Inspection on 17/10/06 for The Grange

This inspection was carried out on 17th October 2006.

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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grange 23/11/05

The Grange 16/06/05

The Grange 13/01/05

The Grange 22/09/04

The Grange 26/03/04

The Grange 12/09/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Grange 15 Holmwood Drive Tuffley Gloucester Glos GL4 0PS Lead Inspector Mr Paul Chapman Key Unannounced Inspection 17th October 2006 09:00 The Grange DS0000016664.V308040.R01.S.doc Version 5.2 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 The Grange DS0000016664.V308040.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 Adults 18-65. 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 DS0000016664.V308040.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Address 15 Holmwood Drive Tuffley Gloucester Glos GL4 0PS 01452 300025 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) Mr Rodney Wayne Correia Susan Ann McQuire Care Home 9 Category(ies) of Learning disability (9) registration, with number of places The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd November 2005 Brief Description of the Service: The Grange is a large detached Victorian house situated in a quiet residential area approximately three miles from the centre of Gloucester. The home offers residential care for up to nine adults with Learning Disabilities who from time to time display some challenging behaviours. Residential accommodation is provided on two floors, with three ground floor bedrooms and six first floor bedrooms. The ground floor of the property provides a lounge, dining room, kitchen, laundry, conservatory, staff office, the communal bathroom and toilets. On the first floor in addition to the bedrooms there are two bathrooms, and an office. Outside there is a fenced garden/lawn area at the rear of the building, car parking area and garage/outbuilding. At the front there is a small garden area, with trees and shrubs. A Service User’s Guide and Statement of Purpose is available from the home’s manager. The range of fees is £1007.83 to £1740.00 per week. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was completed over a period of 6.5 hours. Three people living at the home were met with, along with four of the staff and the manager who was present throughout the day. The principle method used to gather evidence was case tracking. This involves examining the care notes and other related documents for a select number of people living at the home. This is followed up by talking to them or their relatives/representatives, or observing them. This provides a useful, in depth insight as to how people’s needs are being met from more than one source of evidence. At this inspection three of the people living at the home were case tracked. As no relatives or representatives were at the home the CSCI have sent surveys for the home to distribute to people. The findings of these surveys may form the basis of future inspections. What the service does well: The Service User’s Guide and Statement of Purpose accurately reflect the service offered by the home. People’s needs are assessed and reviewed regularly by the manager and her deputy. Care plans are reviewed and updated regularly to reflect changing needs. People are involved in developing their care plans. Potential risks are minimised through thorough assessment and management. People lead active and varied lifestyles that are led by their choices and needs. Food and meals provided by the home are varied and healthy and promote people’s choice. This is being developed further at the moment and will allow people greater, easier choices. People are able to make complaints through the home’s procedure. People are provided with comfortable communal areas that meet their current needs. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 6 Bedrooms are nicely decorated and reflect the characters and interests of the people that live in them. Staff receive comprehensive training that minimises the risk of people’s needs not being met. Health and safety procedures are robust and minimise the potential risks to people. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person has a residency agreement that states the terms and conditions whilst they are staying at the home. EVIDENCE: No one has been admitted to the home since the previous inspection. A sample of people’s files showed that individual residency agreements/contracts were in place. Unfortunately of the sample seen the majority were unsigned by either the person or their representative. The manager was surprised by this and said this would be addressed. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Care plans provide staff with sufficient detail to meet the assessed needs of the people living at the home. People are supported to make decisions about their lives where appropriate but they are empowered to make decisions for themselves. Potential risks to people are assessed and reviewed regularly and this ensures that risks are minimised while people are going about their day-to-day lives. EVIDENCE: Three files were examined, they all showed comprehensive care plans that covered areas of personal hygiene, anxieties, mealtimes, communication, assisting in the kitchen, laundry, cleaning, behaviour, independence, living skills and other topics. Care plans clearly identified people’s needs and the actions required by staff to meet those needs. All care plans were regularly reviewed a minimum of twice in a twelve-month period, and more often where The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 10 appropriate. Where a care plan was no longer appropriate it had been updated to reflect the new need. When people are unable to read staff read their care plans to them and people are given the opportunity to sign the document if they are in agreement with it. Examples of this were seen. In addition to the care plans already in place the manager is introducing Essential Lifestyle Plans (ELP) for each person. The manager stated she plans for these documents to be linked to care plans. People’s files gave examples of staff supporting them to make decisions where appropriate. One person that lives at the home has episodes where for their own safety staff must place restrictions on them. The care plans seen relating to this provided some detail for the staff, but could be more detailed to ensure a consistent approach. When this person is well they have been judged as having the capacity to make decisions, therefore it is recommended that the manager speak to the person about the restrictive actions they must take when they are unwell. They should explain why these actions are necessary and seek the person’s agreement. People living at the home have regular meetings and a notice on the board gave the date of the next meeting. The three files examined all contained comprehensive risk assessments that were regularly reviewed. All records are stored securely. