Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 05/04/06 for The Lodge

Also see our care home review for The Lodge for more information

This inspection was carried out on 5th April 2006.

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

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

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

What the care home does well

There was a relaxed feel to the home. Most staff were seen to be very caring towards the residents and supporting them appropriately. Visitors are welcomed on arrival to the home. A visitor spoken to during he inspection said " the staff on the whole do a good job". External entertainers were in the home during the inspection and residents taking part appeared to be enjoying it.

What has improved since the last inspection?

A number of requirements have been met since the last inspection including new flooring to the dining room. The controlled drugs were well kept and recorded appropriately. Temperatures were being taken and recorded daily of both the medical room and the medical fridge to ensure they are maintained within appropriate limits. Fire equipment was being stored appropriately and all exits were clear at this inspection.

What the care home could do better:

The manager must ensure that all residents have a full assessment carried out prior to an admission to ensure that the home can fully meet their needs. Care plans must be kept under review and ensure that information recorded on the daily notes is reflected within the residents care plan. Where residents have an identified behaviour need a detailed plan must be put in place to ensure staff know the action required and that a consistent approach is carried out. Some medication record and procedures need improvement, although some progress since the last inspection is acknowledged. All staff must receive formal training on Adult Protection to ensure that they are aware of the procedure to follow to ensure that residents are protected at all times from abuse. Re-training is needed for some staff in moving and handling to ensure residents are moved and handled correctly and with dignity. Although activities take place on an adhoc basis it would be beneficial to plan and displaying a calendar of events as this would give residents something to look forward to.

