Inspection on 27/04/05 for Winsford Grange Care Home

This inspection was carried out on 27th April 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Winsford Grange Care Home 27/10/08

Winsford Grange Care Home 15/04/08

Winsford Grange Care Home 10/04/07

Winsford Grange Care Home 29/06/06

Winsford Grange Care Home 22/09/05

Winsford Grange Care Home 14/10/04

Winsford Grange Care Home 17/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Winsford Grange Care Home Station Road Bypass Winsford Cheshire CW7 3NG Lead Inspector Denis Coffey Unannounced 27 April 2005 09:00 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Winsford Grange Care Home Address Station Road Bypass Winsford Cheshire CW7 3NG 01606 861771 01606 861705 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Community Integrated Care Mr Mark Laight Care Home with Nursing 60 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Dementia - over 65 years of age (30) Physical disability (4) Dementia (3) Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for a maximum of 60 service users to include: * Up to 30 service users in the category of OP (old age not falling within any other category. * Up to 30 service users in the category of DE(E) (dementia over the age of 65.) * Up to 3 service users age 60 years upwards in the categories of PD or DE. * One named service user under the age of 65 in the category of PD. 2 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection. 3 Date of last inspection 14th October 2004 Brief Description of the Service: Winsford Grange is a purpose built facility. It comprises of two units: one for elderly frail service users and one for the elderly mentally infirm service users. Each unit has two wings of 15 beds each. Dickens and Austen are the wings accommodating the elderly frail service users, and Bronte and Chaucer the wings accommodating the elderly mentally infirm service users. The home is a single storey building with good access for wheelchairs. Each wing has eleven single bedrooms and two double bedrooms. there are no en-suite toilet or bathroom facilities. There are private enclosed gardens. The home provides good car parking facilities, and is located on a local bus route, and is close to rail services. Registered nurses are on duty at the home at all times in accordance with statutory requirements. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6.5 hours; during which time a tour of the premises took place, and staff care records were inspected. The inspector spoke with ten of the service users and eight members of staff. Three sets of visitors were present at the time of inspection, all of who commented favourably on the standard of care provided. All but two of the requirement made at the last inspection had been complied with. The outstanding requirements are in relation to care records and the management of medicines. What the service does well: What has improved since the last inspection? What they could do better: The garden and storage area at the rear of the home is in need of improvement. The grass is overgrown and not pleasant to look at from the service users windows. The management of medicines was identified as a problem at the last inspection and this still needs improving to make sure that residents receive their medicines as prescribed. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 6 Care plans need to be updated more frequently to show what action staff are taking to meet residents’ needs. A situation has arisen on one of the units that is affecting the social care of some of the service users. This needs to be managed more effectively by staff at the home. 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. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 6 Residents are assessed before moving into the home to make sure that they know their needs can be met at the home. EVIDENCE: Detailed assessments of residents’ care needs that had been done before they moved into the home were available in their care records. These provided the information necessary to make a judgement on whether the home could meet the needs of prospective service users’. The home does not provided intermediate care therefore Standard 6 does not apply. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9, & 10 Although there were care plans for the residents, there were gaps in them that could lead to residents not receiving all the care they needed. There were problems with the medicines that could result in service users not receiving their medicines as prescribed. EVIDENCE: The home is split into four separate units. A sample of residents’ care records was examined on each of these units, and service users and relatives were spoken with. Dickens Unit Two sets of care records were checked, and were found to contain all the relevant information needed to make sure that the needs of the service users could be met. Risk assessments were in place; an example of one of these was where a service user had fallen. The risk assessment for this was well documented and reviewed monthly. References to visits by the residents’ general practitioner, optician and physiotherapist were included in the care files. Residents said that staff continued to meet their needs and they were complimentary about the staff on the unit. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 10 Staff who spoke with the inspector displayed a good awareness of the needs of the service users, and were observed carrying out tasks in a professional manner. Three residents were sitting in a quiet area just off the corridor where there was no call bell. The residents said they would shout if they needed help. Staff said they usually had a small hand bell to call for assistance but this was not available on the day of the inspection. Austin Unit Three sets of care records were examined. There were temporary care plans dated January 2005 in the records of one resident. The nurse in charge of the unit stated that temporary care plans are usually put in place for the first few weeks after a resident moves in. During that time the staff do an in-depth assessment, following which new care plans are put in place. Residents on the unit were satisfied with the staff and the care they provided. One resident said she stayed in her own room because of the behaviour of another resident. Staff confirmed that other residents did the same. However there was no information in the care records to show how this situation was being managed. Chaucer Unit Two sets of care records were examined. These contained a range of care plans to show how the needs of the resident were being met. However, the records of one resident did not contain a moving and handling assessment, and the risk assessment for the use of bed rails for this person was incomplete. The records of the second resident identified that they suffered with cataracts, but this problem had not been addressed in a