Inspection on 10/05/05 for Holly Grange Residential Home

This inspection was carried out on 10th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Holly Grange Residential Home 17/03/08

Holly Grange Residential Home 27/03/07

Holly Grange Residential Home 11/05/06

Holly Grange Residential Home 19/10/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE HOLLY GRANGE Cold Ash Hill Cold Ash Thatcham Berkshire RG18 9PT Lead Inspector Marie Carvell Unannounced 10/05/05 at 10.00 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. HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Holly Grange Address Cold Ash Hill Cold Ash Thatcham Berkshire RG18 9PT 0118 9410767 N/A N/A Mr Sundith Ramdany Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Sundith Ramdany Care Home 19 Category(ies) of Older Person (OP) registration, with number of places HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection N/A Brief Description of the Service: Holly Grange provides accommodation and care for up to nineteen service users over the age of sixty five years, who have care needs associated with old age. The home is not registered to provide care to people who have dementia or require nursing care; this would require additional registration categories. HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this inspection on a week day morning from 10am until 6.15pm. A tour of the communal areas of the home and service users’ bedrooms were made. A sample of service user, staff and records required to be kept in the home were examined when available. Time was spent with ten of the twelve service users, two visiting relatives, the provider, all staff on duty, a member of staff who was off duty and a person who is not employed at the home, but provides on call cover in the home in the absence of a second member of staff. A frank and full feedback was given to the provider/manager at the end of the inspection. The manager said that he appreciated the feedback and understood what action needed to be taken. Since the last inspection, the ownership and management of the home has changed. In February 2005, Mr and Mrs Ramdany, were registered as providers’ of the home, by the Commission for Social Care Inspection. Mr and Ramdany are experienced home owners and have owned a second care home in Reading for many years. Mr Ramdany manages Holly Grange, with Mrs Ramdany managing the second care home. At the time of registration, it was agreed that a second member of staff would be available in the home, to provide assistance between the hours of 8pm until 7am, each night, as previously only one person had been on duty with a second person providing “on call cover” from their own home. This staffing arrangement was considered to be no longer acceptable, as this put service users at considerable risk. The providers are to be invited to a meeting at the CSCI office, to discuss the contents of this inspection report and the progress made. What the service does well: Service users benefit from a staff team who have worked in the home for many years. Staff provide a good standard of care to all service users. Staff have a good rapport with service users and service users expressed the view that staff work hard to improve their quality of life. Staff work well as a team and are flexible in their approach. HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 6 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. HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 and 5 The home must develop a comprehensive pre-admission assessment of all service users to ensure that the home can effectively meet the service users needs. EVIDENCE: The manager has recently updated the Statement of Purpose and Service User Guide. A copy of these documents is to be sent to the CSCI. The manager confirmed that the home does not have a written admissions procedure, which includes a pre-admission assessment of need. Prospective service users and their relatives are given the opportunity to visit the home and move in on a trial basis. This information needs to be recorded. The manager asked for six weeks to produce a written pre-admission assessment that includes an opportunity to visit the home and move in on a trial period. HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 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 Service user plans contain minimal information and need to be developed to enable care staff to provide care based on individual needs. The health care needs of the service users need to be developed to include psychological health and nutritional screening. All care staff need training in medication administration. Care Staff would benefit from training in recording practices. Service users feel that they are treated with respect at all times and their right to privacy is upheld. EVIDENCE: Service user plans do not contain sufficient information to ensure that all aspects of health, personal and social care needs of the service user are met. The sample of service user plans examined were not routinely updated as the needs of the service user changed, although each month the plan of care was signed and dated as “no change”, when it was evident that the needs of the service users had changed. Service user daily records did not validate service user plans and do not evidence care provided. Service users are not involved in their plan of care or their wishes recorded. Service users and care staff confirmed that the district nursing team and GP surgery provide a high level of care and visit the home on a regular basis. HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 10 Service user plans do not evidence that psychological health or nutritional screening is monitored on a regular basis. Medication administration records were well maintained with no obvious gaps in recordings. None of the staff who administer medication have received medication administration training. One service user had requested that staff do not enter his bedroom without permission. This was clearly documented and staff were aware of this. Service users were seen to be well dressed and well groomed. Care staff were observed to be respectful in their interactions and used the preferred term of address. Personal care and medication examinations/treatment is provided in the service users bedroom. Privacy screening is provided in shared bedrooms. HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 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 Activities provided to service users are dependent on staff time and are limited. Service users who require minimal staff assistance are able to make choices about routines of daily living. Choices and preferences for the more dependent service users are not recorded. Service users maintain contact with family and friends. Service users were complementary about the meals provided and choices available. EVIDENCE: Staff and service users confirmed that very few activities now take place. This is due to reduced staffing levels. The home has previously had a designated