Inspection on 06/11/07 for Darenth Grange Residential Home

This inspection was carried out on 6th November 2007.

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

The inspector 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

Darenth Grange Residential Home 05/03/09

Darenth Grange Residential Home 13/03/07

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Darenth Grange Residential Home Darenth Hill Dartford Kent DA2 7QR Lead Inspector Gary Bartlett Key Unannounced Inspection 6th November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Darenth Grange Residential Home DS0000068714.V350618.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. Darenth Grange Residential Home DS0000068714.V350618.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Darenth Grange Residential Home Address Darenth Hill Dartford Kent DA2 7QR 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) 01322 224423 01322 224435 D.F.A. Care Ltd Margaret Lee Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Darenth Grange Residential Home DS0000068714.V350618.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th March 2007 Brief Description of the Service: Darenth Grange is a home for up to 29 older people requiring residential care. It is owned and operated by D.F.A. Care Ltd, one of the partners being the Deputy Manager. The home is situated on the outskirts of Dartford in a rural area. The building is a historical 18th century manor set within over 7 acres of grounds. Accommodation is provided over two floors with the ground floor consisting of a good range of communal spaces and bedrooms and the upper floor being mainly bedrooms. There are two double bedrooms, which are currently single occupation. There is accessible garden space close to the building and parking is available for a number of cars. The home is some distance from any substantive amenities and private transport is required. The current fees for the service at the time of the visit range from £390.00 to £550.00 per week. Darenth Grange Residential Home DS0000068714.V350618.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Darenth Grange from 9:30 a.m. until 4:20 pm. During that time the Inspector spoke with some residents, 4 visitors and some staff. Parts of the home and some records were inspected and care practices observed. The Deputy Manager, who is a partner in the owning company, was present throughout the inspection and the registered Manager arrived during the afternoon. The Manager had completed an Annual Quality Assurance Assessment prior to the inspection. All staff gave their full co-operation throughout the inspection. The Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older People refer to people who use the service as “service users”. People living at Darenth Grange prefer to be referred to as “residents”. Accordingly this shall be done in the text of this report. What the service does well: The home has a very happy and “large family” atmosphere. There is an experienced staff team in place some of whom have worked in the home for 15-20 years. Residents benefit from a staff team who work well together, promote a happy and familiar support for individual residents. Good relationships and contact is maintained with residents’ families. Personal health care needs are well supported and residents’ individual preferences are catered for where practicable. The standard of catering is very good, providing a well balanced diet and choice of menus. There is encouragement for residents to partake in activities suited to their preferences and capabilities. Darenth Grange Residential Home DS0000068714.V350618.R01.S.doc Version 5.2 Page 6 There is a variety of communal space which residents have access to. This allows residents to move around freely and choose where they want to be. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Darenth Grange Residential Home DS0000068714.V350618.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 Darenth Grange Residential Home DS0000068714.V350618.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): 2, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good pre-admission procedures so that residents can be confident that they are appropriately placed. The home does not provide intermediate care. EVIDENCE: The Deputy Manager described how a pre-admission assessment is made of each prospective resident. Records show that prospective residents, their families, advocates, and relevant health care professionals are involved in the assessment process. Specialist advice is sought from external sources where required. There was discussion about one recent admission where the Darenth Grange Residential Home DS0000068714.V350618.R01.S.doc Version 5.2 Page 9 assessment process had not been so thorough as usual. The shortcomings in this instance are acknowledged and being addressed. Residents said they or their families had been able to visit Darenth Grange before moving in. They also said staff had been very helpful in assisting them to settle in; this was confirmed by a relative who was present. It was established at the last inspection that a clear statement of terms and conditions of residency is provided to all new residents. The contract adequately covers issues of fees, additional charges and rooms to be occupied. It is written in an understandable and clear manner. A signed copy of each contract is kept on file and given to the resident and/or their representative. Intermediate care is not offered at the home. Darenth Grange Residential Home DS0000068714.V350618.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 on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents’ care plans, risk assessments and guidelines need to be developed to ensure consistent support by staff in meeting residents’ individual health and social care needs. Residents are protected by the appropriate administration of medicines. EVIDENCE: Each resident has a care plan and four were inspected in detail. Some parts of the care plans are not completed adequately or signed. It is important that the care plans provide easily accessible information of individuals’ care needs and are directive to ensure staff know how the needs are to be met. The management team are looking at ways of improving the care planning system used. Darenth Grange Residential Home DS0000068714.V350618.R01.S.doc Version 5.2 Page 11 The standard of daily record keeping is generally good. The Manager is aware that some records need to be more detailed and informative to accurately reflect care given and is addressing this through the regular review of records and by staff training. There is a key worker system and staff spoken with have a very good understanding of residents’ individual preferences. Risk assessments are continually being improved and written/reviewed in response to incidents and accidents, although some need to be more comprehensive and detailed to