Inspection on 17/05/07 for Hatherley Grange Nursing Home

This inspection was carried out on 17th May 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

Hatherley Grange Nursing Home 16/11/05

Hatherley Grange Nursing Home 23/05/05

Hatherley Grange Nursing Home 09/11/04

Hatherley Grange Nursing Home 18/05/04

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

CARE HOMES FOR OLDER PEOPLE Hatherley Grange Nursing Home 26 St Stephen`s Road Cheltenham Glos GL51 3AA Lead Inspector Mr Adam Parker Unannounced Inspection 09:50 17 & 21st May 2007 th 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 Hatherley Grange Nursing Home DS0000016457.V330754.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. Hatherley Grange Nursing Home DS0000016457.V330754.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hatherley Grange Nursing Home Address 26 St Stephen`s Road Cheltenham Glos GL51 3AA 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) 01242 251321 01242 574322 HatherleyGrange@ALMONDSBURYCAREFSBUSIN ESS.CO.UK Almondsbury Care Limited Mrs Sheila Ann Crew Care Home 25 Category(ies) of Dementia - over 65 years of age (25) registration, with number of places Hatherley Grange Nursing Home DS0000016457.V330754.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th November 2005 Brief Description of the Service: This care home specialises in the care of elderly people with dementia. It is located on the outskirts of Cheltenham town in a residential area. It is close to local shops and a church. It can offer both single and double bedrooms, situated over 4 floors accessed via a shaft lift or stairs. On the ground floor there is a large lounge, conservatory, and dining room with smaller quiet area. Viewed from the conservatory and accessed via a ramp, is a small but safe patio area. The home has a registered nurse on duty at all times. Current fees are £490.75.00 to £650.00. hairdressing and chiropody, are charged extra. The home makes information about the service, including CSCI reports available to residents and their representatives through a service user guide and statement of purpose available in the home. Hatherley Grange Nursing Home DS0000016457.V330754.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was carried out by one inspector over two days in May 2007. The registered manager of the home was present for both days of the inspection visit which consisted of a tour of the premises and examination of residents’ care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A sample of residents were selected for inspection against a number of outcome areas as a ‘case tracking’ exercise. Observation was made of the care and supervision of the residents in communal areas. Comment cards were received from residents, their relatives, staff working in the home and one from General Practitioners (GP). The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? What they could do better: Hatherley Grange Nursing Home DS0000016457.V330754.R01.S.doc Version 5.2 Page 6 The home should check that it has written plans of care for all the assessed needs of the residents and invite resident’s relatives and representatives to view and sign care plans. The home should have a record about why prospective employees have left previous employment in care settings. The home must ensure that it has a record of all alternative meals provided for residents in the interests of monitoring dietary intake. Given the homes’ registration and resident group, consideration should be given to providing more training to staff in dementia care. The home should review its risk assessment regarding legionnaires disease. 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. Hatherley Grange Nursing Home DS0000016457.V330754.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 Hatherley Grange Nursing Home DS0000016457.V330754.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s admission procedure ensures that residents are admitted to the home on the basis of a full assessment of their needs, so that they can receive the care that they require. EVIDENCE: The pre-admission assessment forms for three residents were looked at. These included a description of assessed needs and a dependency profile. An area of the form for a mental test assessment had not been completed although where appropriate additional information had been obtained from health care professionals about the resident’s mental health needs. On the first day of the inspection visit the registered manager carried out an assessment of a prospective resident at another care home. The assessment form was looked at and in this case the mental test assessment had been completed. Hatherley Grange Nursing Home DS0000016457.V330754.R01.S.doc Version 5.2 Page 9 Assessment and care plan documents from funding authorities were seen although the registered manager described how in some cases in the past these documents had not always been received prior to admission. The home does not provide intermediate care and so Standard 6 does not apply. Hatherley Grange Nursing Home DS0000016457.V330754.