member of staff with responsibility for group and individual activities. Any activities are now fitted in when all other care tasks have been completed. Service users said that they pass the time by chatting to each other, reading, board games or television. Staff no longer have time to take service user out shopping or in the garden. Many service users maintain regular contact with family and friends. Relatives spoken to felt that they were always made welcome by staff. The inspector observed two service users wearing their nightclothes in communal areas of the home at 4.30pm. It was clear that this was not at the request of the service user and when asked care staff said that this was always HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 12 done. Choices and preferences for the more dependent service users are not recorded in service user plans and this is left to care staff discretion. The midday meal was tasty and attractively served. Care staff were attentive and assisted service users as necessary. Menus were varied and well balanced. Some service users felt that the food choices had been reduced other service users felt that “you can’t please everyone”. Food stocks were adequate. The cook confirmed that service users could request a snack with their supper drink. It is the inspector’s opinion that the responsibility is with the care staff to offer a snack and not with the service user to ask. One service user said that she had complained several times, to the manager that she was not offered any food other than a hot drink, after the evening meal served at 5pm until the following morning when breakfast was served. HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 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’s complaints procedure is displayed in the entrance hall. The complaints book was blank. However, several complaints have been received by the manager. Service users were not confident that their complaints would be listened to or acted upon by the manager. All staff need training/updating in the protection of vulnerable adults from abuse. EVIDENCE: The home’s complaints procedure is displayed in the entrance hall. Several positive comments were written in the visitor’s book. These included “Thank you for taking such good care of my nan” She enjoyed living here and considered it her home” dated 05/05/05. The complaints book did not contain any written complaints. In discussion with service users, several complaints had been made to the manager. These included lack of snacks being offered with the supper drinks, the assisted bath being out of order for several weeks and a service user bedroom move without any negotiations taking place. The manager confirmed that he had received these complaints, but was unclear about the definition of a complaint. The inspector’s opinion is that a complaint is any expression of dissatisfaction. Many service users said that they rarely saw the manager in the home and who did not often talk to service users other than to say “good morning”. Those service users’ who had made complaints to the manager, were not confident that their concerns would be acted upon. HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 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) 19,20,21,22,23,24 and 26 The home provides safe, comfortable and spacious accommodation for the service users. Service users are not able to make a positive choice about who they share a double occupancy bedroom with. EVIDENCE: Records confirm that the building complies with the requirements of the local fire service and environmental health department. Since the last inspection all radiators that previously posed a heath and safety risk to service users have now been covered. All windows have been fitted with appropriate restrictors. The gardens are safe, secure and accessible to service users. Communal areas include a lounge, conservatory, a quiet area and a dining room. Furniture is comfortable and domestic in character. There are sufficient and suitable lavatories and washing facilities. Several bedrooms have en-suite facilities. One assisted bath has been out of action for several weeks and was due to be repaired within the following days. At the last inspection a requirement was made that the premises and facilities were to be assessed by an occupational therapist and evidence provided that the HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 15 necessary equipment was provided and adaptations made available to meet the needs of the service users. This requirement has not been complied with. One service user in a shared bedroom was distressed that a service user with behaviours that challenge the service, was moved into the room, despite the fact that the home has several single bedrooms currently vacant. What was concerning that neither service user was consulted. The manager confirmed that he had received complaints about this move and agreed to address the issues within the following two weeks. Bedrooms are attractively decorated and appropriately furnished. Several double bedrooms are currently used as single occupancy rooms. Some bedrooms are below 10 sq. m of usable space and are not suitable for wheelchair users. Few bedrooms have appropriate door locks fitted. The domestic staff work hard to make sure that the home is clean, pleasant and hygienic. The laundry facilities need to be updated in order to meet the required standard. HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 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 and 29 Reduced staffing levels do not ensure that all of the service users needs are being met. Service users are not protected by the home’s recruitment policies and practices. EVIDENCE: Staffing levels have been reduced with some staff being asked to voluntarily reduce their contracted hours of employment. This was disputed by the manager. Staff are not being recruited to vacancies. This is due partly to the home having only twelve service users at present. In discussion with staff and examination of duty rosters, staffing levels are frequently inadequate to meet the needs of a service user group, who are on the whole, physically and/or mentally frail. The deputy manager undertakes “hands on care” for the service users and is often one of the two care staff on duty. She is also responsible for managing the home in the absence of the manager. Duty rosters show that the two care staff on duty are also responsible on a regular basis for cleaning, laundry and on occasions meal preparation in addition to care of the service users. The majority of care staff felt two staff on duty would be able “to manage” with the basic care of the current service users, but not with the additional tasks to be undertaken. A new service user is due to be admitted to the home in the next two weeks. HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 17 From 7.45pm until 7.00am only one care assistant is on waking night duty. Care staff and duty rosters confirmed that care staff are working from 1.45pm