Inspection on 23/06/05 for Grange, The

This inspection was carried out on 23rd June 2005.

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

The inspector 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

Grange, The 12/07/07

Grange, The 07/09/06

Grange, The 31/10/05

Grange, The 16/12/04

Grange, The 22/07/04

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

CARE HOMES FOR OLDER PEOPLE THE GRANGE 33-34 Woodside Grange Road North Finchley London N12 8SP Lead Inspector David Hastings Announced 23rd June 2005 at 09.30am 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. THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service The Grange Address 33-34 Woodside Grange Road, North Finchley, London N12 8SP 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) 020 8446 5378 020 8446 4827 Mr James Skeath, Mrs Lena Skeath & Mr David Skeath Mr David Skeath PC Care Home only 28 Category(ies) of DE(E) Dementia over 65 registration, with number OP Old Age of places THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1 Limited to 28 people who fall into the category of old age (OP) and who may have dementia (DE (E)). Date of last inspection 16 December 2004 Brief Description of the Service: The Grange is a privately run residential home for 28 elderly people, some of whom may have dementia. The care home was originally two houses, which have been converted into a single home. Bedrooms are provided on three floors; there are a range of lounges and dining rooms. All the floors are accessible via a shaft lift. There is a large well-tended garden with a patio accessible through French windows. The Grange is situated close to public transport services; other amenities: shops, churches, surgery are within a reasonable distance. The aims of the home are:“ To provide its service users with a secure, relaxed and homely environment in which their care, well-being and comfort are of prime importance.” THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on Thursday 23rd June 2005 and lasted six hours. Six staff and eight residents were spoken to. A partial tour of the premises took place and care records were inspected. Six comment cards were received by the CSCI from relatives, seventeen comment cards were received from service users and three comment cards were received from doctors and other care professionals. These were overwhelmingly positive regarding the care provided by the staff at the home. An additional visit took place on 4th February 05 as a result of a complaint received by the CSCI from am relative of a service user at the home. The complaint related to: • The pre admission process (upheld) • Falls and supervision (upheld) • Use of walking frame (not upheld) • Information given to relatives (upheld) • General care of the service user (not upheld) • Medication (not upheld) • Calling the doctor out (partially upheld) • Items of missing clothing (partially upheld) As a result of the investigation carried out by the CSCI seven requirements were issued to the home in connection with fully assessing the needs of potential service users, risk assessments, notifying relatives of accidents, notifying the CSCI of accidents, accurate recording of medication, access to health care professionals and the accurate recording of any complaints. As detailed in this report all seven requirements issued have now been complied with. What the service does well: The home is well run by a dedicated and professional manager who is aware of his responsibilities and supports staff to provide a good standard of care to the residents. The stable staff team have a good understanding of the needs of the residents in their care and the vast majority of residents were very positive about the home. Residents have a say in how their care is to be delivered and the management of the home quickly responds to any concerns they may have. Residents are encouraged to live as independently as possible and can choose from a range of activities provided by the home. Relatives and friends of residents are made welcome. THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 6 The building is clean, well maintained and decorated to a high standard. Health and safety is taken seriously by the home and potential risks to residents’ safety are assessed and as far as possible reduced. 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 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 THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 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 (6 not applicable) The registered manager makes sure that all potential service users have a comprehensive assessment completed before they move into the home so that the service users know the home will be able to meet their needs. EVIDENCE: Three files were examined from the last three service users to be admitted to the home. As a result of a recent complaint made by a relative of a service user, a requirement was issued that no service users were to be admitted without first confirming that the home can meet all of the assessed needs of that service user. The files examined contained detailed assessments carried out by the registered manager and relevant professionals. The assessments covered all the topics of Standard 3 of the National Minimum Standards for Older People. The inspector also saw satisfactory evidence that the registered manager confirmed in writing to all potential service users that the home could meet all the assessed needs of service users before they moved in to the home on a trial basis. The requirement has now been complied with. THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. Individual care plans clearly record how the staff at the home are to meet the needs of service users. Service users have good access to health care professionals and are given the correct medication at the right times and by appropriately trained staff. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: The inspector examined six care plans during the inspection. All care plans seen included information regarding the interests of service users and how staff are to keep service users occupied during the day. This was a requirement from the previous inspection that has now been complied with. As a result of a recent complaint made by a relative of a service user, a requirement was issued that all risk assessments must include a detailed account of how risks actually identified are to be reduced. All individual risk assessments seen included this information. The requirement has been complied with. Care plans examined contained satisfactory written information regarding the treatment of pressure wounds. This was a requirement from the last inspection that has now been complied with. The inspector observed good communication between the visiting district nurse and the staff at the home. The registered manager said that service users are registered with a GP, many THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 10 with the GP who is contracted to make monthly visits to the home for consultations. All service users have access to district nurses; a dentist, optician and chiropodist visit the home to examine and treat service users. Service users are referred to the geriatrician, community psychiatric nurse, psycho-geriatrician, as necessary. The home operates a continence management system and receives advice from the district nurses. Armchair