specific plan of care. Bronte Unit The care records of one resident were examined. The records showed that they were at risk of falling, and that they had limited mobility due to sustaining a fractured femur. There was no evidence of a moving and handling assessment, or risk assessment regarding falls found in the resident’s records. There was no assessment about the resident’s skin integrity, despite the records showing that the service user had a damaged skin area on 1 April 2005, pressure marks on their left hip on 13 April 2005, and red buttocks on 21 April 2005. An alternating pressure mattress and pressure relieving chair cushion had been supplied and were in place. Medicines were examined as part of this inspection. management of medicines are in need of improvement: Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Practices in the Version 1.30 Page 11 Dickens and Austin Units • • There were several instances where medication had not been signed for on the medicine administration record (MAR) sheets. This included the application of prescribed creams. Some instructions on the MAR sheets had been changed. These had not been signed by the person making the amendments, and no explanations given on the back of the MAR sheets for the changes. When checked, the original administration instructions were on the bottles and boxes of medicines. Some medicines were recorded as being out of stock leading to a service user not having several doses of their prescribed medication. • Chaucer and Bronte Units • • A tube of cream available only on prescription was found in the sluice room on Chaucer Unit (the door to which was unlocked). A number of residents on both units were prescribed eye drops. This medication has a limited life once opened, and a number of these were not dated as to when their use had commenced. The MAR sheets were correctly filled in, and a medicines profile identifying present and previously prescribed medicines was kept with each resident’s MAR sheet. An examination of medicines subject to stricter control measures was carried out. These were found to be managed well. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 There are a range of social activities available, providing variety and interest for people living at the home. Menus are varied and food is served in an appetising manner. There is however a lack of alternatives identified on the menus, thus limiting the residents’ choice about what they want to eat. EVIDENCE: Residents said that activities are offered regularly. One resident confirmed that the vicar had visited the home the previous day, and that a quiz had been held on the night before. A list of activities was displayed in the entrance hall and another displayed on the units. Activities identified on this list included; cake making, a quiz, church service, skittles, karoke and dominos. Residents confirmed that relatives visit the home regularly, and that community links are maintained. The inspector spoke with three sets of visitors at this inspection, all of whom said that they are made to feel welcome. They also confirmed that they were kept informed of their family member’s condition, and that they felt the standard of care provided was good. Three residents said that they are not given a choice of meal, but one confirmed that she was offered such a choice. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 13 Members of staff said that residents who are able to communicate with staff are asked which dish they want from the menu on the previous day, and a note is made of this. They confirmed that residents who are on a soft diet are not given a choice of meals. It is the usual practice that kitchen staff decide what the soft diet will be. The nurse in charge of one of the units said that this problem had been brought to the attention of the kitchen staff, and a complaint has also been received about the lack of choice. As a result meetings have been convened to discuss the menu options for service users to ensure that they are nutritionally sound and have enough calories. This member of staff stated that full fat milk and dairy produce is now provided for service users who are assessed as requiring increased calorie intake. Members of staff have attended a workshop on the nutritional needs of service users. The menus were looked at as part of this inspection. It was noted that on some days there was limited choice available. A vegetarian/ethnic option was listed for some days. Staff did not know what the vegetarian/ethnic option might be; therefore, service users would also not have known what this option entailed. Lunch on the day of inspection was chicken chausseur, potatoes and carrots, with minced turkey and the same vegetables for service users requiring a soft diet. Pineapple upside down cake and custard, or yogurts, pureed fruit or fresh fruit was served as a dessert. Service users were complimentary about the food in general. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 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 standard(s) 16 & 18 There is information available to guide residents and relatives on how to make a complaint and who to make it to. Staff training records showed that they have received training on adult protection. There are procedures and guidance available for staff to ensure that residents are protected from abuse, harm and poor practice. EVIDENCE: The complaints procedure was on display at the home, and service users confirmed that they were aware of whom to complain to if they had a problem. The complaints folder was inspected, and one complaint had been recorded since the last inspection. The letter to the complainant stated that the management of the home dealt with the issues raised, but there was little evidence to suggest that this issue was resolved to the satisfaction of all parties. Two of the staff spoken with said that they had received adult abuse/protection training. A copy of the Department of Health’s document ‘No Secrets ’(that identifies the different forms abuse can take and how to report this) was seen on all the units but neither of these two staff were aware of it. Similarly, they were aware of the home’s whistle blowing policy but confirmed that they had not read it. However, both of these staff members displayed a sound knowledge of the actions to be taken if they witnessed or suspected abuse taking place. They also confirmed that they had read the home’s policy on abuse. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 24, 25 & 26 The standards of decor and furnishings have been well maintained,and the service users bedrooms were comfortably furnished, providing people living at the home with safe and comfortable surroundings. The home was clean and tidy providing a satisfactory standard of hygiene with no unpleasant smells. EVIDENCE: The standards of décor and furnishings throughout the home have been well maintained. Service users bedrooms are comfortably furnished and evidence was seen of the majority of these being decorated with personal items such as pictures and ornaments. The home was clean and tidy and free from unpleasant smells on the day of inspection. However, the back of the building that is overlooked by some bedrooms appeared neglected, with several items stored there. These were removed on the day of inspection. The road to the rear of the home is in a poor condition and needs attention. There is a secure enclosed garden, with a patio, outside the lounge of Chaucer Unit that was well tended. The lawn was cut, flowerbeds were well stocked and garden furniture was available. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 16 The inspector was informed that a member of the housekeeping staff is maintaining this garden in her own time. Members of staff were observed using the residents’ dining room and small foyer area on one of the units during their break period. As this room is for the residents, it should not be used for staff purposes. Although there is a staff room, it is a smoking area, which is not acceptable if staff wished to eat there. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Appropriate numbers of staff were on duty to meet the needs of the service users, and the homes procedures for the recruitment of staff were thorough ensuring that the service users were supported and protected. EVIDENCE: There were sufficient staff on duty to meet the needs of the service users. The staff spoken with knew the service users and were aware of their needs. The staff files of two new newly appointed members of staff were examined. These contained all the necessary checks required before staff start work at the home. One newly employed member of staff confirmed that she had undertaken induction training that included fire safety, and moving and handling. Although she had not received any formal training on protecting people from abuse, she was aware of the procedure for reporting any incidents to the nurse in charge or the manager of the home. She was also aware of the whistle blowing policy. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,35 & 38 There are systems in place to ensure that any money handled by the home on behalf of residents is safe and managed in the residents’ best interests. On the whole, the practices at the home protect the health and safety of residents and staff but all staff need to be trained to ensure that they can move residents safely. EVIDENCE: The home manager is on a three-month secondment at the company’s head office and the deputy manager has assumed responsibility of managing the home in his absence. At the time of this inspection the deputy manager was attending a three-day residential management-training course. The company that runs the home acts as appointee, through its finance department, for the personal money of three of the service users. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 19 Small amounts of money are left at the home by relatives for purchasing personal items such as sweets, toiletries and tights, or for hairdressing. The balance of money held was checked against individual receipts and found to be correct. There was no evidence to suggest that service users and relative meetings are held. The last minuted staff meeting was dated 19th January 2005 and 25th January 2005. The home’s administrator confirmed that relative/service user/visiting professional surveys are carried out, and the completed forms for these are returned directly to the company’s head office. She confirmed that the home is usually informed of the results of these, however these could not be found and the acting manager was not available to access these. Records were seen of the fire alarm system being tested weekly, and the emergency lighting, monthly. A satisfactory engineers service report for these systems was issued in November 2004. Accidents sustained by service users are audited in the home on a monthly basis. On Chaucer and Bronte Units there had been a total of 30 accidents recorded between 6th January 2005 and 31st March 2005. The majority of these accidents were attributed to falls/trips. One service user had fallen nine times in this period and there was a falls risk assessment in her care records. There had been no recorded accidents for this period on Dickens and Austin Units. The trained nurses on two of the units provide safe moving and handling training for the staff on those units only. Records of training were seen that showed that not all of the staff employed at the home have received this training. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 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 3 13 2 14 x 15 3 COMPLAINTS AND PROTECTION 3 2 x x x 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 3 x 3 x x 2 Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 21 YES 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 7 Regulation 15 Requirement A written plan must be implemented that identifies how all of the service users needs with respect to their health and welfare are going to be met. This requirement remains outstanding from the last inspection. A satisfactory system whereby service users can summon assistance must be provided in all areas of the home used by service users. Appropriate risk assessments must be implemented and put in place for any identified risk relating to the health and welfare of the service users. Suitable arrangements must be made for for the recording, handling, safe keeping and safe administration of medicines at the home. This requirement remains outstanding from the last inspection. Arrangements must be put in place to ensure the dignity and privacy of service users are maintained at all times. The service road leading to the rear of the premises must be F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Timescale for action 06/06/05 2. 8 13 06/06/05 3. 8 13 13/06/05 4. 9 13 06/06/05 5. 10 12 06/06/05 6. 20 23 30/06/05 Page 22 Winsford Grange Care Home Version 1.30 7. 8. 20 38 23 13 attended to to make it safe for anyone accessing this road. Staff must cease using the service users facilities for their breaks and meals. All staff employed at the home must receive training from an approved instructor on the safe moving and handling of service users. 06/06/05 13/06/05 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 18 Good Practice Recommendations It is recommended that all staff at the home are encouraged to read the Department of Healths document No Secrets, along with the homes whistle blowing policy. Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire CW9 7LT 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 Winsford Grange Care Home F51 F01 S18743 Winsford Grange V222337 270405 Stage 4.doc Version 1.30 Page 24 - 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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