish their meals. This may mean that they do not receive the nutrition they need. Not all service users were provided with aprons to protect their clothes whilst eating so their clothes were stained for the rest of the day. The kitchen is not near the eating area in the home and meals are delivered on a trolley. Service users presently eat in the reception room, dining room which seats 16 and two adjacent lounges. Four service users also receive food in their rooms. The food trolley is wheeled in to the reception area and meals are dished out from this central point. However this room is cramped and hot food is being passed to the various rooms from this point. The number of people passing through this room and eating here could result in an accident occurring. The present organisation is The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 13 not conducive to creating a pleasant mealtime experience for service users and must be addressed. The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The arrangements for addressing service users and relatives complaints are handled well but staff are not confident that concerns they raise are always addressed. This means that service users may not be protected from abuse. EVIDENCE: The home has a clear complaints procedure in place. Residents and relatives spoken to said that they had no complaints about the home. Complaints are recorded appropriately in a complaints log and addressed by the manager. There have been two complaints since the last inspection, one which was dealt with appropriately, and the other is in the process of being addressed. The complainant’s level of satisfaction with the outcome was recorded which is good practice. Staff spoken to have received vulnerable adults training but there was some confusion about responding to allegations made by service users owing to their conditions. Staff must be clear that any allegation is reported to senior staff and referred to social services for discussion on how to progress the concern. Staff also spoke of concerns they had about incidents of poor practice in the home. They had reported their concerns appropriately but were not confident that these issues had been addressed. This may discourage staff from reporting future concerns and compromise the protection of service users. The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The environment is clean, safe and well maintained but there are some issues that require addressing so that the health and safety of service users is not compromised. EVIDENCE: The home is clean, well presented and homely. A planned programme of maintenance is in place and work is ongoing to further improve standards in the home. The home carries out all recommendations from the Environmental Health and Fire departments. During a tour of the building, the inspector noted that a bedroom door was difficult to open and close due to the thickness of the carpet. This could present as a fire risk and make it difficult for the service user to get in to and out of their room. This must be addressed. There was also a strong smell of urine in one of the shared bedrooms. Staff said that the carpet might need cleaning. This must take place. The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 16 Service users are provided with the equipment they need to maximise their independence. Appropriate grab rails and hoists are in place throughout the home. Wheelchairs are currently being stored in two of the homes toilets. This is inappropriate and presents as a health and safety risk to service users. More appropriate storage must be provided. Policies for the control of infection are in place and followed in practice. The service users and relatives spoken to were positive about standards of cleanliness in the home. However, the recent relatives meeting had raised issues of concern regarding the cleanliness of the home at the time. The home subsequently employed an additional cleaner in response to this. Laundry facilities in the home are appropriate and meet the needs of the service users. The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are looked after by staff who are safely recruited and receive regular training but the inadequate staffing levels in the home compromises the ability of staff to meet the needs of service users. EVIDENCE: The home’s staffing levels are not adequate to meet the needs of the existing group of service users. Staff said that the home has been experiencing problems in this area for some time. The manager discussed with the inspector plans to recruit more staff so that there are six members of staff on during the day and three at night. The current ratio is three staff and a care manager during the day and two staff at night. With only two staff being on duty after 7.30pm. This is not adequate and compromises the choices that service users have of when to go to bed. Staff said that they have to get service users ready for bed before night staff come on duty which means that the home is being run around staff shifts rather than in the best interests of the service users. The staffing levels are causing the staff difficulties in meeting all service users needs, which is reflected throughout this report. The deployment of staff may also be a factor. Staff said that the care managers are unable to assist them in personal care tasks as their duties involve them undertaking tasks away from service users. Staff reported feeling tired and fed up with situation and were concerned that this is having a The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 18 negative effect on how they work with service users. A couple of shorttempered exchanges were observed during the inspection between service users and staff which is