exercises take place weekly under the supervision of an occupational therapist. The inspector examined the records in relation to the receipt, storage, administration and disposal of medicines at the home. Since the last inspection the accuracy of recording has improved and three requirements issued at the last inspection and one from a recent complaint have now all been complied with. The deputy manager in the process of compiling a record of medication used at the home with information for staff on possible side effects. The registered manager described arrangements for personal care. Examinations are usually carried out in the service user’s room; staff are expected to knock at bedroom, toilet and bathroom doors and were observed doing this. Service users’ preferred form of address were recorded. Personal care was provided discreetly. Service users were observed to be appropriately dressed and clothes are individually marked. Service users that the inspector spoke with said that staff were respectful and considerate in regard to their privacy. THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. Service users can choose from a range of activities and entertainments provided by the home. Visitors to the home are welcomed and can visit at any reasonable time. The manager and staff encourage service users to exercise choice and control over their lives. Service users receive a wholesome, balanced diet in relaxed and comfortable surroundings. EVIDENCE: During the inspection there was evidence that service users were able to exercise choice in their daily lives. The home has introduced a formal activities programme to respond to differing interests: once a week, a visiting occupational therapist runs a session comprising reminiscence, general knowledge and chair exercises; about once a week staff provide an arts & crafts session. Both have proved increasingly popular with service users and participation has been good. In addition outside entertainers visit approximately twice a month. On the day of the inspection an entertainer had been booked and service users said they were looking forward to this. Case records recorded preferred times of rising and retiring, when service users wanted to take breakfast. Lunch and supper are served at set times. Records showed that choices are offered. The deputy manager has THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 12 implemented a new section of the care plan in which key workers build up a written life history for individual service users. As a result of a recent complaint made by a relative of a service user, a requirement was issued that all service users are asked if they would like their relative to be notified of any accidents during the night. This requirement has now been complied with and satisfactory records were seen. The manager informed the inspectors that visitors are always welcome. Service users can meet their relatives in their own rooms or in any of the communal rooms. The inspector examined a satisfactory record of visitors to the home. The registered manager said that none of the service users were able to handle their own financial affairs; some are handled by their relatives or the local authority. Service users are encouraged to bring personal possessions with them and evidence of this was seen in the bedrooms. The registered manager said that, although no service user had asked for this, access to their records would be facilitated on request. The registered manager said that relatives act as advocates for many service users; for those without families, he would approach the social worker. Breakfast is based on individual choices. The menu for lunch, drawn up by the manager in consultation with the cook, is based on service users’ known preferences with a range of alternatives. Supper consists of a range of cooked choices, sandwiches and cakes. Hot drinks and biscuits were served morning, afternoon and at a late supper. Fruit drinks are served at each meal and are available throughout the day. The inspector was able to have a general discussion with service users regarding the quality of the food. Service users stated that they liked the food and the inspector saw that the food was well presented and balanced nutritionally. One service users said the food was “always very good”. Lunch was enjoyable, relaxed and friendly. Service users and staff were laughing and joking with each other and after the meal the cook came out of the kitchen to ask the service users if they enjoyed the meal. Staff were sitting opposite service users and engaging them in conversation while providing discreet assistance when needed. This was done in a relaxed and friendly manner. It was noted that where meals had to be liquidised this was being done with all the food mixed together. The registered manager must ensure that where food is liquidised, that all parts of the meal are liquidised separately so service users are able to taste meat, potatoes and vegetables separately. A requirement relating to this has been issued in the relevant section of this report. THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home deals with complaints properly and all complaints are recorded and investigated in line with the home’s complaints policy. Service users are protected from abuse by clear policies and procedures and from a suitably trained staff team. EVIDENCE: The home’s complaints procedure, displayed on the notice board, specifies how complaints can be made, a 28-day timescale for a response and gives the details of the CSCI. The register of complaints was examined; the complaint is logged, together with the action taken and the outcome. As a result of a complaint made by a relative of a service user at the home a requirement was issued that all complaints received by the home are to be accurately recorded. Examination of the complaints register confirmed that this requirement has now been complied with. The home has a satisfactory Adult Protection procedure, which includes Whistle Blowing. The manager was aware of his responsibilities in regard to this issue and has obtained a copy of the Department of Health’s guidance “No Secrets”. The registered manager was aware of his responsibilities in connection with the Protection Of Vulnerable Adults list. There was evidence that staff have undertaken training in adult abuse awareness and staff spoken to had a good understanding of the issues of protecting service users from abuse. THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 Service users live in a safe, well-maintained home which is decorated and furnished to a good standard. EVIDENCE: The home is accessible, with a shaft lift connecting all floors; small flights of stairs on the first and second floor have been replaced with ramps. The lounges and dining rooms are comfortably furnished and well decorated. A regular maintenance check is made by senior staff and faults rectified when reported. The laundry and sluice are situated on the second floor, thus the removal of soiled articles and clinical waste are kept separate from the kitchen and food storage areas. The registered manager said that the washing machines washed at 65°C and conformed to the Water Supply (Water Fittings) Regulations 1999; hand washing facilities were available. The flooring in the laundry area is in need of a though clean as a build up of washing powder has occurred. A requirement relating to this