Inspection on 17/01/06 for Wellcross Grange

This inspection was carried out on 17th January 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 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

Wellcross Grange 21/06/07

Wellcross Grange 15/06/05

Wellcross Grange 12/01/05

Wellcross Grange 23/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Wellcross Grange Lyons Corner, Five Oaks Road Slinfold Horsham West Sussex RH13 0SY Lead Inspector Mr D Bannier Unannounced Inspection 17th January 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Wellcross Grange Address Lyons Corner, Five Oaks Road Slinfold Horsham West Sussex RH13 0SY 01403 790140 01403 790388 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) Balcombe Care Homes Ltd Mrs. Elizabeth Lawrence Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A total of 42 Service Users in the category older age not falling within any other category (OP) may be accommodated. A total of 38 Service Users in the category old age not falling within any other category (OP) may be in receipt of nursing care. 15th June 2005 Date of last inspection Brief Description of the Service: Wellcross Grange is a Care Home, which is registered to provide nursing and personal care to a maximum of forty two residents users in the category old age, not falling within any other category. A condition of registration is that up to a maximum thirty- eight residents who require nursing care may be accommodated at any one time. The property is a detached house, originally built in the 1920’s, which is set in its own extensive grounds and is located in the village of Slinfold, near Horsham. The property has been extensively improved and adapted to ensure it is suitable for its current use. The accommodation comprises thirty single bedrooms, twenty-six of which have en-suite facilities and six double rooms, all having en-suite facilities which are located on the ground and first floors. Communal areas comprising of a reception area, a dining room, three lounges and a conservatory, are located on the ground floor. A vertical lift provides residents with access to each floor. Balcombe Care Homes Ltd privately owns this service. The Responsible Person operating on behalf of the company is Mr David Williams, whilst the Registered Manager is Mrs Elizabeth Lawrence and is responsible for the day to day running of the care home. Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 10am. It took place over seven hours. A second inspector who is also a level 1 nurse accompanied the lead inspector. This inspection focussed on the nursing care provided at this care home. The inspectors also looked around some areas of the care home, including the communal areas and several bedrooms. Some records were also examined. What the service does well: What has improved since the last inspection? Records that set out the care needs of residents have been looked at since the last inspection. Changes have been made to some records so that they provide staff with clear information to ensure they were caring for the resident in an appropriate way. Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 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. Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 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 the following standard(s): 3 and 6 The registered manager assesses the care needs of each new resident before they are admitted. This care home does not provide intermediate care. EVIDENCE: Assessment records of two residents, who had been admitted since the last inspection, were looked at. The manager told the inspectors that she goes out to their own homes, or to the hospital, to see prospective residents. The manager also said that, according to the home’s terms and conditions, the admission is dependent on a successful four-week trail period being completed. As the manager was unable to confirm this, it is recommended that, at the completion of this period, the manager holds a formal recorded review meeting with the resident and their relatives to confirm that Wellcross Grange can meet the resident’s needs and that the resident is satisfied with this. It is also recommended that the outcome of the meeting should be confirmed in writing Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 9 to the resident with reasons why the decision to accept the resident or not was taken. The registered manager confirmed that Wellcross Grange does not provide intermediate care. Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Residents had a plan of care in place. This did not always contain sufficient detail as to how the identified needs should be met. Discussions showed that some of the health care needs of the residents were being met. The documentation for this was not present with some of the identified health care needs of the residents not being fully assessed with a resulting plan of how to meet these needs in place. Several practices around the administration and recording of medication were not in line with current guidance and did not safeguard the residents. Residents were treated with dignity and respect. EVIDENCE: All residents had a plan of care in place. Since the last inspection a new format for the care plans had been tried. This consisted of tick boxes with some information added if needed. It was discussed that this format did not allow for enough detail to be added, which would make clear to the staff delivering care, how the resident’s needs should be met. Some plans on the Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 11 previous format had been reviewed following the last inspection. These contained varied amounts and quality of information with some being very detailed. The plans of care should contain sufficient information for staff assisting the residents to understand how their care should be delivered. They should include the wishes and preferences of the residents and be drawn up in consultation with them. All plans should be kept under review and be up to date at all times. Specific assessments for the risk of falls were not present, despite evidence of frequent falls for several residents. These should be carried out and a management strategy put in place to reduce the risk. Qualified Registered General Nurses were employed in the home, over a twenty-four hour period, and worked in charge of each shift. They were responsible for delivering the nursing care for those residents who required this level of care. It was discussed that for those residents requiring personal care only the district nurses should be responsible for any nursing needs, which may occur. As discussed above the amount of information about a resident’s health care needs varied. Some health needs were assessed, such as the risk of developing a pressure sore. The information following this assessment, should a plan of care for prevention be necessary, varied and did not always contain enough information about the actions needed or equipment to be used. These assessments had not been reviewed on a frequent basis. The information recorded should a resident have a wound, which required dressing, did not contain a clear regime for the dressings to be used or information about the progress of the wound. This documentation should be reviewed and contain