indicative of this problem. Despite the staffing difficulties the home has recently admitted three more service users. This should not have occurred given the existing staffing difficulties. The provider of the home was contacted following the inspection and has agreed to freeze admissions to the home until the staffing issue is resolved. Recruitment is on going and two staff are due to start work this week. Staff receive regular training and four staff are currently trained to NVQ level 2 or above. This does not yet meet the recommended level of 50 ; however a number of staff are currently undertaking this qualification and when completed the home should meet this standard. It was noted that not all staff have received training in working with people with dementia. It is recommended that this be given priority owing to the nature of work that staff undertake and the shortfalls in meeting service users needs identified within this report. Two written references and POVA first checks are in place prior to staff starting work, which means that the risks of employing unsafe people are reduced. The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 19 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, 35, 38 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The process of a change of ownership has had an unsettling effect on the home’s management and administration. EVIDENCE: The home has recently undergone a change in ownership, which has caused a period of uncertainty for staff. The new owners are now in place and it is hoped that the fall in standards of care provided can now be resolved. The registered manager remains in post and is currently undertaking the registered manager’s award. Staff said that the manager of the home was approachable and they felt supported by her. It was noted during the course of inspection that a number of incidents such as accidents to service users had not been reported to CSCI as required by regulation 37. This must be addressed. The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 20 The home’s system for monitoring the quality of care provided is to change due to the change in ownership. A member of staff has recently been appointed to carry out audits of care. Owing to the fact that this system is in transition, it is difficult to comment upon its validity. However this standard has been met previously. Any future system should take in to account the views of everybody involved in the service. This should include staff and health professionals external to the home as well as service users and their relatives. Reports of any review of quality of care must be sent to CSCI for information. Residents are protected by the financial procedures of the home. The home does not act as appointee for any residents or look after any money. The home operates in the best interests of the health and safety of residents and staff. Generally, all safety checks are carried out within the specified time frame and policies are in place for safe working practice. The gas safety certificate was out of date on this occasion but there was a note on the file explaining the delay. A copy of the new gas safety certificate must be sent to CSCI on receipt so that the home can evidence that the system is safe. Staff receive health and safety training at regular intervals. The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 21 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 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 4 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 22 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. 2. Standard OP8 OP9 Regulation 12 12, 13 Requirement Service users’ personal care needs must be met. To include hand and nail care Medication must be administered as prescribed. Accurate records of medication held in the home must be kept. 1. Appropriate activities to suit the needs of service users must be provided. 2. The registered manager must ascertain the religious and cultural needs of all service users and provide appropriate facilities to meet identified needs and wishes. Service users must receive appropriate assistance at mealtimes: 1. Feeding must take place on a one to one basis. 2. Staff must follow food hygiene guidelines when feeding service users. 3. The way in which mealtimes are organised must be reviewed. Timescale for action 20/07/06 12/07/06 3. OP12 12, 16 14/08/06 4. OP15 12, 18 31/07/06 The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 23 5. OP18 6. OP19 7. 8. 9. 10. OP22 OP27 OP31 OP38 12, 13, 18 The whistle blowing policy must be followed by all staff. Training must be given in the correct reporting procedures should an allegation be made. 16, 23 The building must meet health and safety requirements: 1. The door to bedroom 3 must be repaired. 2. The unpleasant smell in one bedroom must be addressed. 16, 23 Wheelchairs must be stored appropriately. 18 The home must be adequately staffed at all times. 37 All notifications outlined in regulation 37 must be sent to CSCI for information. 23 The gas safety certificate must be sent to CSCI for information 31/08/06 14/08/06 14/08/06 31/07/06 31/07/06 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP15 OP27 OP28 Good Practice Recommendations The care plan for one service user should be fully completed. Service users should be provided with appropriate coverings to protect their clothes during mealtimes. The deployment of staff should be reviewed to assist in the staffing of the home. 50 of staff should be trained to NVQ level 2. The Lodge DS0000067509.V304307.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 The Lodge DS0000067509.V304307.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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