until 7.00am the following morning, a total of over 17 hours on duty. Care staff confirmed that this was normal practice in the home. On call cover from 8.00pm until 7.00am the following day is provided by a bank care assistant, in discussion with the bank care assistant she confirmed that she may not necessarily be in the home, but was “available by mobile phone”. This leaves only one care assistant in the home. The bank care assistant also undertakes awake night duty. On these occasions, a member of the general public provides with the manager’s agreement “on call” cover to the night care assistant in exchange for free accommodation in an unregistered flat in the home. The manager confirmed that the individual has no previous care experience and no references, CRB or POVA checks have been undertaken. The manager accepted that this practice was unacceptable and put service users at risk. Immediate requirements were made, that the staffing levels must not fall below two care staff on duty during the day with additional management and ancillary staff on duty. That the current “on call” arrangements of using a member of the public must cease as from the day of this inspection and that the manager is to record the actual hours he is on duty in the home. HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,36,37 and 38 No evidence was available to demonstrate that this home is being managed effectively. EVIDENCE: Staff told the inspector that the manager is rarely in the home, and when he is in the home spends time either gardening, undertakes the home’s shopping or when the cook was off work sick for two weeks, cooked the midday meals. Staff expressed the view that the manager was “pleasant”, “ a nice man, but not approachable”. Communication between the manager and staff is, the inspector was told is “almost non existent”. The manager communicates with the deputy manager who then verbally cascades the information to staff. Staff felt this was in effective as frequently not all staff received the information or as staff pass information to each other the information becomes diluted. Staff feel that there is no sense of direction in the home and staff are carrying on with HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 19 established routines. Staff feel supported by the deputy manager and colleagues. Only one staff meeting has taken place since the new providers/ manager has been in post. This was on the 16 th February, and involved only the staff on duty. No evidence was available to demonstrate that the manager is aware of the home’s policies, procedures or home routine, and was dependant on the deputy manager for answers. It is not evident that the manager is managing the home effectively. Staff and service users are concerned about the lack of information given to them about the ethos of the home. This has resulted in a demoralised staff team. Requests have been made via the deputy manager, for improved communication including staff meetings and training. The manager, when present in the home, does not attend staff handover meetings. There are no permanent records kept of information given to staff. The manager is to introduce a staff communication/message book. One service user asked the inspector, whether she was able to have a glass of sherry with other service users and whether she was able to invite other service users to her room. Service users said that they were disappointed that the annual garden party would not be taking place. However, the manager said that no decision has yet been made. Not all records requested were available. Since December 2004, 16 accidents to service users were recorded in the accident book, however, some accidents to service users were recorded in daily records but not in the accident book. No evidence was available of quality assurance systems used in the home or how the views of service users are sought. HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 3 3 3 2 1 2 x 2 STAFFING Standard No Score 27 1 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 1 x 1 x x x 1 1 2 HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 21 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 3 Regulation 12(1) Requirement The manager is to ensure that a written admissions procedure is developed. A copy is to be sent to the CSCI. The manager is to advise the CSCI of action taken to ensure that prospective service users are invited to visit the home and move in on a trial basis. That the manager ensures that service user plans are generated from a comprehensive assessment. That the manager ensure that service users psychological health needs and nutritional screening are monitored on a regular basis. That all staff who administer medication receive appropriate training. That the manager consults with service users about leisure and activities opportunities. The manager is to advise the CSCI of action taken to ensure that service usersare able to exercise personal choice and autonomy. That all complaints are recorded in the complaints book and Timescale for action 10/07/05 2. 5 14 10/07/05 3. 7 15 10/09/05 4. 8 13 10/09/05 5. 6. 7. 9 12 14 13 12 12 30/11/05 10/09/05 10/07/05 8. 16 22 11/05/05 Page 22 HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 action taken. 9. 18 13(6) All staff require training/updating 10/07/05 in the protection of vulnerable adults from abuse. That the manager arranges for an assessment of the premises and facilities to be undertaken by an occupational therapist. That the CSCI are advised of action taken to ensure that service users are given a choice not to share a bedroom. That all service users are provided with appropriate locks to bedroom doors, if declined this should be evidenced. The manager is to advise the CSCI of action to be taken to ensure that the laundry facilities meet this standard. Staffing levels must not fall below two care staff on duty during the day with additional management and ancillary staff on duty. The manager is to advise the CSCI of action taken to develop recruitment procedures to ensure the protection of service users. That the manager advises the CSCI of action taken to meet this standard. The manager is to make arrangements for all staff to receive formal supervision, by an individual who has received appropriate training. That all records required by regulation are up to date, well maintained and accurate. That the manager advises the CSCI of action taken to meet this standard. 10/07/05 10. 22 23 11. 23 23 10/07/05 12. 24 23 10/09/05 13. 26 23 10/09/05 14. 27 18 with immediate effect. 01/07/05 15. 29 18 16. 17. 32 36 24 18 01/07/05 17/07/05 18. 19. 37 38 17 17 17/06/05 01/07/05 HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 23 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 none made. Good Practice Recommendations HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale Reading RG7 4SA 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 HOLLY GRANGE H52-H01 62526 Holly Grange V217230 100505 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!