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Inspection on 16/06/05 for Autumn Grange Care Home

Also see our care home review for Autumn Grange Care Home for more information

This inspection was carried out on 16th June 2005.

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.

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

The registered manager always responds quickly to any requirements or recommendations, implementing those things within her authority almost immediately. The manager is keen to raise standards and has a clear sense of direction for the home. Meals are varied and well-balanced offering variety and choice. All residents spoken with were happy with the meals provided and level of care provided.

What has improved since the last inspection?

There is a continuing programme of refurbishment. The registered manager has now purchased ceramic cups for the home ensuring those that do not need plastic cups have a choice. The registered manager has worked hard to arrange for a variety of training courses both for her and for staff. All staff now receive regular supervision provided by the manager. This is recorded and clearly shows outcomes and actions to be taken and by whom. All staff are now given a copy of the home`s whistle blowing policy at their supervision.

What the care home could do better:

Some plans of care that were drawn up need to be improved with greater detail and brought up to the same standard as other plans of care. Where residents have identified risks for example dehydration evidence is needed to show what steps have been taken to minimise this risk. Although the home is generally clean the manager needs to investigate the cause of the odour in the identified bathroom. It is recognised that death and dying is a sensitive subject but the registered manager must work with residents and /or relatives to establish a care plan that meets the residents` needs should they deteriorate. All complaints must be recorded and show clear outcomes and action taken and by whom, even where a complaint may be considered `trivial` the complaints may result in distress for the individual concerned.