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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home works well to meet residents’ health and personal care needs whilst upholding their privacy and dignity. EVIDENCE: The care plan files for three residents were looked at. Following the preadmission assessment a document entitled ‘Resident Long Term Need Assessment and Care Plan’ is completed in addition there is a further care plan document completed. It was noted that the care plan document had only been completed for selected needs. One resident had a care plan for wandering which took into account the risk and how to manage this. However another resident had some specific dietary needs and this was further emphasised in the outcome score of a nutritional risk assessment. Although her needs were known there was no actual written plan of how the resident’s needs would be met. Hatherley Grange Nursing Home DS0000016457.V330754.R01.S.doc Version 5.2 Page 11 There were no examples of care plans being signed by resident’s relatives or representatives although both the registered manager and relatives spoke of the good communication in relation to the needs of the residents. Residents had dependency profiles completed which had been reviewed on a monthly basis. Risk assessments had been completed for moving and handling, pressure sores and nutrition. There was recorded evidence of residents having input from health care professionals such as GPs, opticians and chiropodists. With one example, the GP had been contacted and had visited the resident regarding pain relief. This had been documented as well as the plan to manage the pain. The home has four residents who require the use of a hoist due to their frailty and these all have bedrooms on the ground floor for ease of moving and handling. Medication administration and storage arrangements were looked at. Where medication was stored in a refrigerator, records had been kept and these indicated that temperatures were within the correct range. However there was no monitoring of storage temperatures in the main medication storage area and although this was not considered to be too warm on the day of the inspection visit, monitoring would be useful in periods of hot weather. It was noted that bottles of liquid medication had been dated on opening with a view to establishing the expiry date of the medication. Hand written entries on medication administration records included dates and signatures by the person making the entry in the majority of cases and it is accepted that this is general practice in the home. The medication records were in good order with no gaps in the recording of medication administered. The home has a homely remedies policy and this has been agreed by GPs. Out of the 7 responses received from GPs, all who answered the question indicated that residents medication was appropriately managed. Staff were observed treating residents with respect and up-holding their privacy. In particular two instances were observed, one where a resident had some food stains on their clothing and a staff member intervened to change the item in a sensitive way. The other was when a member of staff acted quickly to protect the privacy of another resident. In the one shared room looked at, a dividing curtain was in place for privacy. In general staff were very attentive to resident’s needs and able to spend time with individuals when required. Hatherley Grange Nursing Home DS0000016457.V330754.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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home takes an active part in encouraging residents’ contact with family, friends and parts of the local community, which provides a good degree of social contact. In addition resident’s are well supported by staff at mealtimes. EVIDENCE: The home does not organise formal group activities preferring to offer time to residents on a one to one basis which includes attending to residents hair or nails. A dart board is available and some residents do drawings with one example seen. Music is played in communal areas and it was refreshing to see that television was not used as a general entertainment but used for example to fulfil one resident’s interest in horse racing. Residents’ interests are recorded on admission in a personal history. The home has links with a nearby church which holds a service in the home every Wednesday and invites residents to any events held such as the Church fete. Residents who are Roman Catholic receive visits from a Priest. During the two days of the inspection visit relatives of residents’ were seen visiting the home and they all spoke of how they were welcomed by the Hatherley Grange Nursing Home DS0000016457.V330754.R01.S.doc Version 5.2 Page 13 management and staff and confirmed that flexible visiting arrangements were in place. It was noted that resident’s individual rooms contained personal possessions. The registered manager stated that the home did have information on advocacy services for residents although these could not be found during the inspection visit. The serving of lunch was observed in the main dining room, here tables were laid in an attractive way. Some residents took their meals in other communal areas or in their own rooms if this was their preference. The atmosphere during lunchtime was calm. It was noted that staff were assisting residents with eating where needed and this was carried out in a dignified manner with staff sitting with the residents. Where meals were pureed they were presented in an attractive way with all the portions of the meal identifiable. The menu is changed every week for four weeks with breakfast, lunch and supper offered. Although there is no choice of main course offered for lunch, individual likes and dislikes can be catered for. It was confirmed that no record of alternative meals provided had been kept although this had been done in the past. Supper is usually a cooked snack with a dessert. One relative commented that their relative “loved” the meals provided and had gained weight since being in the care home where in another setting they had been losing weight. The home celebrates residents’ birthdays with a cake and party food. Hatherley Grange Nursing Home DS0000016457.V330754.