Inspection on 22/06/06 for The Grange

This inspection was carried out on 22nd June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grange 05/06/07

The Grange 06/12/06

The Grange 03/11/05

The Grange 21/04/05

The Grange 18/11/04

The Grange 30/04/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 The Grange 75 Reculver Road Herne Bay Kent CT6 6LQ Lead Inspector Christine Lawrence Unannounced Inspection 22 and 23 June 2006 10:30 The Grange DS0000023231.V297707.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 DS0000023231.V297707.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 DS0000023231.V297707.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Address 75 Reculver Road Herne Bay Kent CT6 6LQ 01227 741357 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) Lifetime Care Development Limited Mr Eddie Fisher Care Home 4 Category(ies) of Learning disability (4) registration, with number of places The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 3 November 2005 Unannounced Inspection 1 February 2006 Additional Visit Brief Description of the Service: The Grange is a small care home for four people with learning disabilities. It is within the village of Beltinge which has some local facilities, and a short distance from Herne Bay, a nearby town with more facilities. A bus route is close by and there is a mainline rail station at Herne Bay. Parking is not restricted in the roads around the home. The Statement of Purpose relating to the home, as well as business cards and information leaflets are made available to prospective residents and their representatives on request, as is a copy of the latest Commission for Social Care Inspection (CSCI) inspection report. In the information sent by Mr Fisher (12 May 2006), prior to the visit to the home, fees were noted as between £800.00 and £2000.00 per week. No items were recorded as extra to the fees. The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector undertook an unannounced site visit to the home. This took place over two days and in total lasted approximately 10.5 hours. The proprietor, Mr Fisher, who owns Lifetime Care Development Limited, had previously sent in a pre-inspection questionnaire with information about the home, staff and residents. There are currently two residents living in the home and one person comes to the home three days a week. Surveys had previously been provided for the residents and their relatives. Two residents and their relatives responded. Comment cards from the family and a care manager of a resident who has recently moved from the home were also received. Comment cards were sent to the care managers for the current residents and one of them responded. During the site visit the inspector spoke to residents and staff members and made observations of interactions between residents and staff. The inspector also walked around the building, including spending time with residents in their rooms. The owner/manager, Mr Fisher, as well as one of the senior care staff, also spent time talking to the inspector and providing information. Information from previous inspection reports was also used for this inspection. What the service does well: What has improved since the last inspection? Care plans have been improved, as have the risk assessments. Staff are also using ‘person centred planning’ to ascertain residents wishes and aspirations. The recruitment procedures are now satisfactory. Some furniture has been replaced. The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 6 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 DS0000023231.V297707.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 DS0000023231.V297707.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): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents’ individual needs and wishes will be assessed ensuring that a judgement can be made about the suitability of the home. EVIDENCE: The individual records of two residents were viewed during this visit. One has lived at the home for 18 months and one for 4 years. They were both referred through social services departments ie the original assessments were carried out by care managers. Both residents have care plans formulated by the care manager, updated after formal reviews, as well as care plans compiled within the home (see Standard 6). Subsequent to requirements from the previous two inspections the home has begun the process of improving the gathering and monitoring of information under the ethos of ‘person centred planning’. Staff are using a new format which includes sections identifying the individuals wishes and priorities. The inspector was informed that no resident has been admitted other than through social services/health authority but Mr Fisher and the senior member of staff spoken to confirmed that they would use the new ‘person centred planning’ format and the checklist in Standard 2.3 of the National Minimum Standards if necessary. Mr Fisher gave examples of two prospective residents who he did not admit as he considered that they would not be suitably placed at The Grange. This was based on assessments from care managers which he reviewed. The Grange DS0000023231.V297707.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Needs and goals are reflected in individual plans. Residents and/or their representatives are involved in the care planning process, ensuring that staff know how to support residents according to their own wishes. EVIDENCE: As noted under Standard 2, two individual care plans were seen. Subsequent to previous requirements the home has improved the plans of care for the current two residents in the home. There are care plans from care managers and the records also contain reviews carried out by the care manager, involving residents, relatives, staff from the home etc. A new format for ‘person centred planning’ is now being used. One of these was signed by the resident, with a comment from staff … “This plan written and compiled with xxxx’s help”. In conversation with the inspector later, the resident confirmed an awareness of the care plan and what was included. An example was noted of pictures being used to illustrate daily living activities. Risk assessments are included within individuals’ records. Some examples seen were out on own, employment, bowling, kitchen safety and swimming alone. A risk assessment The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 10 relating to holidays needs to be improved and some risk assessments were duplicated making it possibly unclear which was the most current. Clearly the home has responded to previous recommendations and requirements regarding care plans and ‘person centred planning’ but some more work needs to be done to make the care plan folder more useful. Decisions need to be made about where and how things are recorded and filed. This was discussed with the senior member of staff who agreed that this was an issue that was being looked at currently. Examples were noted of residents being enabled to make choices and decisions about their lives, either in simple everyday things like food, spending time in own room, times for going to bed etc and also wherever possible in more complex ways such as wishing to have employment, which activities to pursue and issues about relationships. Residents’ abilities to manage their own money vary and this was reflected in the way they are supported by staff. The Grange DS0000023231.V297707.