has been issued in the relevant section of this report. The home has a policy on infection control and dealing with spillages; latex gloves and protective aprons were seen being used and to be available in THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 15 appropriate places throughout the home. Continence management systems are in place to deal with incontinence. All areas of the home were clean and free from offensive odours. During the inspection of the kitchen it was noted that the back door was open as the day was extremely hot. This practice is obviously needed but the back door must be fitted with a fly screen. A requirement relating to this has been made in the relevant section of this report. THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 Service users benefit from a positive, caring and competent staff team. The home has good staff recruitment policies and procedures that are designed to protect service users. In general the staff team receive a good level of training but the manager must make sure that all staff receive the required mandatory training needed for working in a residential home for older people. EVIDENCE: The registered manager said there are 5 care staff (including a senior staff) on duty during the morning and 3 or 4 in the afternoon; at night there are 3 waking night staff. The staffing rota confirmed this. The staffing establishment consists of: the registered manager, 1 deputy manager, 1 assistant manager, 22 care staff (including night staff), cook, domestic staff and administrator. The home meets the guidelines set by the previous regulatory authority on staffing ratios. One service user informed the inspector that the staff at the home are “very nice”. Another service user commented that the staff are “very good and like a joke”. It was clear from observations during the inspection that the staff were aware of the communication issues faced by people with dementia and how to communicate effectively with them. The home has a Recruitment policy and an Equal Opportunities policy. The records of six staff appointed were examined. All of these files contained the required information. The manager was well aware that no new staff could be employed until a satisfactory CRB disclosure has been received including a POVA check. There was evidence that all staff working at the home had received a suitable CRB disclosure. THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 17 The registered manager has implemented an excellent induction and foundation work programme for staff which links in with NVQ and Care Skills requirements. Individual training records were seen. It was noted that there were a few gaps in the mandatory training undertaken by staff. A requirement has been issued in the relevant section of this report that the registered manager undertakes a training audit of all staff to ensure that everyone has completed the required mandatory training. The manager informed the inspector that nine of the twenty-two staff have completed NVQ level 2/3 and a further eight staff are booked to undertake the NVQ in the near future. THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 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 38. Service users are able to have their say in the way the home is run and their input is used by the management to improve the quality of the service. The home has good systems in place to monitor health and safety compliance as well as service users’ money held by the home on their behalf. EVIDENCE: There was evidence that the home has good quality monitoring systems in place. A sample of the most resent questionnaires sent to service users and their families was examined. These were very positive regarding the quality of the service with comments such as “my relative is in good hands”. Minutes of service users meetings were seen. These were detailed and clearly identified were suggested improvements have been implemented. The home holds small amounts of money for most service users for hairdressing, chiropody and other minor expenses. THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 19 All records examined were accurate and included a clear audit trail. Service users money is being stored appropriately. As a result of a complaint made by a relative of a service user a requirement was issued that all service users have a accurate inventory list in their file. Satisfactory inventory list records were seen in all files examined. This requirement has now been complied with. Overall there are good policies and procedures in place at the home to monitor compliance with health and safety requirements. The fire alarm and emergency lighting were last checked on 07/05/05 and the fire extinguishers were checked in June 2005. The boiler was last checked on 14/07/04. The home has risk assessments for safe working practices at the home including fire safety. The registered manager informed the inspector that these fire risk assessments will be reviewed by the home’s fire consultant. Records indicated that fire training took place in the last month, which included a fire drill. The manager informed the inspector that he carries out night-time visits to the home and during the last visit all fire doors were closed. The manager was aware of his responsibilities in relation to Health and Safety at work. The fire log and accident book were examined and found to be satisfactory. The inspector saw a satisfactory gas safety certificate, which was dated July 2004. The manager informed the inspector that the electrical installation check had been carried out recently and the certificate would be available shortly. Portable appliance checks are carried out by the manager. As a result of a complaint made by a relative of a service user a requirement was made that all incidents and accidents detailed under Regulation 37 of the Care Homes Regulations must be reported to the CSCI. The CSCI has received notification from the home relating to this regulation. The requirement has now been complied with. The registered manager must ensure that a Legionnaires test is carried out at the home, as no records were available to indicate that this has taken place. THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x 2 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x 2 THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 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 15 Regulation 16(2)(i) Requirement The registered manager must ensure that where meals have to be liquidized that all parts of the meal are liquidized seperately. The registered manager must ensure that a fly screen is fitted to the back door of the kitchen. The registered manager must ensure that the flooring in the laundry is cleaned on a regular basis. The registered manager must carry out a training audit of all staff at the home. Where mandatory training is required an action plan must be produced to indicate when this training has been booked. The registered manager must ensure that a Legionnaires test is carried out for the home. Timescale for action 01/08/05 2. 3. 26 26 13(3) 23(2)(d) 01/08/05 01/08/05 4. 30 18(1)c 01/10/05 5. 38 13(3) 01/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 22 THE GRANGE 1. THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI THE GRANGE G59 S10446 The Grange V221430 23.06.05 Stage 4.doc Version 1.20 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!