Inspection on 27/02/07 for Birchams Grange

This inspection was carried out on 27th February 2007.

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

Other inspections for this house

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Heathlands

Aston Court Nursing Home

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Inspirations

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Birchams Grange Clenchers Mill Lane Eastnor Ledbury Herefordshire HR8 1RW Lead Inspector Wendy Barrett Unannounced Inspection 27th February 2007 09:20 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 Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birchams Grange Address Clenchers Mill Lane Eastnor Ledbury Herefordshire HR8 1RW 01531 632925 01531 632925 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) E.C. Investments (Gloucestershire) Ltd Mrs Jane Fry Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24), Physical disability (24) of places Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of three service users may also have a mental disorder or dementia. Date of last inspection Brief Description of the Service: The registered Provider of this service is a limited company. The Commission has approved Mr. Eric Hardy, as the company’s ‘Responsible Individual’. He acts as the company representative and maintains regular contact and oversight of the service on behalf of the company. A separate registered Care Manager, Mrs. Jane Fry, is employed. Birchams Grange is in a village location two miles from Ledbury. There is good road access being seven miles from the motorway and 8 miles south of Malvern. The building sits in its own grounds and consists of an adapted house with a modern purpose-built extension. All residents have single bedroom accommodation, most with en-suite facilities. The service is registered to care for 24 ladies and gentlemen over 65 years of age who have care needs arising from the general ageing process or physical disability. A maximum of 3 residents may also have a mental disorder or dementia. There is comprehensive information literature describing the service and supplied in a pack to each resident. Prospective residents and enquirers are given an information brochure. From April 2007 the fees are £450-00p. There are additional charges for chiropody, hairdressing, newspapers, toiletries and transport. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written with reference to information about the service and held by the Commission, a pre-inspection questionnaire from the home, feedback survey forms from residents, relatives and visiting professional workers and an unannounced visit to the service. What the service does well: What has improved since the last inspection? What they could do better: Sometimes the staff who handle medication are not following the home’s policy to date containers of new stock when it is brought into use. It would also help stock control if the first dose out of a new stock supply was indicated on the medication administration record. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 6 A few residents continue to feel they don’t always have social opportunities that suit them although there is a programme of regular activities already in place. Further consultation with the residents may identify the reasons for this discrepancy. 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 summary of this inspection report can be made available in other formats on request. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are carefully considered and planned so that prospective residents have the information they need to decide if the home will suit them, and the staff understand how to provide the care once the new resident arrives. EVIDENCE: There is up to date information literature that is made available to residents and other interested parties. All bedrooms are supplied with an information folder and prospective residents receive an information booklet. It can be supplied in a different format if necessary e.g. alternative language. All residents receive signed copies of contracts of residence so that they know exactly what they are paying for. At the time of the inspection visit the Provider was making minor amendments to the standard document so that the contract would reflect guidance recently published by the Office for Fair Trading. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 9 Before any admission is agreed the Care Manager gathers as much information as possible to help her decide if the home will be able to met the prospective resident’s needs and expectations. Records of this work were seen at the home and confirmed thorough attention to all areas of care. Assessment reports from other care professionals had been obtained, where relevant e.g. social work reports. The pre-admission assessment records included details to show that the prospective residents had been fully consulted e.g. signed consent forms regarding any wish to be checked through the night, whether a bedroom door key would be required. A relative described how the admission of her relative was very successful – ‘received a contract within a month – after a trial period at the home – she did pose a challenge to the staff – very active at night – felt sure she would be unable to remain there. With the help of an excellent, caring manager and staff they kindly persevered – being very vigilant at night. She has settled down and is encouraged to enjoy all the activities and made friends’. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Each resident has an up to date plan of care and they are fully consulted in writing this. This results in effective personal and health care for the individual resident. The home implements safe procedures for managing medication and residents are involved in decisions when this is possible. Residents feel they are very well treated by sensitive and efficient staff. EVIDENCE: Every resident has a plan of care. An initial plan is written following the preadmission assessment and this is regularly reviewed to take account of any changing circumstances. Residents are consulted when this work is done – a signed record in one plan confirmed the resident had seen it and been invited to comment and make suggestions for improving it. The son of another resident had signed the care plans for his father to confirm his agreement. The care plans are comprehensive and any potential risks are formally assessed so that action can be taken to protect the individual, if necessary e.g. skin viability, manual handling. Recognised assessment tools are used in this Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 11 work e.g. Waterlow. Social care, mood and relatives’ requests are reflected in the care planning work. There is a very useful system of colour coding the care plans so that the staff can easily find those parts that are most essential to the resident’s safety and welfare. Two G.P.’s who look after residents at the home were very satisfied with the