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, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents take part in appropriate activities and use community facilities. Personal and family relationships are supported and an appropriate menu is provided. EVIDENCE: Residents take part in a variety of activities and viewing records and talking to, and observing residents confirmed this. This includes leisure, educational and household activities. Some things are planned and others are more spontaneous. The senior member of staff explained that they are trying to improve the way activities etc are recorded. Residents have attended local college courses in the past but no one currently goes. The home is currently supporting one person to look at opportunities for employment. There is a television in the lounge and one resident has his own set. Residents also enjoy playing CDs in their own rooms. Facilities within the local community are used for things such as swimming, bowling, going to local pubs, eating out and personal shopping. Residents are involved in some food shopping and staff are looking at extending this to using supermarkets rather that ordering online, in order to give residents more experience. Staff work evenings and weekends to The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 12 enable residents to do things at these times. There are sometimes limitations due to no driver being available. Residents can secure their rooms with a basic lock but for one current resident this needs to be improved to support his wishes, enabling him to have a key. This was discussed with Mr Fisher who agreed to look at the situation Information was noted showing that individuals are supported regarding their family contacts and the opportunities for personal relationships. The menus seen by the inspector were satisfactory and a record is kept of individual’s choices. Specialist dietary advice has been sought and the home identifies any special requirement regarding diet and monitoring of weight. The Grange DS0000023231.V297707.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 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ preferences are known and their physical and emotional care needs are responded to. Residents are protected by the homes’ policies and procedures regarding medication. EVIDENCE: Where a resident is able to speak up about preferences this is responded to. If a resident is not able to fully articulate things on a day-to-day basis, more information is included within the care plan information. Residents were individual in their style of dressing. Additional support will be sought from outside professionals such as speech and language therapists. Physical needs, and wishes associated with them, are noted for each individual and it is clear that residents are supported to attend appointments. Meeting physical health care needs would be enhanced if the home used information and recommendations from the Valuing People website relating to Personal Health Action Plans. Mr Fisher agreed to look at the information on this site. As previously noted, 6 monthly reviews are carried out under the auspices of the placing authority’s representative (care manager). One care manager said that communication from Mr Fisher is excellent and he regularly telephones with updates regarding the resident’s goals and achievements. A relative The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 14 commented that they are consulted about their relatives care and are kept up to date about important matters. All staff have received training regarding medication administration. The medication administration records viewed were appropriately maintained. Storage and policies and procedures are satisfactory. The Grange DS0000023231.V297707.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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ views will be listened to. Appropriate training for staff will enhance their ability to protect residents. EVIDENCE: The home has a suitable complaints procedure. One resident’s relatives said that they knew how to make a complaint but they have never had to. One resident in both the written survey and in conversation with the inspector said they would speak to Eddie (Mr Fisher) if they were unhappy. No complaints have been received by the home since the last inspection. There are policies and procedures relating to adult protection, including whistle blowing and Mr Fisher has the up to date policies and procedure from Kent and Medway social services. Guidelines for staff are available relating to the challenging behaviour of one person but they have not been needed since the resident moved to the home. Although there are policies in place it is good practice that training should underpin staff guidance relating to protecting residents. There have been two reports under adult protection procedures since the last inspection. One alert was closed due to lack of evidence and subsequent to another Mr Fisher has taken some internal actions. Only one person has received training regarding adult protection/abuse. The inspector was informed that more is planned. The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 16 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is comfortable and homely but residents’ (and others) safety could be compromised by poor hygiene practices in the laundry. EVIDENCE: In general the home provides a homely and comfortable environment. Furniture and fittings are domestic in style and as a home in existence prior to 1 April 2002, there is sufficient personal and communal space. The building is adequately maintained and subsequent to previous requirements some furniture has been replaced. One chest of drawers still has inappropriate labels. It would be beneficial to carry out an audit of all parts of the building based on the National Minimum Standards on a regular basis to ensure that standards of décor and furnishings are satisfactory. There is access to buses locally and to a mainline railway station in nearby Herne Bay and the home also has its own vehicle, which allows residents to access local amenities. Some things are within walking distance as the home is on the edge of a village type community. The house fits in with the local community. The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 17 At the time of the inspection the home was clean and free from any unwelcome odours. Conditions in the laundry must be improved. Foodstuff is inappropriately stored and it was clear that the hand washing facilities are not being used. The floor