CARE HOMES FOR OLDER PEOPLE The Lodge 5 Broad Street Hemel Hempstead Hertfordshire HP2 5BW Lead Inspector Mrs Alison Butler Key Unannounced Inspection 5th April 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 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 DS0000019578.V289857.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Lodge Address 5 Broad Street Hemel Hempstead Hertfordshire HP2 5BW 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) 01442 244722 01442 240401 B & M Investments Limited (Trading as B & M Care) Susan Wilson 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 The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd November 2005 Brief Description of the Service: The Lodge is a residential care home for older people who may have a diagnosis of dementia. The home is located in Hemel Hempstead and can accommodate up to 54 service users. There are two lounges on the ground floor and a large dining room. Bluebells is a unit for people who have dementia, where there is a large lounge with separate dining area. The building has been extended and the first and second floors are on two levels, some of the bedrooms are served by a chair lift. There is a dedicated hairdressing room on the first floor. The enclosed garden consists of small paved courtyards, which are attractively decorated with window boxes, flowerpots and garden ornaments. The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken by two inspectors and covered all the key standards. An additional visit took place on the 14th December 2005 and the main focus of this inspection was to undertake a specialist pharmacist inspection. During this inspection several residents and members of staff were spoken to individually. Their views, which were generally positive, have been incorporated into this report. During the inspection a tour of the building took place, including a look at some of the residents bedrooms and communal areas. It is expected that later this year questionnaires will be sent out to a sample number of people involved in The Lodge, this is to gain feedback on the quality of the care and service provided at the home. Where standards remain the same these have been brought forward into this report. What the service does well: What has improved since the last inspection? A number of requirements have been met since the last inspection including new flooring to the dining room. The controlled drugs were well kept and recorded appropriately. Temperatures were being taken and recorded daily of both the medical room and the medical fridge to ensure they are maintained within appropriate limits. Fire equipment was being stored appropriately and all exits were clear at this inspection. The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 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 DS0000019578.V289857.R01.S.doc Version 5.1 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 DS0000019578.V289857.R01.S.doc Version 5.1 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 Standard 6 is not applicable to The Lodge. Quality in this outcome is adequate. This judgement has been made using the available evidence, including a visit to the service. There is a system of pre-assessment in place to ensure that the care needs of people who may chose to move into the home are met and fully understood. But these are not always fully completed. EVIDENCE: Pre- admission assessments had not been fully completed from the sample looked at during this inspection. This was usually caused by accepting emergency admissions because the home had vacancies. This was not seen as good practice as they were not able to fully establish if the personal care needs could be fully met. This can have a detriment effect on the residents especially if their behaviour is challenging. The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 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 is poor. This judgement has been made using the available evidence, including a visit to the service All residents had a care plan in place although they require updating to reflect their current needs. Shortfalls in the recording could have a potential to put both residents and staff at risk. There were a number of errors noted within the medication procedures. EVIDENCE: A number of care plans were examined during this inspection. Information contained had not always been signed and dated so the inspector was unable to verify if this information was up to date. Some care practise had not always been followed through, for example the district nurse attended to a resident and had dressed their heels but there was no further information if these had improved or indeed were still being attended to. A number of residents were on fluid charts although not all had information on their care plans as to why or what information was to be gathered. Some of the charts appeared not to be completed on a regular basis as some days had been completely omitted. The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 10 Evidence was again seen that information recorded within the daily notes stated, “needs encouragement to eat and drink” but this had not been reflected within the service users’ care plan as this stated they eat and drink well. A behavioural programme is required for a named individual to ensure that staff understand how to cope with the issues and that they are under taking with them in a consistent way. A number of medication issues were identified where medication was to be returned to the chemist. This had been placed in a drawer and not been listed within the returns book. This is not good practice as staff were unsure of all medication held and would be unable to reconcile it this potentially putting themselves at risk. Paracetamol was unable to be reconciled from the information provided on the MAR (medication, administration and record) sheet. One resident had their medication signed in although a note had been made to say “awaiting medication”, the inspector was unable to find this medication. Discussion with the deputy showed that the MAR sheet had been incorrectly filled in, and the medication had not arrived in the home as an alternative had been prescribed by the GP. Controlled drugs were well kept and reconciled following a spot check. Temperatures of the fridge and the medication room were being recorded on a daily basis to ensure they remained within the required limits to ensure safe storage of all medicines. The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 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 is good. This judgement has been made using the available evidence, including