CARE HOMES FOR OLDER PEOPLE Autumn Grange Care Home 19-29 Herbert Road Sherwood Rise Nottingham NG5 1BS Lead Inspector Susan Lewis Unannounced 16 June 2005 at 10:00 am 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 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. Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Autumn Grange Care Home Address 19-29 Herbert Road Sherwood Rise Nottingham NG5 1BS 0115 8417475 0115 9620061 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) Mr Munchi Khan Nora Gazeley Care home 72 Category(ies) of DE(E) Dementia-over 65, x 49 registration, with number OP Old age, x 23 of places Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered Manager must be full time and have full time supernumery hours of work. 2. Two Senior Carers to be in charge, one on each unit (two in total) from 08:00-20:00 3. For 72 service users at least 7 (seven) care assistants must be provided from 08:00-20:00. Date of last inspection 24 February 2005 Brief Description of the Service: The home is located in a quiet residential area of Nottingham (Sherwood Rise) with access to local amenities. The city centre of Nottingham is about 1 mile away and there is a direct bus route to and from the city centre with a bus stop about 300m metres from the care home. A park and ride service is available, about 500 metres from the care home. The home is split into three units, two of which provide up to forty-nine (49) places for people who may have a Dementia related illness (residential, non-nursing). The other unit provides personal care (residential care, non-nursing) for up to twenty-three (23) older people.The home provides a reasonable standard of accommodation for service users. There is a choice of lounges and combined dining room areas, all in reasonable decorative condition. The building is wheelchair accessible with adaptations and equipment appropriate to the needs of the service users. The garden area to the front of the premises has been reconfigured, with an enclosed safe garden being created to enable service users to use. Parking is limited, but on the road parking is available only several metres from the front entrance. The manager has considerable experience in the caring field and the staff team have a sound knowledge of the service user group and of the needs of the individuals who live in the Care Home. Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over seven hours and although it was carried out as part of the annual inspection process a complaint had been received from social service at the hospital regarding an alleged adult protection issue. This inspection therefore also looked at issues relating to this allegation. A tour of the premises took place and staff and care records were inspected. Three staff, nine residents and no visitors were spoken with. What the service does well: What has improved since the last inspection? There is a continuing programme of refurbishment. The registered manager has now purchased ceramic cups for the home ensuring those that do not need plastic cups have a choice. The registered manager has worked hard to arrange for a variety of training courses both for her and for staff. All staff now receive regular supervision provided by the manager. This is recorded and clearly shows outcomes and actions to be taken and by whom. All staff are now given a copy of the home’s whistle blowing policy at their supervision. Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 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. Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 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 standard(s) 3, 4, and 6 Plans of care are created at the point of admission and ensure that residents are assured that their needs will be met, however residents are placed at potential risk where needs that have been identified do not have effective methods of monitoring. EVIDENCE: Autumn Grange does not provide intermediate care. Six plans of care were viewed for the purpose of this inspection including the resident’s plan of care involved in the abuse allegation. Plans looked at covered all aspects of the activities of daily living and there was evidence of extended community care assessments. There was also evidence of nursing care input for those residents who required nursing support. Where residents have specific cultural needs these are identified and there is evidence that they are met. Staff receive training that covers the needs of people with dementia. One care plan viewed identified that the person had dehydration however there was no specific method of measuring fluid intake. Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 Page 9 The evidence seen from the plan of care for the resident at the centre of the abuse allegation also had identified fluid intake needs. Although they were clearly acknowledged in a risk assessment, a plan of care and daily notes, there was no formal method of recording how much liquid was taken in a day. The manager must ensure where plans of care specify fluid intake that this is monitored and recorded. Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 Page 10 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 standard(s) 7, 8, 10 and 11 Residents are placed at risk where assessed needs are not monitored effectively and adequately met. EVIDENCE: Although plans of care are generated from comprehensive assessments and provide the basis of the care to be delivered some viewed lacked specific detail on how the care was to be provided, there were two different standard of care plan. All plans need to be brought to the same standard. Plans show no evidence of resident involvement in creating them. The registered manager said that where residents are unable to be involved in creating their plan they wrote to relatives but very few if any respond. The manager should devise a method of evidencing that this action has taken place to show every reasonable attempt has been made to involve relatives in the process. Where dehydration is an assessed risk all residents must have fluid intake charts. Residents spoken with were positive about the way staff spoke to them and generally treated them, confirming that staff knocked on their door before entering their bedroom. One resident spoken with who had a hearing impairment said that staff usually stood at the door and asked to come in, as she could not hear if they knocked. The resident was happy with this Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 Page 11 arrangement. Residents confirmed that they wore their own clothes and that they went to their bedrooms if a doctor or nurse came to see them. Staff spoken with understood the need to maintain the dignity of residents. Plans of care indicated what term of address residents wished to be known as. Although plans viewed had a section for the care and comfort of residents whose health is deteriorating, none of the plans viewed had this section filled in. The registered manager said that relatives receive a letter asking for information but they do not reply. There were three requirements made at the last inspection, firstly that all care plans be signed by residents or relatives, although the registered manager has not achieved this she has made attempts to contact relatives for residents who are unable to sign themselves but has had little or no response. The second requirement was linked to the use of continence pads. The registered manager has now ensured that there is a sufficient supply of pads to the home and the requirement is met. The third requirement was about staff knocking on residents’ doors and residents spoken confirmed that this standard is met. Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13, 14 and 15 Residents are provided with nutritious and appetising meals, they are given opportunity to spend their time as they choose. EVIDENCE: Residents spoken with were happy that they could spend the day as they chose, they could get up and go to bed when they wanted, this was also detailed on some residents plans of care. Residents’ interests and hobbies were also detailed on plans. Residents spoken with were not always sure of any activities, but staff were seen to talk with residents during the course of the inspection. Residents confirmed that they could have visitors when they wanted, and visitors were seen coming and going throughout the day. Information is available for all residents and relatives on how to contact advocacy services this had been a requirement at the last inspection and is now met. The manager said that this was usually kept on the notice board. The requirement from the last inspection regarding the quantity of food left for residents for their tea has now been met and all residents spoken with confirmed that there is plenty of food. An invoice was seen showing how much food had been ordered for that week’s tea. The lunchtime meal was not sampled however it was observed and appeared both appetising and nutritious. The residents spoken with said that the meals were good. New beakers have been purchased so there are enough for all residents to have a Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 Page 13 drink with their meal this had been a requirement set at the last inspection. The registered manager has also bought ceramic cups and saucers for the older person unit. Ensuring that those residents who do not need plastic cups can have an alternative. Evidence was seen whilst touring the building. Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 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 standard(s) 16 and 18 Not recording complaints places residents at potential risk, however residents are protected from the risk of abuse. EVIDENCE: Residents spoken with all confirmed that they would speak to the manager if they needed to complain and that ‘she would sort it’. It was noted in the daily notes that a relative had complained about a staff member, this was not recorded in the complaints book. This complaint related to the allegation of abuse being investigated. The registered manager said that she had spoken to the relative concerned and had thought she had resolved the issue with the relative directly as she operates an ‘open door’ policy. Although this is admirable the registered manager must ensure that all complaints are recorded with the details and action taken if any. A recommendation had been made at the last inspection regarding creating a form for complaints; evidence was seen that the manager has now done this. Evidence was seen that all staff receive copies of the home’s whistle blowing policy and that abuse awareness is discussed in staff supervision. Residents spoken with said that they felt safe in the home and staff were lovely and caring. Staff spoken with confirmed that training was either being done or they were due to attend training. Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 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 standard(s) 19, 21, 22, 25 and 26 Improvements to the environment continue to be made. Outstanding requirements have been addressed. However, where odours are a problem this does not make for a pleasant environment for residents to use. EVIDENCE: The registered person continues a programme of decoration and evidence was seen in various parts of the home for this. The grounds are accessible and were well maintained. There are sufficient bathing facilities for residents throughout the building. It was recommended at the last inspection to create another assisted bath. No action has yet been taken. The requirement regarding the ramp between two levels of the home has now been met and evidence for this was seen. The requirement at the last inspection concerning the poor light level in an identified bedroom is still ongoing but the registered manager is currently consulting with an electrician on how best to resolve this without compromising the safety or homeliness of the lighting provided. There was also an issue at the last inspection with the bathrooms being very cold. The inspector and manager was thought this was Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 Page 16 caused by the radiator covers but was later found that someone had turned down the heat in all the bathrooms. On the day of the inspection the weather was very warm and the home felt warm as a result, the temperature in bathrooms appeared appropriate. Although generally the home was clean and free from odour, on the day of the inspection it was noted that one of the bathrooms was particularly odorous the manager must ensure that action is taken to minimise this. It was also noted that the use of bars of soap had now stopped and all communal areas had been supplied with liquid soap. Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The staff recruitment procedures are robust and protect residents from potential abuse. Staff are employed in sufficient numbers to meet residents assessed needs. EVIDENCE: On the day of the inspection there was evidence that there were sufficient staff on duty. Rotas seen also confirmed that staff are employed in sufficient numbers to meet the needs of the residents. Residents spoken with said that although staff were busy they were helpful and ‘you don’t have to wait ages for help’. The registered manager is fully aware of her responsibility in maintaining the safety of residents. A requirement was made at the last inspection regarding references. Evidence was seen that the registered manager has taken action to meet this requirement but it is still not fully met. The registered manager is currently identifying staffs’ training needs during supervision, evidence for this was seen and staff confirmed that access to training has improved. A requirement regarding the number of paid training days staff have has also been met. It had at previous inspections been recommended that the registered manager have at least two deputies due to the size and layout of the home. Two deputies had been employed but have subsequently left. This has left the registered manager running a seventy-two bedded home on her own. In discussion with the proprietor he confirmed that it is their intention to employ more deputies, and they have started the process. Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 36 Although action has not been taken to fully meet the quality monitoring standard the registered manager is proactive in ensuring that residents receive a quality service. Staff are well supervised and know what is expected of them to meet the standard expected by the registered manager. EVIDENCE: The registered manager is aware of the need to have an effective quality assurance system. Resident questionnaires have been created and were seen but as yet not completed. Residents spoken with all said that the registered manager regularly comes round and talks to them and asks if everything is ok. Action is progressed within agreed timescales to meet requirements identified in the Commissions inspection. Action plans are sent to the Commission promptly and where possible the registered manager implements requirements immediately after the inspection. There is evidence that in the past that the manager has acted following complaints to restructure things within the home to ensure problems do not arise again. Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 Page 19 The home has its own bookkeeper who keeps records regarding residents’ finances. Records are kept securely and records and receipts of possessions hand over for safe keeping were also seen. Evidence was seen that staff supervision was taking place. The records show that this supervision is not just a token exercise but covers in detail all aspects of practice, the philosophy of the care home and career development. The registered manager is using this information to plan future training. Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 x 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 3 3 x x 3 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 2 x 3 3 x x Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 Page 21 no 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 4 Regulation 12 Requirement The Registered Person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users, to make proper provision for the care and where appropriate, treatment, education and supervision of service users. Where residents have an specific identified need such as dehydration to make proper provision to ensure that this is both monitored and any remedial action is recorded. The Registered Person should ensure that each service user has a written plan as to how the service users needs in respect of his health and welfare are to be met. The identified plans should be written in more detail. See requirement 1 above The Registered Person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users, to make proper provision for the care and where appropriate, treatment, C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Timescale for action Immediate 2. 7 15 30/09/05 3. 4. 8 11 12 12 Immediate 30/09/05 Autumn Grange Care Home Version 1.30 Page 22 5. 16 17 Sch 4 6. 26 16 7. 25 32 8. 29 sch 2, 19 9. 33 24 education and supervision of service users. The manager must ensure that plans of care provide information regarding the care and comfort of service users as and when they deteriorate. The Registered Person shall maintain in the care home the records specified in Schedule 4. A record of all complaints made and the action taken by the registered person in respect of any such complaint must be kept in the care home. The Registered Person shall having regard to the size of the home and the number and needs of the service users after consultation either the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home. The odour in the identified bathroom must be eliminated. The registered person shall having regard to the number and needs of the service users ensure that ventilation, heating and lighting suitable for service users is provided in all parts of the care home which are uses by service user.’ The registered person must ensure that the lighting in service users bedrooms is suitable for service users’ needs. Previous Requirement 30/04/05 The registered person shall ensure that two written references are obtained in relation to all staff. Previous requirement 30/04/05 The registered person shall maintain the quality assurance system that reviews and Immediate 31/07/05 31/10/05 1/08/05 31/07/05 Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 Page 23 improves the quality of care at the care home, and supply the Commission with a reporting respect of any review and make a copy of the report available to service users. Previously 30/11/04 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 Good Practice Recommendations Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Autumn Grange Care Home C53 C03 S2190 Autumn Grange V232928 160605 Stage 4.doc Version 1.30 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. 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