more detail. A nutritional assessment tool was available in the home. This was not used for all residents and was not in place for some residents who would benefit from this e.g. those with swallowing difficulties. The registered manager discussed that residents with specific health care needs, which the staff felt was outside of their knowledge and competence, would not be admitted to the home. There was no training, specific to the qualified nurses role, carried out in the home. All qualified nurses should keep up to date with their practice, by attending appropriate training. There was evidence of consultation with other health professionals, as necessary. The qualified nurses administered the resident’s medication. A monitored dosage system was in place. The local pharmacy offered support and advice to the home, should this be needed. Medication was suitably and safely stored. The temperature of the fridge containing medication should be checked and recorded. Since the last inspection some recording of the variable dose administered had been done. Not all nurses were doing this and should be reminded to do so. Some gaps in the Medication Administration Records (MAR) were seen. Nurses must sign for medication as soon as it was given. The practice was in place of carrying only one box or bottle of medication when several residents were prescribed the same thing. This resulted in residents being given medication, which was prescribed, for someone else. This is against the qualified nurses code of practice and should cease. Only medication prescribed for that resident should be given. The medication Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 12 should be checked by the label on the box, to ensure it is the correct medication, dosage, time and resident. This cannot be done if one resident’s medication is used for another. External preparations, which were administered for residents, were not signed for as having been administered. This must be done. Should any medication be added to a MAR sheet, the writing of this medication, on the sheet, must be signed and witnessed by a second person. A discussion took place about the recording of insulin given to one resident. This was not written on the MAR sheets, but in a record book. The dosage was varied depending on the resident’s condition and the G.P.’s instructions. These instructions had been taken over the telephone and were not always clear. There was an occasion where it appeared no insulin had been given and no rationale had been recorded. The dosage instructions, from the doctor, should be clearly recorded, along with the actual dosage administered at what time and by whom. The registered manager was advised to remind all nurses employed by the home that they must work in line with the Nursing and Midwifery Council code of practice and the Royal Pharmaceutical guidelines. Risk assessments should be in place for any residents who self-administer any prescribed medication. When touring the building staff were seen to protect the privacy and dignity of the residents. They knocked on the bedroom and bathroom doors, used “do not disturb” signs when care was being delivered and ensured doors were closed. Staff spoke to residents in a respectful manner. Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 13 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 the following standard(s): No standards in this section were assessed on this occasion. Key standards had been fully met at the last inspection. EVIDENCE: Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staff who are left in charge of the care home must receive appropriate training in dealing with reports by staff of incidents of abuse. Other key standards had been fully met during the last inspection. EVIDENCE: Staff training records were seen. They confirmed that all staff have attended training courses in identifying and reporting different types of abuse. The manager also confirmed that policies and procedures, including a “Whistle Blowing” procedure, have been produced for staff to follow. This means that staff know what is expected of them to ensure vulnerable residents are protected from abuse. The manager has received further training in how to deal with staff when an allegation of abuse is reported to her. This includes ensuring the person reporting the incident is protected and what to do to ensure residents are not at risk of further abuse. In addition, the manager has also received training in who to report the allegation to in accordance with the West Sussex Adult Protection procedures. However, other senior staff, which are left in charge of the care home in the manager’s absence, have not received this additional training. It is essential that all staff who are expected to be in charge receives such training to ensure residents are protected from abuse at all times. This is included as part of the Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 15 requirement for staff to be provided with training which enables them to undertake the tasks they are expected to perform. Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 26 Arrangements have been made to ensure residents have appropriate equipment they require. The care home is maintained to a good standard of cleanliness and hygiene. The environment is well maintained and decorated to ensure it is pleasant for residents living there. Other key standards have been assessed as fully met at the last inspection. EVIDENCE: At the time of this inspection some equipment, such as wheelchairs and hoists, were being stored in wide parts of the corridor. They were not causing a restriction to residents using these areas or obstructing fire doors. The registered manager discussed that included in current plans for alterations was that for additional storage to be built for these items. Moving and handling equipment, including three hoists, slings and slide sheets, were seen. Staff Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 17 had been trained in the use of these. Bath hoists, raised toilet seats, toilet frames, grab rails and drop down handrails were present in bathrooms. One of the bath hoists was showing signs of wear and tear. The service and maintenance records for this were not available. It was discussed with the manager that this should not be used until the manufacturer had serviced it. Written confirmation of this should be sent to the Commission. The inspectors visited a number of areas of the care home, including private accommodation such as individual bedrooms, bathrooms and toilets and communal areas such as lounges and the dining room. Areas that were seen were well maintained, pleasantly furnished and decorated. At the time of the inspection corridors on the first floor were being redecorated. Areas seen were very clean, fresh and hygienic. Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30 Staffing levels and skills mix are sufficient to meet the current care needs of residents accommodated. Some work is required to ensure all staff are provided with adequate training to ensure they are competent to do their jobs, and that residents are in safe hands. Other key standards had been assessed as fully met at the last inspection. EVIDENCE: The inspectors saw staff rotas for the week and over a 24-hour period. Staffing levels provided including, trained nurses, care staff, domestic and catering staff were considered sufficient to meet the current care needs of residents accommodated. The inspectors looked at training records for staff. They showed that all staff have received mandatory training such as fire prevention and evacuation, moving and handling and health and safety training. One member of staff on duty confirmed the training she had received. However, it was of concern to note that training, particularly fire training was not up to date. For example one member of night staff had received one training session in 12 months, although fire regulations require that night staff Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 19 should receive at least four sessions in a 12-month period. This means that staff may not be aware of what to do in the event of fire, placing residents and themselves at risk. This is included as part of the requirement for staff to be provided with training which enables them to undertake the tasks they are expected to perform. Three members of staff have been appointed since the last inspection. Each one has completed the home’s own induction training which introduces them to the residents, the premises and to some of the policies and procedures of the care home. This means they should know what is expected of them whilst working at the care home. Records seen showed that they had been assessed as competent by a senior member of staff, known as a “Mentor”. However, the training record did not include information about the aims and objectives of Wellcross Grange as published in the home’s Statement of Purpose. This means that staff will not know the values of the care home with regard to how care should be provided. It is recommended that the induction-training programme is amended to include this. Further information can be obtained by contacting “Skills for Care” who were previously known as “TOPSS” the National Training Organisation for Social Care. Each of the recently appointed staff have been working at Wellcross Grange for at least five months. Yet, the manager was unable to confirm that they had commenced their foundation training. This should be provided within the first six months of appointment and should equip them to provide the appropriate level of care to residents as defined by individual care plans. This is included as part of the requirement for staff to be provided with training which enables them to undertake the tasks they are expected to perform. As Wellcross Grange provides nursing care the registered provider employs registered nurses who perform this function. However, there was no evidence that confirmed that registered nurses have undertaken training in order to update their skills. This is included as part of the requirement for staff to be provided with training which enables them to undertake the tasks they are expected to perform. Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 The manager has been registered with the Commission and is considered fit to manage this care home. The registered provider visits the care home regularly to ensure this care home is being run in the best interests of the residents. Appropriate steps have been taken to ensure residents’ financial interests are safeguarded. Some work is required by the registered person to ensure the health, safety and wellbeing of residents and staff have been protected. EVIDENCE: Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 21 Mrs Elizabeth Lawrence is the manager of Wellcross Grange. She is a Level 1 nurse and has been registered under the Care Standards Act 2000 since 2002. Records seen showed that representatives of the registered provider visit the home on a regular basis to conduct unannounced inspections to ensure the care home is being run to serve the best interests of the residents. Reports of such visits were looked at; they showed that residents are spoken to during such visits to confirm that they are satisfied with the manner in which Wellcross Grange is being run. The manager told the inspectors that fee invoices are dealt with directly between the resident, or their relatives and the registered provider. Mrs Lawrence sends the registered provider invoices for any extra services over and above that which is included in the weekly fee. Such services include, for example newspapers, chiropody and hairdressing. If a resident has received any of these an additional charge will appear on the fee invoice. The manager is able to provide residents with facility to deposit any money or valuables with her for safekeeping. Mrs Lawrence has maintained the necessary records for such items so that she can demonstrate they have been keeping safely and to serve the best interests of the residents concerned. The inspectors viewed several areas of the care home. They noticed that linen cupboards did not have fire signs fitted indicating that cupboards should be kept locked when not in use. The door to the kitchen did not have a sign instructing staff to keep this door shut at all times. It was not clear if doors to bedrooms and doors to communal areas and in corridors were also fire doors. It is important that staff and residents know about this to make sure the systems for fire prevention and containment are appropriate for their safety. It is recommended that the manager contacts to the local fire prevention officer for advice and guidance. Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 x x x 3 x x x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Timescale for action The registered person shall make 20/02/06 arrangements for the recording and safe administration of medicines received into the care home. The registered person shall, 23/04/06 having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. This refers to training to senior staff regarding what they should do when an instance of abuse is reported to them. 20/04/06 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. This refers to training needs of all staff DS0000040966.V274520.R01.S.doc Version 5.1 Page 24 Requirement 2 OP18 18(1)(c) (i) 3 OP30 18(1)(c) (i) Wellcross Grange employed at the care home. 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 OP7 Good Practice Recommendations It is recommended that care plans are reviewed and amended to ensure they include clear instruction to staff with regard to how residents’ identified needs are to be met. Care plans should also include residents’ needs identified by social worker assessments. They should also include more detail about agreed interventions and treatment regarding catheter care, wound care and providing for nutritional needs. It is recommended that risk assessments and strategies are implemented to reduce, where possible, incidents of falls to residents. It is recommended that the registered person contact the local fire prevention officer to seek further guidance with regard ensuring all doors have appropriate signage and to ensure that fire doors have been fitted where necessary throughout the care home. 2 3 OP7 OP38 Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Wellcross Grange DS0000040966.V274520.R01.S.doc Version 5.1 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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