and walls are not easily cleaned. This was discussed with Mr Fisher who agreed to take some action straightaway and subsequent to taking advice or carrying out his own research regarding the standards for laundries, make further improvements. The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 18 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 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from supported and supervised staff. More training needs to be provided to ensure that the aims of the home and the needs of residents can be fully met. EVIDENCE: Three members of staff have achieved National Vocational Qualifications in care at level two. One of these (a senior member of staff) has also completed level 3 and is currently undertaking level 4. The inspector was informed that one other member of staff is currently undertaking NVQ level 2 and another person is planning to do this although no start date is yet available. There is some written information relating to specific disabilities on individuals’ care plans and specialist advisors have been and are involved with residents. Throughout the time of the inspection staff were observed to be responsive to residents. The records of three members of staff were viewed and showed that the recruitment process includes using an application form, asking for at least two references, undertaking criminal record bureau checks, providing written terms and conditions of employment and providing staff with copies of the general Social Care Council code. The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 19 Mr Fisher provided a list of the training sessions that staff have undertaken. Some of these are with outside training providers and some are in house. Where in house training is provided Mr Fisher is endeavouring to reflect how staff competency is judged and this includes using questionnaires. Induction training is provided within a pre-printed format relating to Skills for Care recommendations. Mr Fisher is aware that the new Common Induction Standards are now available and will form part of the National Minimum Standards from autumn 2006. He is confident that the provider he uses for induction materials is in keeping with the new standards. However, as Skills for Care and Valuing People are currently working with Learning Disabilities Award Framework (LDAF) to provide appropriate induction and ongoing standards for staff working with people with learning disabilities, it is recommended that these websites be monitored to ensure that the homes’ induction and ongoing training is appropriate. Mr Fisher has also indicated the training sessions that he feels staff still need to undertake. He has details of the Valuing People website which he will be using to ensure that staff are fully up to date regarding current thinking about supporting people with learning disabilities. The three staff records viewed indicated that supervision is being provided. The format used covers training needs, any concerns, any suggestions, where going and any personal issues. The senior member of staff who does the supervisions also records any actions taken as a result of the supervision The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 20 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 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a home which is run by a qualified manager. Residents would benefit from an expanded quality monitoring record. Residents’ health, safety and welfare is mostly promoted and protected. EVIDENCE: Mr Fisher is the registered manager. He has more than two years experience of managing within a care setting and has recently completed his National Vocational Qualifications (level 4) in care and management. He has established a quality monitoring system but the record of this monitoring does not yet include details of the measures that he considers it necessary to take in order to improve the quality and delivery of the services provided in the home. Mr Fisher agreed to look at this aspect of his self-monitoring. The inspector was enabled to spend time privately with residents. Mr Fisher informed the inspector (through the pre-inspection questionnaire) that he has all the The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 21 relevant policies and procedures, and that these were reviewed in December 2005. A spot check on several of these confirmed this. As noted under Standard 35, some further training for staff is planned, some of which relates to health and safety aspects. Although six members of staff have received training/instruction regarding infection control, it is recommended that, due to the poor practices within the laundry (see Standard 30), this training/instruction be refreshed. A spot check on maintenance and service contracts showed that these are appropriate and up to date. Accident recording is compliant with the Data protection Act (1998). Fire safety records and checks were viewed and were appropriately maintained. Risk assessments are in place for various aspects within the home eg secure storage of sharp knives. Water temperatures are monitored. The Grange DS0000023231.V297707.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 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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 23 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 YA23 Regulation 13 (6) Requirement Timescale for action 31/08/06 2 YA30 Mr Fisher to provide details of the planned programme of training staff about adult protection 13 (3) Mr Fisher to provide a report and detailing actions already taken health and plans for further and safety improvements legislation 31/08/06 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 5 6 Refer to Standard YA2 YA6 YA6 YA16 YA24 YA35 Good Practice Recommendations The home should ensure that ‘person centred planning’ is incorporated into any assessment of a prospective resident The home should sort out the care plan folders to ensure that only current and relevant information is included. Risk assessments relating to holidays should be improved A more appropriate lock should be provided to one resident. A regular audit of furnishings and fittings should be carried out and recorded to ensure standards are monitored. The websites for Skills for Care, Valuing People and LDAF DS0000023231.V297707.R01.S.doc Version 5.2 Page 24 The Grange 7 8 9 10 YA35 YA39 YA42 YA42 should be monitored to ensure induction and ongoing training is appropriate. The planned programme of training (care) should be prioritised and progressed. The quality monitoring system should be expanded Safe working practices should be in place regarding infection control (See Requirement 2 above) The planned programme of training (health and safety) should be prioritised and progressed. The Grange DS0000023231.V297707.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 DS0000023231.V297707.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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