better safeguard residents. The healthcare needs of residents are appropriately managed. Staff say they receive good support from healthcare professionals such as District Nurses and GPs. Records are maintained of any consultations and input received including outcomes.. The home addresses key needs and areas of healthcare such as nutrition, pressure area care, oral hygiene and continence. Residents are supported to access chiropodists, dentists and opticians. The medication room, whilst adequately maintained, is small and cramped. The home is considering possible alternative locations. Records show that staff administering medications have been trained and signed off as being competent to do so. The Medication Record Administration Record (MAR) sheets seen were completed appropriately and medicines were observed being given in accordance with good practice guidelines. Residents feel that staff are kind and gentle, this was confirmed by observation. It is clear that staff have developed friendly and positive relationships with residents and are considerate of their age and dignity. Comments made by residents included: • “The staff are really lovely and always help when asked”. • “They are a great bunch of people.” Darenth Grange Residential Home DS0000068714.V350618.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 can enjoy a fulfilling lifestyle with good outside links maintained and have as much choice and control over all aspects of their lives as their individual abilities allow. Dietary needs of residents are very well catered for with a balanced and varied selection of food that meets their tastes. EVIDENCE: The home employs an Activities Co-ordinator who works Monday and Tuesday mornings and Wednesday afternoons occasionally at other times, depending on the home’s social activities. The Activities Co-ordinator has been very busy in ascertaining residents’ preferences with a view to developing a meaningful activities programme for them. Other people are employed to assist with activities Thursday evenings and Friday mornings. At the time of the visit a number of residents were taking part in a well organised quiz. Outsider entertainers also visit the home. Darenth Grange Residential Home DS0000068714.V350618.R01.S.doc Version 5.2 Page 13 On the day of the inspection some residents were having their hair done by a visiting hairdresser. They spoke very highly of this service. The Deputy Manager stated residents are supported to manage their own affairs for as long as they wish and are able. Access to independent advocacy schemes can be made available. Family and friends feel welcome and know they can visit at any reasonable time. During the inspection a number of visitors were seen in the home and the visitors book records regular visits by families, friends and others. The design of the Darenth Grange provides seating areas within various communal areas where residents can entertain their visitors, in addition to the privacy of their own room. The home encourages individuals and groups from the community to visit. A visiting relative said: • “The staff are welcoming and they are always very friendly”. Residents’ wishes in respect of any religious observances are ascertained at time of admission and religious ministers visit regularly to conduct services. Residents are very complementary of the food served and say their tastes are met as with a choice of menu always being offered. The meals are generous in portions and look appetising. Meal times are set for practical reasons but can be flexible to accommodate activities when necessary. They are relaxed; staff are patient and helpful and allow residents the time they need to finish their meal comfortably. Hot and cold drinks are available through out the day, as well as snacks. The home employs two cooks and the cook on duty has a very good understanding of residents’ tastes as well as religious, cultural and other special diets. A resident said • “The food is here is very good indeed and there is always more than enough to eat” Darenth Grange Residential Home DS0000068714.V350618.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 their complaints are listened to and acted on. There are systems to protect residents from abuse. EVIDENCE: The complaints procedure is readily available to residents and their relatives. They said they feel confident that they would be listened to and any necessary action would be taken. A visitor said: • “They always listen and act quickly if we have any concerns”. The Home keeps a record is of all complaints received by them. The Annual Quality Assurance Assessment received prior to the inspection indicates there has been 1 complaint received by the home in the last 12 months. This was not upheld and was resolved within an appropriate timescale. The Commission has not received any formal complaints about the home in that time. Darenth Grange Residential Home DS0000068714.V350618.R01.S.doc Version 5.2 Page 15 There are procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. Staff spoken with have a sound understanding of safeguarding adults procedures. During the last year, there has been 1 alert raised. This was raised by the home and managed effectively. Darenth Grange Residential Home DS0000068714.V350618.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, 21, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is safe and comfortable, although further updating of the environment would enhance the quality of residents’ lives. EVIDENCE: Darenth Grange is a large 18th Century building set within extensive 7-acre grounds. It has been used as a care home for many years, initially being council owned and subsequently run by a number of private owners. During the latter part of that time there was little investment in maintaining or upgrading the building. Darenth Grange Residential Home DS0000068714.V350618.R01.S.doc Version 5.2 Page 17 The current management team who have been in place since November 2006 is very aware of the work to be done and is prioritising accordingly. There are have plans for redecoration and refurbishment. These plans were augmented recently when the home won a competition in a professional journal and the prize was the “make-over” of the main lounge. The home is very spacious, bright, airy and well-ventilated. There is a good range of communal space. The bedrooms seen are of a good size, each with an individual character. Residents are encouraged to personalise their bedrooms and can bring in furniture following discussion with the Manager. Not all bathrooms are fitted with equipment needed for residents with physical frailties, but there are sufficient numbers of bathrooms and toilets to meet their needs. All the bathrooms, toilets and sluices seen are clean and well maintained. They have appropriate hand washing and drying facilities. The Deputy Manager said she is intending to equip all high infection risk areas with foot-pedal operated bins. It is reported that the home meets the requirements of the environmental health and fire departments. The Manager stated there is a regular audit of the home to identify any environmental issues that pose a health and safety risk. There are attractive and accessible gardens surrounding the home within the larger extensive grounds. The home is clean and hygienic throughout and free from offensive odours. The home has adequate laundry facilities for the current number of residents, however this should be kept under review. Darenth Grange Residential Home DS0000068714.V350618.