Care Home: The Grange

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What the care home does well The Grange provides guidance and support to residents enabling them to indulge in activities and work they choose to be involved in. Residents are provided with good individual accommodation, which is personalised and reflects their interests. The communal accommodation is well furnished, maintained to a good standard and meets the collective needs of the current resident group.One resident spoken with said they enjoyed their hobbies and is helped by staff to complete his models. The staff team are knowledgeable about the needs of residents and can communicate with them well. There is a good rapport and relationship evident. Residents spoken with said they liked living at The Grange and that it was good there. What has improved since the last inspection? Risk assessments highlighted at the last inspection visit as being out dated have been reviewed and updated to reflect the present situation to ensure that there are plans in place should a risk present itself. The home`s quality assurance monitoring systems have been further developed to provide a report and an action plan about how the service can improve following feedback from residents, their families and people with an interest in the home. There has been further investment in the home`s environment with fire doors being upgraded for the protection of residents. There have also been developments in the home`s garden areas with handrails fitted to the gardens approach pathway to assist older residents who wish to enjoy the gardens. A new sensory garden has been constructed and planted with a variety of herbs, flowers and vegetables for the enjoyment of the resident group. The manager said this had been a success over the summer period. CARE HOME ADULTS 18-65 The Grange 30 Vinery Road Bury St Edmunds Suffolk IP33 2JT Lead Inspector Ray Burwood Unannounced Inspection 18th December 2007 09:30 The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Address 30 Vinery Road Bury St Edmunds Suffolk IP33 2JT 01284 769887 01284 701057 karenkrabbendam@btconnect.com 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) Grange Residential Homes Limited Mrs Karen Frances Krabbendam Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (9) of places The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th March 2007 Brief Description of the Service: The Grange is registered as a care home for nine adults with learning disabilities. It is situated in a residential area of Bury St. Edmunds, approximately one mile from the town centre and close to local amenities. The house itself is a large detached building and provides seven single and one double bedroom’s. The communal facilities include a large and a small lounge area and a spacious kitchen/dining area. The home has an established and well-maintained garden with a summerhouse for the use of residents. The range of monthly fees supplied to the Commission for Social Care Inspection (CSCI) on the 18/12/07 and charged by the home is currently between £424:00 and £701:00. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection carried out on the 18th December 2007 and lasted for five hours. The inspection visit focused on the Key Standards relating to Younger Adults. This report has been written using accumulated evidence gathered prior to, and during the inspection visit. The Commission for Social Care Inspection (CSCI) surveys were sent to the home on the 12th December 2007 for relatives, staff and professionals to complete. This gave an opportunity for relatives, people working in, and associated with the service to give their views on how they thought it is run. At the time of writing this report no surveys had been received. Prior to the inspection, the agency was asked to complete an Annual Quality Assurance Assessment (AQAA). This provides the CSCI with information on how the home is meeting/exceeding the National Minimum Standards, and any planned work for the next 12 months. Comments from which have also been included in this report. The Registered Manager and staff were available throughout the inspection, to answer any questions and provide records to support work undertaken at the home. A tour of the home took in all the communal rooms, dining room, some bedrooms and the gardens. Records viewed included, care plans, staff recruitment and training records, menus, staffing rotas. Time was also spent talking members of staff and observing the daily routines of people living at the home. What the service does well: The Grange provides guidance and support to residents enabling them to indulge in activities and work they choose to be involved in. Residents are provided with good individual accommodation, which is personalised and reflects their interests. The communal accommodation is well furnished, maintained to a good standard and meets the collective needs of the current resident group. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 6 One resident spoken with said they enjoyed their hobbies and is helped by staff to complete his models. The staff team are knowledgeable about the needs of residents and can communicate with them well. There is a good rapport and relationship evident. Residents spoken with said they liked living at The Grange and that it was good there. What has improved since the last inspection? What they could do better: The main objective of The Grange is to continue with the good quality of care they currently provide. When asked, the manager said there was always room for improvement and she would be concentrating on staffing levels to create a more one to working with residents who are in the older age group. The manager pointed out in the Annual Quality Assurance Assessment (AQAA) that the day services attended by residents was under review and being part of the review process with the Social Services could help with any transitional process that may occur. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 7 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. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The home’s assessment process is well managed and ensures that admissions are not made to the home until a full needs assessment has been undertaken. EVIDENCE: The resident group at The Grange remains the same as the home’s previous inspection visit carried out earlier this year. Following the assessment process, which could take up to six months to ensure the transition period involves all interested parties, a key-worker is nominated to monitor the progress of the application/referral. During assessment process, information and planned visits to the home by prospective new residents are agreed with the home’s ‘House Council’, that is made up of residents living in the home, who would help to decide on new admissions to the home. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 10 Evidence seen in residents’ files examined, showed that a community care assessment and risk assessments are in place for residents with annual reviews by social services that show that placements are monitored and remain to be appropriate for those residents currently living at the home. Contracts were seen to be in place and are developed with the local authority. Information contained in the home’s Annual Quality Assurance Assessment (AQAA) confirmed that each resident has a Licence to Occupy and a Suffolk County Council Individual Placement Plan. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. People who use the service are involved in decisions about their lives, and where possible, play an active roll in planning the care and support they receive. EVIDENCE: The files of two residents were tracked as part of this inspection. All of their information was examined and they were spoken with during the visit. Both residents appeared happy and said they were happy to live at The Grange. Care plans are in place for all residents, had been reviewed and up to date. The care plans contain both short term and long terms goals for each resident. The daily statements in place record support given and by whom and what activities the individual participated in each day. The main source of information for staff comes from ‘Guidelines to The Grange routine’. This is a document and information displayed in the home sets out the structure for each shift that ensures each resident preference and needs The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 12 are met. The guides ensure that daily programmes contain sufficient information to both staff and residents to ensure that residents get to their chosen activity or group activity with the support they require. There are risk assessments in place for residents that allow them more independence and choice. These have recently been reviewed and updated with changes where required. Residents hold what they call a ‘House Council Meeting’ once a month. These are held without staff and the residents keep a record of what was spoken about. Topics include activities and outings. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. People living at the home experience a varied life at the home with visitors encouraged, various informal activities made available, and good meals. EVIDENCE: As previously reported, records relating to programme planning and support given to residents is well displayed for information and guidance about what is on each day in terms of activities and employment. The main source of information for staff comes from ‘Guidelines to The Grange routine’. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 14 Daily activities for people living at the home include a range of day care services such as horticulture, social skills groups and drop in centres where residents can meet up with their friends and be part of social group lunches. Two people who live at the home take part in voluntary work at the local hospital by helping with administrative work by addressing envelopes and posting. After work activities include four residents attending church and being part of the church club. Visits to local theatres, cinemas and eating out are also part of the activities accessed by the residents living at the home. The manager explained that certain residents only like to go to specific clubs and this wish is respected. Other visits are made to the seaside summer shows Various hobbies such as bird watching and photography are enjoyed by some residents, together with gardening in the home’s gardens and model making with Lego bricks. Information received from the home’s AQAA explained that residents take great pride in showing their many photographs taken during outings. This year, their holiday experiences were put onto a DVD for relatives to look at. One resident allowed the inspector to see their room and the models they had made since living at the home. There are several other activities available at the home such as foot spas, beauty treatments, crafts, knitting, jigsaws or some residents just doing their own thing in the privacy of their own room. One resident who was knitting at the time of the inspection visit explained to the inspector that the knitting squares would be sewn together and sent abroad for use by children in orphanages. The interaction between staff and residents seen during the inspection visit was seen as warm and supportive, with residents smiling and enjoying the company of staff as well as other residents. Those residents with family and friends are supported in maintaining contact whether local or further away. The home welcomes visitors to the home through general visits or parties and fund raising events throughout the year. Those residents with long distance relationships are supported in writing letters and making telephone calls. One resident is escorted by the manager in making visits to their family who live in another town some distance away from the home. Another resident has recently started having visits from a relative who had lost contact over the years. The lunchtime period was observed, with those residents not going out sitting together with their chosen meals, desserts of their choice followed these. One resident said they liked the food at the home. Residents have their own kitchen area where they are able make their own breakfast, snacks and drinks at any time. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 15 There is a changing menu that is based upon good home cooking and shows a varied wholesome diet. Examples include roast turkey dinner, liver and bacon casserole, meat loaf, salads and each meal has a dessert. None of the people living at the home currently require a special diet. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that the health care needs of people who live there are identified and met. EVIDENCE: Care plans examined were found to provide clear evidence about how residents preferred and wished to be supported in respect of their personal healthcare. Plans seen were written with a view to ensuring equality and diversity, respect, dignity and privacy of all residents. People living at the home are registered with a GP practice and specialist healthcare services are accessed such as Psychiatry in learning disability as well as Opticians and Chiropodists. Records of healthcare professionals visits were maintained and outcomes clearly recorded for staff information and guidance. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 17 Annual health checks are completed on all residents and a winter influenza inoculation provided for residents by their general practitioners. One person living at the home carries an Epi-Pen in case of wasp stings and wears a Medi- Alert disc. The manager said the resident concerned had not had to use the medication for a long time. During this inspection visit a resident was attending the local hospital to have some teeth extracted, they later returned to the home with their carer who had been supporting them during the visit. The relative of the resident also visited the home on their return. The medication systems in operation at the home were examined and all medication is kept secure. All staff that administer residents’ medication were trained in November 2006. Evidence of this training was seen in a training report provided by the local Pharmacist. All records were available to examine and were able to be audited to show that medication prescribed is administered correctly. Policies and procedures on medication are available to staff. At the last inspection visit it was noted that the practice of two staff signing for each medication administered did not match the homes policy that states one person. This practice has now been change to one person signing as stated in the medication policy and procedures document. A new medication cabinet has been purchased sine the home’s last inspection visit. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that the home has appropriate procedures in place to deal with complaints and protect residents from abuse and neglect. EVIDENCE: The Commission for Social Care Inspection (CSCI) or the home has not received any complaints since the last inspection visit. The home has a complaints procedure and log in place. This also forms part of the Service Users Guide. In relation to protection of residents, information contained in the home’s AQAA report and discussions with both the manager and staff confirmed that they had received the appropriate training in Adult Protection. In the office there was a copy of the joint local procedure agreed with Suffolk Social Services and Police. Refresher training has been included in the home’s business plan for 2008. Staff recruitment files showed that the home take up an enhanced Criminal Records Bureau (CRB) check on staff and a Protection of Vulnerable Adults (POVA) check before staff start work at the home. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a homely, comfortable and safe environment and can expect their bedrooms to suit their needs and promote their independence. EVIDENCE: During the inspection a tour of the home was undertaken with the manager. The home is clean and hygienic, the toilets and bathrooms inspected had all been recently cleaned. The manager showed the inspector rooms that were open and all of these were individual and personalized. One room where the resident liked models and puzzles, purpose built shelving had been built to store them. The kitchen areas was bright and designed so that it is part of the main dining area. The lounge area has comfortable chairs and had a big TV an organ and many activities for the residents to choose from. The home also has another area separate from the other communal areas; here the residents can see their visitors in private. The home has been redecorated and all the windows have been replaced. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 20 The outside area is nicely set out, there is a garden for the use of the residents and has a small fishpond. The gardens are spacious and offer residents safe access since new handrails had been fitted to the driveway. Each year the residents are involved in the local ‘Bury in Bloom’ competition and look forward to the spring and summer when they start the preparation. Information in the home’s AQAA confirmed that during the last summer, a marquee was put up to enable residents to sit in the shade and have their meals outside if they wished. This year the home was inspected by the local Fire Service, some remedial work was required to fire doors and has since been completed. The manager said that although the fire alarm system is operating within the requirements of the fire service, it is to be replaced. The work has been agreed with local contractors who maintain the fire system. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that the home employs suitable numbers of staff that are well recruited and adequately trained to meet the needs of the people living at the home. EVIDENCE: The staffing rosters for the home were examined and provided evidence that the staffing levels for the home are two staff on duty during the day and at night one person sleeping in. Suitable on call arrangements are in place should additional staff support be required during the night. The staff group is a group of long serving staff who when spoken with said that they are very happy working at the home. The manager confirmed that the home does not use any agency or relief staff and offers consistency of care from within the staff group. The home employs a total of eight care staff, three of who are full time and five part-time staff. All but one staff member has an NVQ qualification. There was evidence of training in basic food hygiene training, first aid training, fire training, infection control, health and safety and manual handling. There was also evidence of regular formal supervision of staff and appraisals. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 22 Recruitment records for one staff member recently employed by the home was examined and showed that all the required checks were in place and that a thorough recruitment process was followed. Residents are involved in the staff recruitment process and have the final say as to whether a new staff member is permanently employed following their three-month probationary period. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There is leadership; guidance and direction to staff to ensure that the personal wellbeing and safety of residents is promoted through regular safety checks. EVIDENCE: The registered manager is appropriately qualified and has several years’ relevant experience in working with people who have a learning disability. Staff and residents spoken with spoke highly of the manager. During the inspection staff were spoken with and records were looked at. This indicated that the homes approach creates an open and inclusive atmosphere. There was evidence of consistent opportunities for staff and residents to contribute to matters of the home in counsel meetings, staff meetings and daily one to one interactions. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 24 Further development of the home’s quality assurance process demonstrated that the home is underpinned by the views of the residents and the home has suitable systems in place through surveys sent out to relatives and people who have an interest in the home. Residents are helped to complete surveys by staff if they wish to contribute to the process. The findings of the surveys had been collated and a report and action plan subsequently generated. Staff files inspected contained up to date supervision sessions with action notes and recommendations in place. Staff spoken with said they received supervision on a regular basis. Records relating to sessions were seen in staff files inspected. Records relating to the health and safety of individuals living and working in the home were well maintained, with appropriate training undertaken by staff in safe working practices. The testing of equipment and servicing records seen were all up to date. The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 26 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 The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 The Grange DS0000024399.V356711.R01.S.doc Version 5.2 Page 28 - 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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