way the staff deal with health care issues – ‘Jane (Care Manager) is excellent’, ‘it is always a pleasure to visit – there is a good atmosphere and the staff very caring’. All resident and relative feedbacks indicated satisfaction with personal and health care – ‘received the best possible care’, ‘efficient and caring’, ‘excellent care’, ‘always found staff to be kind and caring’. Arrangements for managing medication were inspected during the visit to the service. There had been good attention to 2 related requirements and a recommendation arising from the last inspection i.e. medication is now always administered to residents directly from the packaging in which it is received from the dispensary, a suitable, fixed cupboard had been installed to store controlled drugs (together with a stock register), a policy had been implemented to address the management of medication prescribed on an ‘as and when’ required basis. Storage arrangements and records of medication management were satisfactory and all staff who handle medication have received appropriate training. They were receiving refresher training at the time of this inspection. The staff try to use as little medication as necessary. This is commendable. Residents are consulted in this – a resident had reduced her reliance on analgesia and medication for panic attacks. The resident led the way this was done, with staff offering guidance and support. Written medication care plans were being maintained although these need to be more detailed to be sure they fully address the need for staff guidance in administering ‘as required’ medication to individual residents. A few containers had not been dated when first brought into use although it is the home’s policy to do this. It helps when checking stock supplies. The Care Manager was advised to remind staff to do this consistently and to make sure the administration record indicated the first dose given out of a new supply. Residents and relatives express considerable confidence in the attitude of staff ‘many difficulties settling her in previous home – am convinced it is the special care and personal attention received (at Birchams Grange) that seems to have transformed her behaviour – settled in so well and so quickly’. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are asked how they would like to live and they are given support with this when necessary. They are encouraged to spend social time with their families and have an activity programme at the home. A few residents feel they need alternative choices of activities to fully suit them. Keeping a record of all activities offered, even when refused, may help clarify the actual situation. The Provider takes notice of residents’ views because he is already arranging for additional staff time for social care. EVIDENCE: The staff find out how each resident prefers to live and support them in pursuing this when they are admitted to the home e.g. an assessment report referred to a resident’s enjoyment in going for walks. Records at the home confirmed that staff were, indeed, escorting the resident out for walks. There have been some comments from residents that they would like more social opportunities. In response to this the Provider is arranging to introduce some hours dedicated to social support each week. There are already regular activities taking place, and records kept of participation, but perhaps these are not suiting some residents. The records should show when appropriate Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 13 activities have been offered (following consultation with individual residents) but been declined. This will clearly show the actual opportunities available. A relative mentioned seeing daily activities including quizzes, Easter bonnet competition. The majority of resident feedback forms suggested they were always or usually satisfied with the activity opportunities. During the inspection visit residents were observed receiving visitors in the home. Staff were welcoming and there was relaxed chatting between staff, residents and visitors. Two residents were anxious to show off their bedrooms because they were so proud of them. They obviously viewed these rooms as their private space (one was using her bedroom door key to secure her possessions) although both residents had chosen to sit with other residents in the communal lounges when they were first met. One of the residents had a family photo album in her room. It might help staff to help her enjoy the album if the names and relationship of the people shown were entered in the book because, although she obviously enjoyed her album she couldn’t remember who everyone was in the photographs. The meals are prepared in a well-equipped, clean and tidy kitchen. They are served in a very attractive dining room with a small group of residents having theirs at a table in one of the lounges. Residents can choose to eat in the privacy of their own room. The cook has worked in the catering industry all her working life and understood about nutritional needs, hygiene considerations etc. She had refreshed her food hygiene training in October 2006 so that she kept her knowledge up to date. The cook was aware of individual dietary needs and preferences and alternative dishes are offered for anyone who doesn’t like the main meal. The residents are consulted about their meals e.g. suppertime had been made later in response to their suggestion. 7 out of 8 resident feedback forms confirmed that they always enjoy their food – one resident added ‘faultless’. Residents are able to invite their relative to sit down and enjoy a meal with them. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives know how to make a complaint. When concerns are raised they are listened to and acted upon. The residents are protected by a staff group who understand how to identify and report abuse. EVIDENCE: These standards were satisfactory when inspected in February 2006. Each resident has written guidance so they know how to raise any concerns. When the home receives a complaint there is a record kept of the detail, and any action taken to address it. This record was inspected at the home. It contained 5 entries and reflected appropriate responses e.g. re-arrangement of dining room, purchase of booster aerial to improve television reception. There haven’t been any complaints or allegations about the service made directly to the Commission. All but one of the resident and relative survey responses indicated awareness of how to make a complaint. None indicated a complaint had been made and one resident commented ‘have no reason to make any complaint’. The staff have recently received further training in adult protection and a related policy and procedure was updated in September 2006. Staff signatures confirm that they have read this type of guidance. Records of the induction of Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 15 a new staff member referred to the supply of an ‘Adult Abuse’ booklet and plans for a future training session. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a high quality environment that is well maintained to ensure their safety and comfort. The accommodation is designed and equipped to suit the residents’ needs, kept very clean at all times and they feel very happy with their home. When they ask for anything extra to improve their comfort the Provider is prepared to respond. EVIDENCE: Residents and relatives are very satisfied with the accommodation –‘furnished beautifully’, ‘very impressed with the cleanliness’, ‘always fresh flowers to greet visitors’, ‘there are 2 cleaners and they are very good’. The Provider has completely upgraded the original premises and built a new extension since his registration. This work has been done to a very high standard, with a lot of attention given to the comfort and safety of the Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 17 residents e.g. style of seating, colour schemes, appropriate aids and adaptations, window restrictors and covering of heated surfaces following risk assessment. There are examples of the Provider’s willingness to make further adaptations in response to resident requests e.g. additional lighting in lounge area, purchase of aerial boosters. A new, separate facility for hairdressing, chiropody and district nurse use provides residents with professional equipment in a dedicated area. The grounds and gardens have been landscaped to offer easy access and interesting outlooks from bedrooms. Mr. Hardy and the Care Manager regularly audit the safety of the premises so that any maintenance work or potential hazards are promptly identified and dealt with. Records of this work were seen. There are routine checks of essential services by outside contractors and an inspection by a Fire Officer in November 2006 did not identify any additional work needed. Aids and adaptations are regularly serviced e.g. baths, hoist. The premises were very clean, tidy and bright when the unannounced inspection visit took place. There were examples of good attention to infection control measures e.g. cleaning schedules, temperature checks, hand washing facilities. The laundry is well-equipped (the Provider has recently purchased a new washing machine), and impermeable surfaces make it easy to keep clean. The staff have written guidance to guide them in keeping the environment clean and hygienic. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to meet the residents’ needs. New staff are carefully selected and there is regular training provided so that staff work safely and professionally. EVIDENCE: In May 2006 the Commission received comprehensive details of the way staffing levels are monitored to ensure there are enough staff to meet current care needs. This was a satisfactory response to a condition linked to the original registration of the Provider. An acting Deputy Manager was in charge of the home when the unannounced inspection visit started. 2 care assistants, a cook, a housekeeper, an administrator and a gardener/handyman supported her. This was a satisfactory situation. Mr. Hardy arrived for a pre-planned period of work at the home soon after the inspection commenced. The Care Manager chose to come in on her day off to assist and this is appreciated. Information regarding staff training reflects satisfactory attention to health and safety and professional practice training e.g. half the care staff hold a national vocational qualification, 10 staff hold a current first aid certificate, national vocational qualification in housekeeping during the previous 12 months. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 19 Training programmes include things like palliative care and dementia care so staff receive guidance about the specific care needs of the resident group. Two staff records were inspected. They confirmed a through recruitment procedure that ensures only people who are suitable to work with vulnerable adults are employed. An interviewed staff member confirmed the application of this procedure in her own recruitment to the home. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service is managed by an effective Provider and Care Manager who understand their responsibilities and discharge them well. The way the home is run actively encourages the participation of the residents in decision making so that their best interests are always central. EVIDENCE: Mr. Hardy spends a lot of time in the home, working alongside other staff and meeting residents and their visitors. Observations made during the inspection visit confirmed that the residents knew him well and had plenty of opportunity to speak to him if they wished. This approach enables him to monitor the service carefully and support the Care Manager. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 21 The Care Manager has obtained an appropriate qualification and has the confidence of residents, relatives and visiting G.P’s – she is described as ‘excellent’. This report contains examples of a strong commitment to involving residents in the management of their own care, and seeking their views on ways to improve the overall service. This is exactly how a care service should be managed. A report of a quality questionnaire for 2006/07 is attached to the home’s Statement of Purpose. All residents were consulted as part of this exercise and the report provides further evidence of the Provider’s willingness to listen to residents’ views and to respond to their suggestions. The home does not get involved in supporting residents with their financial affairs. Relatives or financial representatives more appropriately do this. Small amounts of personal money are kept in safekeeping for some residents and the way this is managed was satisfactory when the home was last inspected. The policies, procedures and auditing methods adopted at the home confirm a good understanding of legislative requirements regarding health and safety. Staff receive the statutory training they need to work safely and those responsible for maintaining the residents’ accommodation and utility areas achieve above-average cleanliness throughout. Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 x 3 x x 3 Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP9 Good Practice Recommendations Care plans for ‘as required’ medication should be written with more detail that reflects the individual resident’s situation. Staff who administer medication should be reminded to adhere to the home’s policy for dating containers when new stock is brought into use. It would also help audit control if the first dose from new stock were identified on the medication administration record. Further consultation with residents about their preferred activities may help clarify why a few residents feel they don’t always have appropriate social opportunities. 3 OP12 Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Birchams Grange DS0000067130.V334913.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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