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. Recruitment processes are robust and offer protection to people living at the Home. Training is available to the staff so they have the skills to meet the needs of the residents. EVIDENCE: Resident’ and their relatives speak very highly of the staff, saying they are hard working. Comments made included: • “The staff are all very caring people”. • “They do a very, very good job”. • “I like the staff”. • “They are lovely people”. Records seen indicate that robust recruitment procedures are used and the home directly employs only staff that have been properly vetted. Darenth Grange Residential Home DS0000068714.V350618.R01.S.doc Version 5.2 Page 19 A competency based induction programme is being introduced in line with the Skills for Care Common Induction Standards. A training matrix is used to give a management overview of staff training needs. Records show that ten staff have NVQ level 2 in care and five are working towards it. The staff rosters seen indicate staffing levels are geared to peak times of activity. During the inspection staff were seen to be busy but residents did not have to wait for long before receiving help. Staff and residents spoken with said they considered the staffing levels to be generally adequate. There is good interaction between residents and staff. Darenth Grange Residential Home DS0000068714.V350618.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, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home benefits from a management team that is experienced, accessible and supportive. EVIDENCE: The registered Manager has many years of experience within the care sector and has achieved her NVQ level 4/ Registered Manager’s Award. She has been managing Darenth Grange for the past 18 months. The Deputy Manager is a partner in the owning organisation. They demonstrate a clear vision of the future of the home with a commitment to providing a high standard of care. They have good relationships with residents, staff and visitors. Darenth Grange Residential Home DS0000068714.V350618.R01.S.doc Version 5.2 Page 21 The home has some quality assurance processes including monthly monitoring visits and 6 monthly resident/relative surveys. The Deputy Manager said residents’ meetings are also held. However, it is important that these selfmonitoring systems are now expanded upon. The results of resident, staff, visitor and professionals questionnaires should be collated within an annual report detailing positive and critical points with a resulting action plan where required. Formal supervision of staff is being undertaken and this takes generally takes place within the time scales dictated by the National Minimum Standards. Staff meetings take place at regular intervals. It was established at the last inspection that the accounting for resident’s monies is satisfactory. Residents and relatives did not express any concerns about the Home’s management of monies or valuables held on the residents’ behalf. Records seen are kept in a manner that preserve confidentiality. The standard of cleanliness in the kitchen and surrounding area is good. There are records of fire systems checks and fire drills/training. Staff spoken with have a good understanding of emergency procedures. The Annual Quality Assurance Assessment received prior to the inspection indicates records of maintenance and safety checks are up to date and the organisation regularly reviewes policies and procedures to ensure they comply with current legislation and good practice advice. Darenth Grange Residential Home DS0000068714.V350618.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 X 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X 3 3 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 3 X 2 X 3 3 3 3 Darenth Grange Residential Home DS0000068714.V350618.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. 1. Standard OP4 Regulation 14(1)(a), (d) Requirement “The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so: (a) needs of the service user have been assessed by a suitably qualified or trained person (b) the registered person has confirmed in writing to the service user or their representative that having regard to the assessment, the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare” in that appropriate preadmission assessments must be undertaken routinely prior to service users’ admission to the home. To be implemented by the given timescale, if not sooner, and maintained thereafter. DS0000068714.V350618.R01.S.doc Timescale for action 30/11/07 Darenth Grange Residential Home Version 5.2 Page 24 2. OP7 14(2)(b), 15(2), 17 Schedule 3, Schedule 4 The registered person shall maintain records as specified in Schedules 3 and 4. The registered person shall keep the service user’s plan under review in that service users’ individual plans and records must be kept and be up to date in that they must be consistent and specific in detail of information required. Whilst it is acknowledged there has been much work done towards this, all service users must have an accurate care plan by the given timescale, if not sooner, which is thereafter maintained. The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated in that risk assessments must be more comprehensive and recorded in response to incidents and changes in residents welfare. Whilst it is acknowledged there has been much work done towards this, all necessary risk assessments must be in place by the given timescale, if not sooner, and maintained thereafter. 31/03/08 3. OP7 13(4) 31/03/08 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 OP9 Good Practice Recommendations It is strongly recommended alternative medication storage DS0000068714.V350618.R01.S.doc Version 5.2 Page 25 Darenth Grange Residential Home 2. OP33 facilities with more available space are provided. It is recommended that the registered person further develop the quality assurance and monitoring systems based on a systematic cycle of planning-action-review. Darenth Grange Residential Home DS0000068714.V350618.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Darenth Grange Residential Home DS0000068714.V350618.R01.S.doc Version 5.2 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. 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