Care Home: Northwick Grange

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What the care home does well The home provides good written information so that people can decide if it is the right place for them. Assessments of people`s needs are carried out before they move in, so that the home can provide the care and support they need. The home generally meets people`s health and personal care needs. Care plans are reviewed regularly and changes are made as necessary. People who use the service can be involved in planning their care. Medication is managed safely. Family and friends are made welcome at all times. Meals are nutritious and provide a varied diet with plenty of fresh fruit and vegetables. People who use the service know how to raise any concerns. They are confident that complaints will be listened to and that staff will do their best to resolve them. Staff are recruited in a way which helps to protect the people who use the service. The home is a safe and comfortable environment for the people who use the service. It is kept clean and tidy, and staff have a good knowledge of infection control. There are enough staff to ensure that the needs of the people who use the service can be met. Staff are well-motivated and have a good understanding of the people for whom they are caring. Recruitment procedures help to protect the people who use the service. The home is managed in a way, which protects the people who use the service, and puts their needs and wishes first. The manager is well qualified and has the skills and experience to run the home for the benefit of the residents. What has improved since the last inspection? Care plans are reviewed at least once a month, and more often if necessary. Medication is administered and recorded safely and accurately. Recruitment procedures include two written references, and staffing levels are sufficient to meet the needs of the people who use the service. Some furniture has been replaced, and an ongoing programme of refurbishment is in place. CARE HOMES FOR OLDER PEOPLE Northwick Grange 19 Old Northwick Lane Worcester Worcestershire WR3 7NB Lead Inspector Sarah Blake Unannounced Inspection 1st August 2008 09:45 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 Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northwick Grange Address 19 Old Northwick Lane Worcester Worcestershire WR3 7NB 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) 01905 453916 chris.bradley@redwoodcare.co.uk Northwick Grange Limited Georgina Betty Moss Care Home 32 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (32), of places Physical disability over 65 years of age (32) Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st May 2007 Brief Description of the Service: Northwick Grange is a Georgian house, situated in a residential area on the outskirts of Worcester. It was first registered in 1993, and is part of the Redwood Care Home group. The home is on three floors and has a stair lift in place. Northwick Grange provides personal care for a maximum of thirty- two older people who may have a physical disability and / or a mental health need associated with the ageing process. A comfortable lounge and dining room are provided on the ground floor. The schedule of fees is available from the home. Additional charges are made for services such as hairdressing, private chiropody and newspapers. There is a copy of this report at the home, which is available for people visiting the home to see. Northwick Grange DS0000018666.V369477.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 outcomes. We spent a day at the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. These include records relating to the care of people who use the service. The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the manager’s comments have been included within this inspection report. We also received completed survey forms from people who use the service, their relatives and health professionals who work with the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. What the service does well: The home provides good written information so that people can decide if it is the right place for them. Assessments of people’s needs are carried out before they move in, so that the home can provide the care and support they need. The home generally meets people’s health and personal care needs. Care plans are reviewed regularly and changes are made as necessary. People who use the service can be involved in planning their care. Medication is managed safely. Family and friends are made welcome at all times. Meals are nutritious and provide a varied diet with plenty of fresh fruit and vegetables. People who use the service know how to raise any concerns. They are confident that complaints will be listened to and that staff will do their best to resolve them. Staff are recruited in a way which helps to protect the people who use the service. The home is a safe and comfortable environment for the people who use the service. It is kept clean and tidy, and staff have a good knowledge of infection control. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 6 There are enough staff to ensure that the needs of the people who use the service can be met. Staff are well-motivated and have a good understanding of the people for whom they are caring. Recruitment procedures help to protect the people who use the service. The home is managed in a way, which protects the people who use the service, and puts their needs and wishes first. The manager is well qualified and has the skills and experience to run the home for the benefit of the residents. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Northwick Grange DS0000018666.V369477.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 Northwick Grange DS0000018666.V369477.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good information so that people can decide if it is the right place for them. Assessments of people’s needs are carried out before they move in, so that the home can provide the care and support they need. EVIDENCE: The home provides written information to help people decide whether they wish to live at Northwick Grange. We spoke to two families of people living at Northwick Grange. One relative told us that she had visited several homes, and had chosen Northwick Grange because she felt that “there was a sense of warmth and care here”. Another relative told us that she had visited Northwick Grange on several occasions to make sure that it would be the right Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 9 place for her mother, and that the staff had always made her welcome and had answered all her questions. In a survey, a relative said, “Mother was taken to three care homes and chose Northwick Grange herself as she felt comfortable there and that the atmosphere was friendly.” The home’s Statement of Purpose and Service User Guide are displayed in the hall area, and the manager told us that the Service User Guide is available in a large print version. We looked at the records for four people who use the service, and saw that each person had a written contract. We saw records to show that a senior member of staff had been to visit people before they arrived at the home, so that an assessment of their needs could be carried out. These assessments were brief, but covered all the aspects of daily life, and would ensure that staff could provide the support that people need as soon as they move into the home. We saw that a more detailed assessment of people’s needs had been carried out within a few days of admission. We did not look at Standard 6, as Northwick Park does not provide intermediate care. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good systems in place to meet people’s health and personal care needs. Care plans are reviewed regularly and changes are made as necessary. People who use the service can be involved in planning their care. Medication is managed safely. EVIDENCE: We looked at records for four people who use the service. These records showed that each person has an individual care plan, which is reviewed at least once a month. As people’s needs change, the plan is amended as necessary. The care plan covers all aspects of daily living and sets out clearly how much help and support is needed. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 11 We saw a letter which had been sent to relatives, asking if they wished to be involved in the reviews of care plans (with the consent of the people who use the service). Records showed that people who use the service had signed to say that they were in agreement with their care plans. We observed that one person who had been assessed as at high risk of developing pressure sores had not had all her care provided as set out in her care plan. When this was mentioned to the manager, she immediately requested a member of staff to provide the care needed. Records showed that medical help is sought swiftly if people need a doctor or nurse, and this was confirmed by surveys we received from health professionals. We saw staff helping people with their personal care needs, and this was done sensitively and respectfully. Records show that people are asked how they like to be addressed, and relatives told us that staff always show respect for the people who use the service. Medication is stored safely and there are good procedures for administering medication. The home has recently has a full audit of its medication procedures by the local Primary Care Trust, and this showed good practice. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are limited activities to occupy the people who use the service. Family and friends are made welcome at all times. Meals are nutritious and provide a varied diet with plenty of fresh fruit and vegetables. EVIDENCE: The home provides a limited range of activities for the people who use the service. During the afternoon, we saw a group of people playing dominoes with a member of staff. This was the same activity, which had been seen at the previous inspection over a year ago. Although one relative told us in a survey “There do not appear to be any activities to stimulate the residents”, other relatives told us that they had seen plenty of activities such as games and entertainers. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 13 The manager told us that one member of staff is designated to be in charge of activities every afternoon for about two hours. We saw an activity planner, which showed some of the activities on offer, for example: reading, bowls, classical music, quizzes, and watching a film. We did not see any evidence of individual planning to take into account people’s interests and needs. The manager told us that two daily newspapers and a local evening newspaper are delivered to the home. She has plans to develop the patio area so that people who use the service can have the chance to grow vegetables and flowers next year. During the day, we saw visitors coming and going, and we saw that they were made welcome by staff and offered drinks and biscuits. One relative told us “You can come in at any time, and can always talk with the staff”. Records showed that people who use the service are asked on admission if they wish to receive a visit from a minister of their own faith. We saw drinks and snacks being offered throughout the day. The staff offered a choice of drinks including tea, coffee, cranberry juice and lemonade. Biscuits were offered with the drinks, and these were served with tongs, thus reducing the risk of any cross-infection. A relative told us that fruit is often served as a snack instead of biscuits. Staff supported and assisted anyone who had difficulty eating and drinking independently, and this was done sensitively. Menus showed that there is a four week cycle of meals, which has been drawn up by the chef at one of the group’s other homes. The menus showed a good balanced diet, and the manager told us that she takes into account the known likes and dislikes of the people who use the service. For example, chilli con carne was originally on the menu, but many people who use the service are unable to tolerate it, so this has been changed to an option, which appeals to more people. We saw lunch being prepared and it included two fresh vegetables. The manger told us that hot meals always include at least two fresh vegetables. One person had their food liquidised, and we saw that each component of the meal had been liquidised separately, to make the meal more appetising. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service know how to raise any concerns. They are confident that complaints will be listened to and resolved. Staff are recruited in a way which helps to protect the people who use the service. EVIDENCE: In our surveys, people who use the service told us that they know how to make a complaint and who to talk to if they have any concerns. During the inspection, we spoke to relatives who told us that they had copies of the complaints procedure, and that they would feel comfortable raising any issues with the manager. We saw records to show that the home has received three complaints within the last year, all of which have been resolved satisfactorily. The Commission has received no complaints about Northwick Grange within the last twelve months. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 15 One of the ways in which people who use the service can be protected from abuse is by making sure that only suitable staff are able to work at the home, and also that staff are trained in how to recognise and report any suspicions of abuse or neglect. We looked at staff records for three members of staff. These showed that all the necessary checks had been carried out before staff were employed by the home. These checks include a Criminal Records Bureau (CRB) check, two written references and a full employment history. The staff we spoke to demonstrated a good understanding of the ways in which people who use the service can be protected from abuse or neglect. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is a safe and comfortable environment for the people who use the service. It is kept clean and tidy, and staff have a good knowledge of infection control. EVIDENCE: Northwick Grange has a homely and friendly atmosphere. The home has been adapted to the needs of the people who use the service without losing its character. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 17 There is a large airy lounge, which is well furnished with comfortable armchairs, which are arranged so that it is easy for people to chat together. There are two budgerigars in cages in the corner of the lounge, and books, games and videos are available. The dining room is furnished with modern tables and chairs, and the tables are covered with plastic tablecloths. At the end of the dining room is a quiet lounge area with a large fireplace. Most bedrooms have en-suite facilities, and are attractively and simply furnished. We saw that some people who use the service had brought items of their own furniture with them, and most bedrooms contained personal items such as ornaments and family photos. The home has a stair lift to the first floor, but people who need help with mobility all have downstairs bedrooms. Each bedroom has a maintenance schedule and these were seen to be up to date. We checked the temperature in a hot water tap in one of the bedrooms, and it was 45 degrees Celsius. The Health and Safety Executive advises that the hot water temperature in care homes should be no higher than 44 degrees Celsius. The manager immediately arranged for the thermostat to be turned down. Communal bathrooms are kept clean and tidy, and personal protective equipment, such as gloves and aprons, are readily available for staff to use when assisting with personal care. The home appeared clean throughout, and one relative told us ““the home is spotless”. A dispenser of hand sanitiser was available by the signing in book, and every washbasin has a laminated instruction sheet showing the correct technique for hand washing. Staff showed a good knowledge of how to limit the spread of infection, and the manager has an excellent understanding of the principles of infection control. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to ensure that the needs of the people who use the service can be met. Staff are well-motivated and have a good understanding of the people for whom they are caring. Recruitment procedures help to protect the people who use the service. EVIDENCE: During the inspection, everyone we spoke to made positive comments about the staff at Northwick Grange. Comments included “They are sympathetic to the needs of individual residents”, “All the staff are very very kind” and “They’re fantastic”. We spoke to two Community Nurses who were visiting the home. They told us that one of the people who use the service had had a behaviour plan drawn up by a psychologist, and that the staff at the home had consistently implemented the plan. This had resulted in good outcomes, which they attributed to the skill and commitment of the staff. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 19 We looked at the staffing roster and it showed that there are enough staff on duty at all times to meet the needs of the people who use the service. One member of staff comes on duty at 7 a.m. to help the night staff with the morning work, and two staff stay on in the evening until 9 p.m. to help the night staff with the evening work. One relative told us “There are always enough so that two staff can take frail people to the toilet”. We talked to two members of the care staff, and they both showed an understanding of people’s individual needs. We observed staff working with the people who use the service, and they showed sensitivity and empathy. Training records showed that staff have received a wide range of training, including fire safety, manual handling, health & safety, the protection of vulnerable people, and dementia. The manager has recently completed a training course about dementia care, and she told us that all senior staff will be doing the same training this autumn. We saw notes of staff meetings, which showed that issue which affect the people who use the service are addressed, and staff are made aware of any new procedures or systems in the home. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in a way which protects the people who use the service and puts their needs and wishes first. The manager is well qualified and has the skills and experience to run the home for the benefit of the residents. EVIDENCE: The manager is highly regarded by her staff team, the people who use the service and health professionals. Some of the positive comments we received include “one of the best managers I’ve met”, and “very clued up, very observant and understanding of the problems of our patients”. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 21 The manager has many years of experience in care work, and is enthusiastic about continuing to learn and improve the care provided for people who use the service. Relatives told us that they have great confidence in the home. One said “Mum is safe and well looked after here”. One of the people who use the service told us “It couldn’t be better”. The home surveys people who use the service, their families and health and social care professionals every six months to find out their views of the service. The registered provider visits the home regularly to check on the quality of the service, and we saw reports of these visits. In addition, the Redwood group of homes employs a Quality Assurance Manager, who visits Northwick Grange regularly. The home does not take responsibility for the personal finances of the people who use the service therefore this standard was not inspected. Lockable cupboards are available for anyone who wishes to keep small amounts of cash or valuables in their bedrooms. We looked at the accident records for the home, and these were found to be fully completed. We saw records to show that the home has a regular schedule for all maintenance checks. The maintenance log and the fire book were up to date and detailed. Throughout the home, we observed good health and safety practice, for example, fire doors were kept closed, there were no trip hazards, the flooring was in good condition, and lighting levels were adequate. At the previous inspection, we saw that the laundry door was not secured. There is now a keypad lock on the door, which means that only authorised people can access the laundry. Also, at the previous inspection, we were concerned about the build up of heat in a glass-roofed corridor. The glass roof has been painted over and a ceiling fan helps to ensure that heat is not excessive in this area. Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X X X X 3 Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 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. 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. 1. Refer to Standard OP8 Good Practice Recommendations You should ensure that pressure area care is carried out regularly in accordance with the care plan. This will reduce the risk of harm to people who use the service. You should provide a greater range of activities, which take into account people’s individual needs and preferences. 2. OP12 Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Northwick Grange DS0000018666.V369477.R01.S.doc Version 5.2 Page 25 - 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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