Care Home: Middletown Grange

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well People told us through our survey that the home makes sure that they get the medical care they need, and that the home is always fresh and clean. One individual commented in our survey that the home ‘takes good care of us’ and another comment was ‘I am very pleased, good care, entertainment and care. Rooms are clean and light and gardens lovely’. We saw that there is a good range of activities and entertainment available and that the home wants to provide as personalised a service as possible. The home seeks the views of people living in the home and their relatives and responds to the views expressed, and improvements have been made to the running of the home in this way. A person living in the home told us through our survey ‘I find it very well run and all residents very happy and well looked after’. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 What has improved since the last inspection? The home has improved the way the dementia care unit is decorated so that people are better able to find their way around and so feel more at home. People with dementia have their needs better documented and met, and are more settled in the home, as the staff team are now better trained to understand their needs. More activities have been introduced and new items supplied for activities, such as the Wii game. In response to suggestions from relatives there is now better managerial cover at weekends and the gardens and dining arrangements have been altered in line with people’s wishes. What the care home could do better: The home’s manager has identified in the AQAA what action will be taken to continue the improvements to the home. Key inspection report CARE HOMES FOR OLDER PEOPLE Middletown Grange Middletown Hailey Witney OX29 9UB Lead Inspector Kate Harrison Key Unannounced Inspection 27th July 2009 10:00 DS0000040174.V376729.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Middletown Grange Address Middletown Hailey Witney OX29 9UB 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) 01993 700396 01993 775704 middletowngrange@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Mrs Susan Knight Care Home 56 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) 2. Learning disability (LD) - Maximum number of places 1 The maximum number of service users to be accommodated is 56. Date of last inspection 11th August 2008 Brief Description of the Service: Middletown Grange care home is situated in a village location approximately 4 miles from the market town of Witney. The home is registered to provide care for up to 56 residents and is owned by Barchester Healthcare Limited. The home provides care for residents with nursing needs, and care and support for people living with dementia. There are two spacious lounges, a conservatory and a separate dining room on the ground floor, with bedrooms on the ground and first floors. The first floor Memory Lane - also has its own lounges and dining room. An extensive building and refurbishment programme was completed in 2007 and included new kitchen and laundry facilities There is a large enclosed front garden, a garden with water feature in the central courtyard, and a garden at the rear primarily for the use of people living in Memory Lane. The home’s current scale of charges range from £575.98 to £1000 per week. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection of the home was an unannounced Key Inspection, and was carried out by one inspector between 10am and 5pm during the day. It was a thorough look at how well the service is doing. It took into account detailed information provided by the home through the homes self assessment document, the Annual Quality Assurance Assessment (the AQAA) and any other information we received about the home since the last inspection. We saw the communal areas of the home and some private rooms used by people living there. We looked at records and documents relating to the care of the people living there. We saw recruitment records and information about staff training and looked at how peoples medication was managed. We asked the views of the people who live in the home, through questionnaires we had sent out, and we also sent surveys to healthcare professionals involved with the home and to staff members. We sent 10 surveys to people living in the home, 8 for the staff survey and 4 for health professionals, and one person used our website to complete our questionnaire. Altogether we received 9 completed surveys and their views are reflected in this report. We received no replies from healthcare professionals. We spoke to several other people living in the home during our visit, to relatives, to the manager, some staff members and discussed the running of the home with them. This inspection was a thorough look at how well the home is meeting the standards set by the government and in this report we make judgements about the outcomes for the people living in the home. What the service does well: People told us through our survey that the home makes sure that they get the medical care they need, and that the home is always fresh and clean. One individual commented in our survey that the home ‘takes good care of us’ and another comment was ‘I am very pleased, good care, entertainment and care. Rooms are clean and light and gardens lovely’. We saw that there is a good range of activities and entertainment available and that the home wants to provide as personalised a service as possible. The home seeks the views of people living in the home and their relatives and responds to the views expressed, and improvements have been made to the running of the home in this way. A person living in the home told us through our survey ‘I find it very well run and all residents very happy and well looked after’. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 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 Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. The home does not provide intermediate care. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move into the home, so they know the home can meet their needs. EVIDENCE: A nurse from the home carries out a pre-admission assessment about the care needs of individuals before they are admitted to the home. We saw the preadmission assessments for three individuals showing that their physical, social, religious and cultural needs had been assessed before admission to make sure that the home could meet their needs. People told us through our survey that they had received enough information about the home before moving in. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s health and personal care needs are usually recognised and met. EVIDENCE: We saw the care files of three people, including the risk assessments carried out by the home for several health and personal care topics to make sure that all the needs of the individuals were recognised and met. The care plans we saw were detailed and personalised and were regularly updated. The home carries out nutritional assessments based on the model recommended by the nutritionists’ association and this works well for most people. As the model is designed to identify malnutrition it does not highlight the need to address obesity. We noted that the nutritional assessments for two people showed that they were significantly overweight but the individuals had not been referred to their general practitioner (GP) for advice and the home had no plan in place to address the issue. We discussed this with the acting manager and following Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 10 the inspection received information that a GP referral procedure was now in place. We looked at how the home manages medication and saw that records are kept of the medication coming into the home, when they are administered and what happens when they are no longer necessary. We noted that in one instance, one strip of medication from a discarded dispensed box was stored in another box of the same medication, and the effect was that the original pharmacy label on the box containing the medication was no longer accurate as it contained more than stated on the label. The nurse agreed that this was not good practice and said that this would be brought to the attention of the individual who had thrown away the original box, so that it would not happen again. At our last inspection in August 2008 we made a requirement that the home takes action to meet the needs of people with dementia living at the home. We noted at this inspection that people with dementia had their needs documented and met through individualised risk assessments and care plans. People told us through our survey that they ‘always’ or ‘usually’ receive the care and support they need, and that they ‘always’ receive the medical care they need. One relative told us during our visit that her/his relative was well looked after, and another through our survey said that the home ‘sometimes’ meets the needs of his/her relative. We discussed this response with the manager. We observed that the staff team interacted well with individuals with dementia, and that individuals showed signs of well being and relaxation. We noted that people looked well groomed and were appropriately dressed, and one lady told us that she liked getting her hair done as it made her feel good. People told us through our survey that the staff team listen and act on what they say. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are encouraged to keep control over their lives, express their preferences about how they want their daily lives to be and can choose activities from a wide variety of social entertainment. EVIDENCE: At our inspection of August 2008 we made a requirement that the home take action to meet its statement of purpose regarding the quality of care for people with dementia, and at this inspection we noted that the requirement had been met. We saw from care planning information that the home gathers information about people’s social cultural and religious interests at the time of admission, and tries to use this information to make the individual’s life in the home to their liking. We noted that it was easier for people to get around the dementia care unit, as there were more signs and better use of colour to help people to remember where they were. Use is made of pictures and other items to encourage memory. Some rooms had items displayed near the door Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 12 to help people recognise their rooms and there were soft toys and chairs in the corridors for people to use as they wanted. There is a monthly schedule of activities including trips out, film shows, bingo, photography club, reminiscing sessions and the Wii game. The activities organiser is aware of individuals’ preferences and ability, and this means that everyone at the home has some social opportunities to do what they want. Trips out are organised twice a week, and people are asked to say what they would like to do. People were able to take part in unusual activities such as belly dancing and go to the fairground because the home listened to what they wanted to do. We saw that people take part in musical activities, physical activities such as the basketball league and art club, and outdoor gardening activities. On the day of our visit people took part in a wall painting session, and we saw that staff members used time to talk with individuals and took opportunities to encourage impromptu singing sessions. We noted that this has a beneficial effect on individuals. The staff team are aware of those who do not take part in organised activity and individual sessions are organised for them. People told us through our survey that there are ‘always’ activities arranged that they can take part in. People are encouraged to continue practising their religion after admission to the home, and can attend the regular religious events in the home or go with assistance to the local church. The home encourages people to visit their relatives and friends, and holds gatherings where people can get together in a social setting, such as the recent informal summer event. One relative commented through our survey that the home makes visitors welcome by providing teas and a room for meeting, and does not restrict visits by imposing visiting hours. A newsletter is regularly produced and distributed to keep people in touch with happenings in the home. The dining rooms are organised to suit people’s preferences and people can usually choose where they want to eat. The home produces a menu for people to choose from and we saw that a choice of drinks was available during the day and staff encouraged people to drink. People told us through our survey and on the day of our visit that the home provides good food, and one individual commented that what the home does well is the provision of good food. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are kept safe from harm and they and their relatives can make complaints to the home and be confident that they will be addressed. EVIDENCE: We saw the home’s complaints procedure displayed near the entrance hall explaining the process of making a complaint, and what to expect of the home once a complaint is made. People living in the home told us from our survey that they knew how to complain. We saw the record of complaints made since our last inspection and noted that the home has responded to issues brought to the attention of the manager. One issue concerned the inadequacy of home’s telephone system and a new system has recently been installed to address the issue. The home has a policy and procedure in place to make sure that people living in the home are kept safe from harm. The procedure shows how the home works with the local authority in any suspicion or allegation about abuse, and when we asked a staff member about the procedure she/he was able to tell us about the procedure. We saw from staff training records that training is available for staff at induction and further training is provided every year. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, clean, well maintained home. EVIDENCE: The home is comfortable and welcoming, with recently updated furnishings and décor. The maintenance is managed by a member of staff and there is a system in place to record and address routine maintenance matters. Routine checks, such as regarding fire safety, are carried out regularly to make sure that the home is safe. We noted that several communal bathrooms had hot water temperatures over the recommended level of 43 degrees Centigrade. When we brought this to the attention of the manager it was quickly investigated, the cause of the error was discovered and corrected, and the Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 15 water temperatures monitored until the recommended temperatures were reached. The majority of people living in the home who responded to our survey told us that the home is ‘always’ fresh and clean, and the information provided by the home shows that a full review of working practises within the domestic team was undertaken since our last inspection and new cleaning schedules introduced. A member of staff working in the laundry told us that she/he had received infection control training and we saw from the training schedule that most staff members receive the training. At our last inspection we made a requirement that the home needed to make sure that it meets the needs of people with dementia, by taking into account their particular needs at assessment and care planning, by ongoing staff training, and by making changes so that the environment in Memory Lane is more suitable for their needs. At this inspection we saw that the environment for people in the home with dementia had improved, with improved use of colour, signage and memory triggers, so that individuals were able to find their way around without getting lost and distressed. The garden for the use of people living upstairs has been improved and the home needs to make sure that people living upstairs have regular access by providing staff to help individuals enjoy the garden more. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their needs met by enough numbers of safe trained staff members. EVIDENCE: The home has a staffing rota showing that a team with a mix of nursing and caring staff are on duty over the 24 hours. The minutes of staff meetings show that the staff team usually take on any unfilled shifts and agency staff is not usually needed. People living in the home who responded to our survey told us that there are staff members available when they are needed, and staff members told us that there is enough staff on duty to meet the individual needs of all the people living in the home. Our observations also confirmed this. The home has a structured induction programme for new staff members, and an ongoing training programme to make sure that the staff team is kept up to date with the knowledge and skill necessary to do the job. We saw a copy of the staff training details and noted that the organisation has a rolling programme of training and updating, including training for all staff members about dementia. Of the 33 care staff 16 have gained the National Vocational Qualification (NVQ) Level 2 in Care, so the home is nearly achieving the national minimum standard of having 50 of care staff trained to NVQ Level 2. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 17 We looked at the home’s recruitment procedure to check that the staff team are safe to work in the home. We saw three staff recruitment records and noted that a thorough procedure is followed so that all the information is available about new staff so that only safe and suitable people are employed in the home. The home was not able to produce the full Criminal Record Bureau (CRB) certificate for one member of staff as only a tear-off part was retained by the home, and we discussed the need for the home to retain CRB certificates for inspection purposes until after our inspection visit with the home’s manager. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is increasingly run in the best interests of those living in the home. EVIDENCE: The home’s manager is qualified and experienced and has been registered to manage the home for over a year. A nurse is employed as head of care and also has the post of deputy manager, as the manager is not a nurse. The manager acted to implement the requirement we made at our last inspection about managing dementia care and at this inspection we found that the quality of the lives of people with dementia living in the home has improved. The homes self assessment document the AQAA was returned on time but did not Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 19 contain sufficient detail in the ‘Evidence’ section to give an accurate picture of what is in place at the home. For example regarding staff training, the ‘Evidence’ section stated ‘training and induction’ but did not give the detail of how the staff team is trained or what training is received. More detail is needed throughout the AQAA to show what the home is doing to meet its obligations. The home has a system of quality assurance that includes reports by senior managers and monthly internal audits, including medication, care planning and cleaning schedules. An annual survey is conducted and the views of people living in the home and their relatives are sought on how the home is run. The home acted on comments made following the autumn 2008 survey and now the managers are more available over the weekend to meet relatives and advocates. All the people living in the home have their care reviewed with relatives at least once a year. People are encouraged to manage their own financial affairs or have their relatives manage on their behalf, and the home does not manage personal monies for people. The home puts individuals in touch with advocates as necessary to make sure their rights are protected. The home has a full time maintenance person who is responsible for all aspects of health & safety. Staff members receive training about managing health and safety in the home, and the organisation employs an external body to carry out health and safety inspections at the home. A risk assessment is in place about fire safety and staff members receive training about fire safety and first aid. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 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 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 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 21 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 22 Care Quality Commission Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Middletown Grange DS0000040174.V376729.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!