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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home promotes a positive relationship with representatives of residents providing confidence that any concerns raised on their behalf will be dealt with. In addition residents are protected from abuse through regular staff training. EVIDENCE: The home has a clearly written procedure for dealing with any complaints or concerns that are raised, with a copy displayed in the entrance hall of the home for relatives and representatives of residents. The home aims to establish good relationships with relatives and representatives of residents and to initially deal with any concerns on a face to face basis. This was confirmed in discussions with relatives and with a visiting social worker. There were no recorded complaints in the home. Information supplied by the home shows that the majority of staff have received training in the protection of vulnerable adults and updates are done on an annual basis, the subject is also covered during the induction of new staff. Hatherley Grange Nursing Home DS0000016457.V330754.R01.S.doc Version 5.2 Page 15 During a discussion staff were able to demonstrate their knowledge based on the training regarding protecting vulnerable adults. The home has a policy and procedure for the protection of the residents that includes directions for contacting external agencies. A number of staff have also attended training in dealing with violence and aggression. Hatherley Grange Nursing Home DS0000016457.V330754.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): 19,24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the benefit of living in a well maintained and clean, environment. EVIDENCE: A tour of the premises was conducted. The home was well maintained with appropriate and attractive decoration. Residents’ individual rooms had varying degrees of personalisation and the shared room looked at had a dividing curtain for privacy. There are plans for further new carpeting to be provided on the stairs. To the side and rear of the home is an enclosed patio area with a number of planted areas and pots, this is accessible to anyone using a wheelchair. The best use has been made of the available space and this enables residents to enjoy the outside with minimal risks to their safety. All areas of the home accessible to residents were found to be very clean and smelt fresh. Hatherley Grange Nursing Home DS0000016457.V330754.R01.S.doc Version 5.2 Page 17 On the second day of the inspection visit the laundry was looked at, the floor which had been painted in the past to seal it was in need of some attention. This had been identified by the provider and remedial work was planned. A recommendation was made at the previous inspection regarding access to hand washing facilities in the laundry. This was looked at again and the sink for hand washing which is situated in an alcove in the laundry was surrounded by clutter both above the sink and on the floor. This did not make for easy access to the hand washing facilities provided. In addition the sink was in need of cleaning. Hatherley Grange Nursing Home DS0000016457.V330754.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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by a generally well trained and consistent staff group with the home aiming to recruit staff with a caring nature. However some improvement should be made to record keeping in relation to recruitment. EVIDENCE: Staffing levels for the second day of the inspection visit consisted of two registered nurses and four care staff for the day and one registered nurse and one member of care staff for the night shift. The home also employs various arrangements of staff for catering, maintenance and domestic duties. The home has a generally consistent staff group with a low turnover of staff. Staff described how they were happy working in the home and this has no doubt led to the low turn over in staff providing a generally consistent staff group. There is only occasional use of agency staff and with this the registered manager insists on only certain agency staff who are familiar with the home. Out of eight care staff employed in the home, three have achieved an NVQ level two. The senior carer has achieved an NVQ at levels three and four. Training records provided by the home show that only one member of care staff, the senior carer has received any training in dementia care. Hatherley Grange Nursing Home DS0000016457.V330754.R01.S.doc Version 5.2 Page 19 This situation should be looked at with the view of providing more care staff with suitable training in dementia care. The records for the three most recently recruited members of staff were examined. Staff had in general started work at the home following receipt of a Criminal Records Bureau check, where this had not happened with one example looked at the correct check had been made against the Protection of Vulnerable adults list. The correct information and documentation had been obtained for staff prior to employment although in three cases information relating to past employment and in particular the reasons for leaving employment in a care setting had not been fully documented. The application form gives a space for the applicant to give this information and although this may have been explored at interview it should be recorded if written verification is not forthcoming from the previous employer. In all but one of the recruitment files looked at there were copies of identification documents on file. It is accepted that this is normal practice and these documents had apparently been obtained but not copied onto the file. The registered manager stated the importance of recruiting new staff with a caring nature. The home provides induction training to all new staff and uses a booklet to record progress with the training which is clearly linked to national specifications in terms of the Common Induction Standards. New staff work alongside a senior member of staff during the initial induction period. Hatherley Grange Nursing Home DS0000016457.V330754.