Inspection on 05/05/05 for Walmer Lodge

This inspection was carried out on 5th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Walmer Lodge 25/10/07

Walmer Lodge 20/03/07

Walmer Lodge 20/09/06

Walmer Lodge 08/12/05

Walmer Lodge 26/11/04

Walmer Lodge 09/06/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood Hall

Muston Road (70)

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

CARE HOME ADULTS 18-65 Walmer Lodge 6 Walmer Villas Manningham Bradford BD8 7ET Lead Inspector Steve Marsh Unannounced 5th May 2005 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Walmer Lodge Address 6 Walmer Villas Manningham Bradford BD8 7ET Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01274 499338 01274 499338 Mr Sikander Khan & Suleman Ahmed Chunara Mr Salihu Tifin Shehu Care Home Only 12 Category(ies) of Learning Disability (12) Mental Disorder (12) registration, with number of places Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 26/11/04 Brief Description of the Service: Walmer Lodge is situated in the Manningham area of Bradford, approximately one mile from the city centre. The home is on a main bus route and both Bradford and Keighley can be easily reached by public transport. The home is registered to care for twelve service users with either mental health problems or learning difficulties in single bedroom accommodation. There is no disabled access to the building or pasenger lift to the bedroom on the upper floors, therefore the home would not be suitable for service users with physical disabilities. There is a small garden to the front of the property and a car park to the rear, although access is quite narrow. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection for the year 2005/06, and was carried out by one Inspector over a period of approximately seven hour. The last inspection of this service was in November 2004 and the main purpose of this visit was to assess the homes progress in meeting the requirements and recommendations highlighted in the inspection report. The methodology used in this inspection included the examination of records, observation of work practices, discussions (group and individual) with service users, staff and management and a partial tour of the premises. Comment cards were provided for service users and relatives to enable them to share their views of the service with the Commission; comments received in this way will be fed back to the management of the home without revealing the identity of the respondents. Feedback relating to the Inspectors findings was given to Mr Shehu (manager) at the end of the visit. The Inspector has visited Walmer Lodge over a period of four years and therefore drew on information already known about the home, when completing the report. Requirements and recommendations from this inspection are detailed at the end of this report. What the service does well: What has improved since the last inspection? Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 6 The registered manager and providers appears to have taken on board the Commissions past concerns about the service, and are now ensuring that all members of the staff receive training appropriate to the needs of the service users. In addition the service users now appear to be more involved in the running of the home and service user/staff meetings are held on a regular basis to seek their views and opinions. More service users are now attending day centres and the manager continues to look for further placements. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3 The manager appears to have taken on board the Commissions previous concerns about admitting service users with complex mental health problems, and is providing the staff team with training relevant to the needs of the service users living. EVIDENCE: All admissions to the home are planned and the manager visits all prospective service users in their own home or temporary place of residence as part of the referral/admission process. There has been no new admissions to the home since the last inspection visit, however the manager confirmed that he is now more aware of the limitations of the staff team in relation to dealing with service users with complex mental health needs, and therefore ensures that the pre-admission assessment is thorough. In addition since the last inspection visit staff have attended training courses relevant to the needs of the service users i.e. learning disabilities and mental health to ensure that they understand their different needs. Further training is also planned for the coming year, some of which will be provided in-house by the manager. The records reviewed indicate that the cultural and religious beliefs of service users from specific ethnic minority groups are taken into account, and to ensure clear channels of communication a number of the staff team are fluent in Asian languages. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 9 Information about the advocacy service is available in the home and one service user confirmed that he is hoping to join a local self-advocacy group in the near future. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,8,9,10 Service users are now provided with opportunities to make decisions about their lives, which promotes their independence and improves their overall quality of life. However, information on confidentiality must be provided to both service users and/or their relatives so they fully understand the reasons why in some circumstances information may have to be shared with other professionals. EVIDENCE: Care plans are in place for every service user and are reviewed on a three monthly basis by the service user, their key worker and the manager. Risk assessments have also been completed for each service user highlighting any potential risks, which may limit their freedom of choice and/or affect their quality of life. Staff/service user meetings are held at regular intervals to give the service users an opportunity to air their views and opinions about the service and the Inspector attended one such meeting on the day of the visit. The service users said that their views and opinions are listened to in relation to the day-to-day running of the home and they were kept informed of any changes in policies and procedures, which directly affective the standard of service provided. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 11 The home only provide the service users and/or their relatives with limited information on confidentiality, and when it may be necessary to share information about them with other professional. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,14,15, Individual service users spend their day in the way they choose, which enables them to maintain their independence. However, group outings/activities are arranged in line with their wishes and the individual decides if they participate or not. Service users are encouraged to maintain strong links with their family, which gives them a feeling of belonging and continued involvement in life outside the home. EVIDENCE: The service users confirmed that they use the shops, cinemas, pubs etc in the local area and participate in community events held in the Manningham area whenever possible. Trips out are arranged either for groups of service users or individuals and at the staff/service user meeting attended by the Inspector, a picnic was planned for later the same week. In addition the staff and service users are planning a weekend trip to Amsterdam during the summer, although some service users made it clear at the meeting that they would prefer to remain at Walmer Lodge and follow their own daily routines. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 13 A number of service users also retain strong links with their families and said they prefer to spend weekends at home with them. The manager confirmed that all the service users are on the electoral role and five of the eleven service users presently living at the home said they had voted at the recent general election either at the polling station, or by using the postal voting system. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20, Records relating to the service users welfare are kept in good order and show that problems are identified early, and a referral made to the appropriate professional agency if necessary. EVIDENCE: All service users are registered with a general practitioner and have access to the full range of NHS services. In addition by the end of May 2005 all service users will have had their annual medical check up at Waddiloves Health Centre, Bradford. Service users confirmed that they are supported by the staff team in accessing healthcare services, and staff accompany them on visits to their general practitioner and/or outpatient appointments. The home continues to use a monitored dosage system of administering medication (blister pack). On cross checking the medication held at the home with the medication administration record (MAR) sheets no concerns were raised and all medication appeared to have administered as prescribed. The home only admin minister prescribed medication and records indicate that the care staff team continue to monitor the general health of service users taking long-term medication. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 15 Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Complaints received by the home are dealt with in line with the homes complaints procedure. The manager must remember his responsibility to follow adult protection procedures to ensure the well being of the service users. EVIDENCE: The complaints procedure is in displayed in the entrance hall in both English and Punjabi. Two complaints have been received by the home since the last inspection visit both were well documented and had involved the Commission for Social Care Inspection. The home has a copy of the Bradford District Adult Protection Committees policy document “No Secrets” and information about the Protection Of Vulnerable Adults (POVA) register is available within the home. In addition training records indicated that members of staff recently attended an appropriate training course and the manager is arranging a course on managing challenging behaviour in the near future. However, following a recent incident at the home the manager did not follow the procedures set out at the adult protection planning meeting, which may have had implications for the welfare of the service user. A policy document is available at the home in relation to dealing with the service users financial affairs, which precludes members of the staff team from involvement in the making of and/or benefiting from their wills. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26,27,28,30 In general the home provides a satisfactory standard of accommodation although some rooms would benefit from decorating. The standard of cleanliness in the communal/private shower facilities was however very poor, therefore the manager must review the cleaning hours and/or work practices, and ensure infection control procedures are carried out. EVIDENCE: Approximately 50 of the bedroom accommodation was reviewed on the day of the inspection visit. The general standard of décor and furnishing was found to be satisfactory although some rooms would benefit from decorating. All the service users have personalised their rooms and have a key to their room unless their risk assessment suggests that this would not be appropriate. In addition to the en-suite facilities available in some bedrooms there are also communal bath/shower rooms and toilets located throughout the building. The shower cubicles in all shower rooms including the en-suite facilities were found to be very dirty and it was apparent that the non slip safety mats had not been removed for some times as there was a build up of dirt and hair. In addition the shower rooms require a thorough cleaning and would also benefit from decorating. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 18 Hand washing facilities are provided in all toilets, however no soap was available in the laundry room where personal clothing and bedding is handled by staff. The communal sitting/eating area’s are situated on the ground floor of the home and consists of a main lounge, dining room and smoke room. There is also a small quiet lounge/library room next to the manager’s office, which can be used by the service users, but is furnished with a bed settee and used by the member of staff providing sleep-in cover. The small communal garden to the front of the property is neglected, and does not provide a pleasant area for the service users to use, or enhance the overall appearance of their home. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34,35,36 Records relating to the employment of staff are well maintained and the manager’s intention to involve the service users in the selection and recruitment procedure will give them a sense of self worth. Senior staffing levels must however be maintained at the home, and the manager must continue to promote NVQ training if at least 50 of the care staff team are to achieve a NVQ at level two by the end of 2005. A planned programme of staff supervision requires implementing to identify the training and personal development needs of individuals. EVIDENCE: At the present time the home are recruiting for a senior member of the staff team and to maintain staffing levels are employing agency staff, which the manager confirmed does not provide the service users with continuity of care. The home has not employed any new members of staff since the date of the last inspection and the personnel records seen for existing staff were in order. The manager confirmed that it is his intention to involve the service users in the recruitment and selection procedure for the new member of staff, perhaps by them showing applicants around the home etc, and getting feedback from them about his/her suitability to join the staff team. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 20 The staff rota indicated that because of the senior staff vacancy there is no senior member of staff on some shifts over the weekend period and therefore an immediate requirement notice was issued to the manager, requiring him to ensure that in his absence a senior member of staff is left in charge of the home at all times. In addition due to the poor standard of cleanliness in the communal/private shower facilities the manager needs to review the cleaning hours at the home to ensure that they are adequate. The manager confirmed that the home has now taken a back to basics approach to staff training, training records indicated that all members of the care staff team have recently completed induction training and will commence foundation training in the near future. Staff said that they had enjoyed the training and found it beneficial. However, only two members of staff have achieved an NVQ at level two or above, although a further member of staff is due to commence studying for the award later this year. In addition equal opportunity training including disability training still as not been completed by the staff team as required in the last inspection report. The manager confirmed that members of the care staff team receive formal supervision every six months, but is aware that this does not meet the requirement of the National Minimum Standards. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,42, The manager gives a sense of direction and leadership to the staff team, however he must negotiate study time with the registered providers to enable him to complete management training. The lack of quality assurance systems means that the manager and providers have no effected method of monitoring the homes performance in meeting the needs of the service users. EVIDENCE: The manager confirmed that although he had completed half the work required to achieve a NVQ at level four in management, he felt unable to finish the course due to pressure of work and the lack of paid study time. Members of the staff team confirmed that the manager has an open and approachable management style, and daily handovers between the staff on morning, afternoon and night shifts are held to ensure clear channels of communications within the home. Service users also said that the manager was friendly, approachable and listens to them if they had a problem. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 22 All service users have recently been asked by the manager to complete comment cards provided by the Commission, but affective quality assurance monitoring systems still needs putting in place to establish if the home is meeting stated aims and objectives. The manager confirmed that the proprietors do however visit the home on a regular basis and monthly reports are completed by them and sent to the Commissions as required. Policies and procedures are in place at the home to ensure the health and safety of the service users, visitors and staff team. The manager confirmed that the risk assessments completed for the building and to ensure safe working practices have now been approved by the Environmental Health Department and are available to all staff. In addition members of the staff team have also recently completed safety compliance training, which covered all aspects of health and safety within the home. SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No Walmer Lodge Score Standard No Score Version 1.20 Page 23 J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc 1 2 3 4 5 x 3 3 x x 22 23 ENVIRONMENT 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x 3 1 2 x 2 Standard No 11 12 13 14 15 16 17 x x 3 3 3 x x Standard No 31 32 33 34 35 36 Score x 2 2 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 3 2 x x 3 x Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 24 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 YA10 Regulation 12 Requirement The registered manager must ensure that the service users and/or their representatives have access to the homes policy on confidentiality. (outstanding from the last inspection report -timescale 31/03/05 not met). The registered manager must ensure that he follows the procedures put in place at adult protection meetings. The registered manager must ensure that the communal and private shower facilities are thoroughly cleaned. The registered manager must ensure that soap is available in the laundry area. The registered manager must ensure that at least 50 of the care staff team a NVQ at level two by the year 2005. The reistered manager must ensure that in his absence a senior member of staff is on duty at all times. The registered manager must review the cleaning hours at the home to ensure they are adequate. The registered manager must Timescale for action 29/07/05 2. YA23 13 31/05/05 3. YA27 23(2)(d) 31/05/05 4. 5. YA30 YA32 13(3) 18 Immediate as agreed 2005 6. YA33 18 Immediate notice issued. 31/05/05 7. YA35 18 29/07/05 Page 25 Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 8. YA36 18(2) 9. YA37 9 10. YA39 24 11. YA28 23(2)(o) ensure that the staff team receive equal opportunity training, which must disability equality. (outstanding from previous inspection report -timescale 31/03/05 not met). The registered manager must ensure that the care staff team receive formal supervision at least six times a year. (outstanding from previous inspection report -- timescale 31/03/05 not met). The registered manager must ensure that he acheives a NVQ at level four in management by the year 2005. The registered manager must ensure that affective quality assurance monitoring systems are put in place at the home.(outstanding from previous inspection report -timescale 31/03/05 not met. Attention is required to the garden area at the front of the property. 29/07/05 2005 29/07/05 29/07/05 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 YA33 Good Practice Recommendations It is recommended that if agency staff are used the same member of staff is employed to provide the service users with continuity of care. Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 Page 26 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Walmer Lodge J52 J03 S1222 Walmer Lodge V221530 210405 Stage 4.doc Version 1.20 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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