a visit to the service. The quality of the activities on offer is good although they are not well advertised to the residents. The quality of the food is generally good although it appeared not to be a pleasant experience. EVIDENCE: On the day of the inspection entertainment was being provided by an external agency, posters were on display to inform residents that this activity would be taking place. A large number of residents were taking part in the singing of old time songs. The cost of this entertainment is divided between the numbers of residents that attend the session. There was no written information that the residents that attend agree to paying towards the cost, some residents would be unable to agree to this due to their dementia. It is recommended that written permission is gained from the individuals or those acting on the residents behalf which would then be used for their records & as part of the audit trail for dealing with the residents monies. The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 12 The daily activity co-ordinator is extremely dedicated to her role and keeps records on who takes part with which activity. Activities are carried out on an adhoc basis. It is recommended that a diary of monthly events be displayed which would give residents something to look forward to. The activity coordinator would also benefit from a trolley to be able to take activities round to each area of the home, as she feels that time is taken up with going to and fro from the storage cupboard to collect items to carry out different activities. The lunch on the day was roast pork, roast potatoes, parsnips, and cauliflower. Gooseberry pie and custard. The alternative was sausage, mash and vegetables. The pureed meals had been divided separately. The staff did not sit with the residents during the lunch but walked around the dining room, one resident was eating their meal with a knife and the staff in the dining room had not noticed this. One resident who was not eating was encouraged by a member of staff to eat, it would have been more appropriate if the staff member sat down with the resident whilst encourage and supporting them to eat their meal. In general the comments made by the residents about the food were it was good although one felt that it was not always very hot. The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using the available evidence, including a visit to the home. There are policies and procedures in place for the protection of vulnerable adults, although staff were not clear on how to put this in action, which could put residents at risk. EVIDENCE: During this inspection a number of staff were spoken to regarding the procedure to follow in the event of an allegation of abuse being made. They were not clear although they felt they would report it to the senior on duty. The senior team had attended training in Adult Protection but when asked about the procedure they talked about reporting under regulation 37 and not under the Adult Protection Procedure. The inspectors pointed out, this was a different procedure although any allegations must be reported to the Commission For Social Care Inspection. All staff must be given formal training in adult protection and not just be provided with handouts as this has proved not to be effective for staff to fully understand their role in protecting the elderly in their care. Where complaints are investigated the manager must ensure that all forms of communication that are used during the investigation are recorded (for example telephone conversations). Any outcomes and actions must be fully documented to produce an audit trail to conclude the investigation. The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 & 26 Quality outcome in this area is adequate. The judgement has been made using available evidence, including a visit to the home. The premises were reasonably comfortable and clean with the exception of an odour on the top floor. A couple of maintenance issues were raised to ensure a safe well-maintained environment was provided. EVIDENCE: The inspectors conducted a tour of the building and a mal odour was detected on the top floor. This must be addressed and monitored to ensure that the appropriate flooring is provided. The lift machinery on the top floor had an enormous hole surrounding it and this is a potential risk to residents as there were electrical wires showing. This must be addressed as a priority. The hairdresser had her ‘fire’ door wedged open with a knife, this is not good practice and an alternative must be sought in case of a fire to protect safety of all persons in the home. A lift door also had an “out of order” notice on it, the The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 15 door could be opened and residents could enter, this must be locked to prevent accidents. There has been new flooring laid in the dining room which provides a homely feel. One of the bathrooms had personal possessions left in which were not named and it would be good practice if these items were returned to an individual’s bedroom after use. This would also help in preventing cross infection. A number of issues have been raised by families regarding the laundry service and clothing going missing. The manager is going to look at ways to address these issues and ensure that where possible clothing is labelled on admission. The manager could look at whether families speak with the laundry assistants direct as they may know where clothing is or be given a description of what to look for in the case of missing laundry. Residents on the whole commented they were very happy with the laundry service. A number of notices where on display on walls giving staff instructions, this does not create a homely atmosphere and it is recommended that these be put up more discreetly for example inside wardrobe doors/cupboards. The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected 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 adequate. This judgement has been made using available evidence, including a visit to the home. Sufficient care staff are available to meet the personal needs of the residents. Some training needs to be addressed to ensure that staff have the skills to care for the residents at all times. EVIDENCE: Those residents who were able to talk to the inspectors said that the staff were caring and they were happy living at The Lodge. Appropriate numbers of care staff are deployed to meet the personal care needs of the current residents. Where agency staff are used it is recommended that the manager receives a pro forma on each agency member of staff used, to ensure they have the required