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): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is managed in their interests with actions carried out to ensure their safety and the quality of the service. EVIDENCE: The registered manager has worked at the home in a management capacity for many years. She is a registered mental nurse and has achieved the registered managers award, she is also an NVQ assessor. Recently the registered manager has attended study days in fire safety and medication and at the time of the inspection was planning to attend wound care training. The deputy manager is currently undertaking the registered manager’s award. The home has various ways of ensuring that the home is run in the best interests of the residents. Monthly visits are conducted by the registered Hatherley Grange Nursing Home DS0000016457.V330754.R01.S.doc Version 5.2 Page 21 provider and reports of these are kept in the home and were viewed during the inspection. Internal audits are carried out monthly looking at different aspects of the service provided. Observations are made regarding practice and reports produced by the registered manager. One area that was identified for improvement was the telephone answering skills of the staff. The manager was able to report a successful outcome following a focus on this area. The home had sent out surveys to relatives of residents regarding the service in 2006 and was also planning this for 2007. The home provides secure facilities for residents’ money and valuables but during the inspection visit this facility was only being used by one resident, appropriate records had been kept in relation to this. Generally all finances are handled with the support of relatives although the registered manger is an appointee for one resident. Staff have received training in infection control, first aid, health and safety fire safety and moving and handling. The home has ensured the servicing and maintenance of electrical and heating systems and appliances as well as hoists and the lift. Regular checks are made on hot water temperatures and recorded along with a number of other safety checks. A risk assessment had been completed regarding the potential risk to residents from Legionella in the home, Hatherley Grange was considered to be low risk. However it was not evident from this document and an associated check list that the vulnerability of the residents had been taken into account. This should be reviewed in line with information published by the Health and Safety Executive. The registered manager reported how the home has been following the advice of the fire safety officer regarding fire drills. A requirement made at the previous inspection in relation to auditing fire doors had been carried out. In addition all actions had been completed following an environmental health inspection of the kitchen. Accidents in the home had been well documented and audited. Hatherley Grange Nursing Home DS0000016457.V330754.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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 x X X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hatherley Grange Nursing Home DS0000016457.V330754.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 OP15 Regulation 17 (2) Schedule 4 Paragraph 13 Requirement When an alternative meal is provided for a resident this must be recorded. This will ensure that a check can be made on dietary intake. Timescale for action 31/07/07 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. 3. 4. 5. 6. Refer to Standard OP7 OP7 OP9 OP26 OP28 OP29 Good Practice Recommendations A review should take place to check if there are care plans for all the assessed needs of residents. Relatives and representatives of residents should be invited to view and sign care plans. The storage temperatures for the medication storage area should be monitored particularly in spells of hot weather. Enable staff to have easy access to hand washing facilities in the laundry at all times. More staff should receive training in dementia care. A record should be kept of the reasons for a prospective DS0000016457.V330754.R01.S.doc Version 5.2 Page 24 Hatherley Grange Nursing Home employee leaving previous employment in a care setting if this information is not presented on the application form or in a reference. 7. OP38 Review the risk assessment for Legionnaires disease taking into account the vulnerability of the residents and guidelines from the Health and Safety Executive. Hatherley Grange Nursing Home DS0000016457.V330754.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Hatherley Grange Nursing Home DS0000016457.V330754.R01.S.doc Version 5.2 Page 26 - 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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