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are empowered to lead active lifestyles that promote their independence. People have relationships with people outside the home and staff support them to maintain these relationships if it is required. The home provides people with a healthy and varied diet that is chosen by them and supports them to maintain their active lifestyles. EVIDENCE: People lead individualised lifestyles that give them the opportunity to maintain and develop social, emotional, communication and independent living skills. A range of opportunities are available on weekdays, including attending the local day services and college. These and other activities are recorded in the daily notes made by staff. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 12 Speaking with one person they explained that they attend the Windows day centre where they work in the café, and go to the college where they are doing a course in computers and film appreciation. The manager explained that since the previous inspection four people now visit the local pub without staff support. To achieve this safely the manager and her team have completed a thorough process of risk assessment. This activity represents a significant development for people increasing their independence, self-esteem and involvement in the local community. From speaking to people, staff and by examining records regular activities are undertaken by the majority of people at the home. Each Tuesday all of the homes that are part of Holmleigh Care meet up for a disco. The organisation’s managing director funds this event. In addition to this other events like fireworks night are celebrated with a display organised by Holmleigh Care. All people have had the opportunity to go on holiday this year. People’s files contained care plans that related to relationships and identified the support needed to maintain them where required. The daily routines in the house are led by people’s needs and records confirmed this. Observations during the inspection confirmed that staff only enter rooms with the service users permission. All of the bedrooms have locks, and the majority of people use them. Where people do not use the locks the reason was noted in personal files. Speaking with the manager they stated that one person attends the local church regularly, and others attend from time to time. At Christmas the choir from the local church visit the home and sing carols. The home employs a member of staff to cook the meals during the week. Menus were examined and showed that people have a varied and balanced diet. Menus are chosen each Saturday, if a person does not like what is on the menu ready meals and jacket potatoes (with various fillings) are available. Each Saturday people have a ‘take away’ meal of their choice. Talking with the manager they explained that they are in the process of developing a picture bank of different foods and meals to enable people to have more choice and make it easier for people to decide what they want. This is really good practice and should empower all of the people to have more choice. When speaking with one person they said there was “lots of choice about meals”, that they “help cook the tea”. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed care plans enable the staff to provide a consistent approach when supporting people with their personal needs. Other professionals are used appropriately to ensure that people’s needs are met. Medication administration is managed correctly minimising the potential risks to people. EVIDENCE: Personal support needs are identified in their care plans. Staff had reviewed the plans seen. The home makes good use of other professionals to meet people’s physical and emotional needs where it is judged the staff are unable to. Examples of this were seen in people’s files. As part of the continuous development of meeting people’s care needs the home are introducing OK health checks for everyone. This document will be The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 14 completed with all of the people with staff support and highlights their medical needs and wishes. Examination of the medication administration at previous inspections has highlighted some shortfalls around recording. These areas have now been addressed and no shortfalls were identified. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to protect the people and statements from staff confirmed that they would take the correct actions if required. Records of people’s income and expenditure are comprehensive and provide a clear audit trail minimising the risk of abuse going unnoticed. EVIDENCE: In conversation with a person they stated that they were aware of the complaints procedure and that they knew they could make a complaint if they wished. They explained that when they had complained previously it had been dealt with to their satisfaction. The home has a complaints procedure in a picture format to meet people’s needs. Staff on duty showed a good awareness of the complaints procedure, and the protection of people. In each of the files examined was a statement signed by the person confirming that staff had explained the complaints procedure to them and they understood it. Each file also had a complaints procedure in it. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 16 Some staff have completed training in the protection of vulnerable adults and the need to ensure that all of the staff have completed this training was discussed. This training has been planned for the future. Staff manage the financial affairs for the majority of the people living in the home. The records of income and expenditure examined were correct. A shortfall identified was the need to implement care plans that explain the reasons for staff needing to manage people’s finances. The manager agreed with this. No complaints have been made to the home or the CSCI since the previous inspection. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 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. The home is maintained to a high standard and meets the current needs of the people that live there. EVIDENCE: Talking with a person who lives at the home they said it was “alright living at the Grange”. At the time of the site visit the home was having a new carpet fitted throughout the majority of the downstairs. At each of the site visits over the past two years the fabric of the home has continued to improve. The manager explained that a new boiler is due to be fitted in the laundry. The present boiler takes up a large amount of the laundry and the manager has felt that it has been unsafe for people to use the laundry to learn the skills of doing The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 18 their own washing. Once the new heating system is fitted it is intended that people will be supported to do their own washing. All of the bedrooms were seen to be clean, comfortable and decorated to a good standard. The bedrooms reflected people’s personalities and hobbies with their personal possessions. One of the bedrooms was slightly better quality than the others (decoration and furniture), the manager stated that it is her aim that all of the bedrooms will be this standard in the future. All of the bathrooms and toilets were seen. The upstairs bathroom is decorated to a high standard, but it is planned that this will be re-fitted in the future. It was noted that the lock did not work and this must be addressed. The downstairs bathroom has been re-fitted in the past twelve months and remains in a good state of repair. The previous report made a requirement for one person’s bedroom to have privacy film fitted to the windows. At this site visit this had been done, but some of the film was missing and being covered with bin liners. This must be addressed properly with the film being refitted. To the rear of the house is a good-sized garden that is well maintained. Where appropriate adaptations have been made to maintain service users’ independence. This is mainly in the form of additional handrails. The home was clean and hygienic. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential risks to people living at the home could be minimised through following the organisation’s recruitment procedure. Staff training is comprehensive and provides the staff with the skills and knowledge to meet people’s needs. Staff are employed in sufficient numbers to ensure that people are not put at unnecessary risk. EVIDENCE: Comprehensive training records were available for all staff. All of the staff made comments confirming that the training provided by the organisation is good. Examination of the staffing rota showed sufficient staff were available for each shift. Sickness has been an issue within the staff team but staff spoken with commented that “people cover”. All staff confirmed that they receive regular supervision sessions. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 20 A sample of staff’s files were seen. These focused on people that had been employed since the previous inspection. Four files were examined and all were found to provide the correct information required by the regulations, except one where a three-year gap in the person’s employment history was identified. This was brought to the attention of the manager and must be addressed. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is appropriately qualified to manage the home and this should ensure that the staff team follows good practices. All of the documents examined had been regularly reviewed and this ensures that peoples changing needs are recognised and practices continuously developed. Risks to people are minimised through health and safety being effectively managed. EVIDENCE: As part of the manager’s registration process with the CSCI she was required to complete National Vocational Qualifications in Care and Management to level four. This has now been completed with the manager recently finishing the The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 22 management element. Comments from the staff during the site visit were positive about the manager’s approach and philosophy. The inspector has been responsible for inspecting the home for the previous four years and recognises the huge improvements in both the homes environment and the peoples care management. The manager continues to review the practices around the home for ways of improving the current methods. An example of this being the way in which menus are chosen. Examination of the fire safety records showed that four fire drills and been completed in 2006. Records of the fire alarm system being checked regularly showed a shortfall, the manager must monitor this. The manager has completed a fire risk assessment for the home. Fridge and freezer temperatures are recorded twice a day. It is recommended that the manager remind the staff team to use the food probe when they have cooked meat. Records showed hot water outlet temperatures are recorded monthly and adjustments are made where appropriate. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 4 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 24 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 YA5 Regulation 5 Requirement The registered person shall produce a written guide to the care home (in these Regulations referred to as the service users guide) which shall include (b) The terms and conditions in respect of accommodation to be provided for service users, including as to the amount and method of payment of fees; The registered person must ensure that either the people living at the home, or their representatives sign residency agreements. 2. YA23 13(6) The registered person shall make 31/03/07 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person shall make 15/12/06 suitable arrangements to ensure that the care home is conducted (a) in a manner which respects the privacy and dignity of service users. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 25 Timescale for action 31/12/06 3. YA25 12(4) a The manager must fit privacy film to the bedroom window of the service user who pulls their curtains down. This is to ensure that at no time their privacy and dignity is compromised. 4. YA34 7, 9, 19 Schedule 2 The registered person must ensure that a complete employment history is gathered for all future staff and the gap identified with the current staff member is addressed. 15/12/06 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. Refer to Standard YA7 YA23 YA42 YA42 Good Practice Recommendations The registered person should ensure that where a restriction is imposed on a person when they are unwell that they have been consulted with. The registered person should ensure that where people’s finances are managed by the home care plans are in place identifying the need for this. The registered person should monitor the records for testing the fire alarm to ensure that it is done regularly. The registered person should ensure that the food probe is used with all cooked meat. The Grange DS0000016664.V308040.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 DS0000016664.V308040.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!