training and appropriate checks have been carried out to protect the residents in her care. The recruitment records for staff employed at The Lodge examined showed that appropriate checks had been made to ensure that they were fit to carry out their roles and the residents are protected. Training and refresher training for some staff is required which, includes moving and handling as poor practice was observed during the inspection where one resident was being moved using the condemned under arm The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 17 technique and also they were using the residents trousers to assist in the manoeuvre. This must have been extremely uncomfortable. Adult protection training must also be carried out (see section on complaints and protection for further details). The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 35 & 38 Quality outcome in this area is adequate. This judgement has been made using available evidence, including a visit to the service. The home is managed reasonably well although some areas could be improved especially around care planning and training were identified. Residents’ financial interests are not fully safeguarded; a procedure must be put in place for the recording and safe keeping of monies held by the home to ensure full protection of both staff and residents. Quality assurance report must be written to ensure that views have been sought from residents, relatives and stakeholders about the service that is provided at The Lodge and that it is meeting its aims and objectives. Some care practices not always promoting and safeguarding the health, safety and welfare of the residents. The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 19 EVIDENCE: The registered manager holds the Registered Managers Award. It was noted that some of the paperwork requires updating especially with regard to the care plans. A policy and procedure must be put in place for the handling of the residents’ money as to how this is to be done, safe storage, receipts and recording of transactions. Where external activities are provided and the cost is shared between the residents that have attended, the manager should obtain written permission from either the residents themselves or a relative/friend acting on their behalf. The manager had carried out a resident/relative survey asking them their views on the service provided at The Lodge. A report has yet to be written and copy must be forwarded to the Commission For Social Care Inspection and made available to residents, relatives and other interested parties. A number of issues regarding health & safety were noted during this inspection see other sections of the report for information. Loose carpets and storage of fire equipment had been addressed since the last inspection. The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 21 Yes 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 Standard OP3 Regulation 14 Requirement The registered person must ensure that a full assessment has been obtained or carried out prior to admission to ensure the home is fully able to meet the residents needs The registered person must ensure that care plans are kept under review and a record made. The registered person must ensure that care plans are kept under review and a record made. A care plan must be in place for the staff to deal appropriately with an individuals behaviour to ensure safety and consistency in approach A care plan must be in place for the staff to deal appropriately with an individuals behaviour to ensure safety and consistency in approach All medication must be recorded appropriately to ensure a full reconciliation can be carried out at any time. The registered person must ensure that all complaints are fully investigated and appropriately recorded DS0000019578.V289857.R01.S.doc Timescale for action 31/05/06 2 2 3 OP7 OP31 OP8 15(2)(b) 15(2)(b) 15(1) 31/05/06 31/05/06 19/05/06 3 OP31 15(1) 19/05/06 4 OP9 13(2) 31/05/06 5 OP16 22(2) & (3) 19/05/06 The Lodge Version 5.1 Page 22 5 OP31 22(2) & (3) 13(6)18 (1)(a)(c) 13(6)18 (1)(a)(c 23(2)(b) 13(4)(a) (c) 13(4)(a) (c) 12(4)(a) 13(5) 24 6 6 7 8 8 9 10 OP18 OP30 OP19 OP19 OP38 OP30 OP33 The registered person must ensure that all complaints are fully investigated and appropriately recorded All staff must receive formal training in Adult Protection. All staff must receive formal training in Adult Protection Repairs to the area around the lift machinery on the top floor must be carried out. An alternative device for holding open fire doors must be sought An alternative device for holding open fire doors must be sought Staff must receive training in correct moving & handling procedures. The registered person must complete a Quality Assurance Review and provide a written report to the resident, the Commission For Social Care Inspection and other interested parties. 19/05/06 30/06/06 30/06/06 19/05/06 19/05/06 19/05/06 30/06/06 31/05/06 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 Refer to Standard OP8 Good Practice Recommendations The manager should ensure that where treatment has been carried out any follow up information is documented to give a clear picture of any improvement has been made. Where charts are being completed to gather information this should be documented within the care plan. Where information is recorded within the daily notes this should be reflected within the care plan. Records of medicines waiting disposal should be listed in the returns book immediately it is added to the returns drawer. DS0000019578.V289857.R01.S.doc Version 5.1 Page 23 2 3 4 OP8 OP8 OP9 The Lodge 5 6 7 7 8 9 10 11 OP12 OP12 OP12 OP15 OP19 OP21 OP26 OP35 The activities should be arranged and a calendar of events displayed in an appropriate format. The activities co-ordinator should be provided with a trolley for transporting equipment around the home. The manager should obtain written permission from residents or relatives acting on their behalf to say they agree to contribute to external entertainers. Staff should remember to sit down with residents when supporting them with eating. The manager should look at more appropriate and discreet ways of displaying instructions to staff. Personal items should be labelled and returned to individual rooms after bathing. The manager should look at alternative ways to address laundry issues with families. A policy and procedure should be written on maintaining records and safe storage of residents monies held by the home. The Lodge DS0000019578.V289857.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 DS0000019578.V289857.R01.S.doc Version 5.1 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!