Inspection on 22/09/09 for Hennel Lane

This is the latest available inspection report for this service, carried out on 22nd September 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Hennel Lane 99 Hennel Lane Lostock Hall Preston Lancashire PR5 5UL Lead Inspector Mrs Felicity Lacey Key Unannounced Inspection 22nd September 2009 09:00 Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 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 home adults 18-65 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. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 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 Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Hennel Lane Address 99 Hennel Lane Lostock Hall Preston Lancashire PR5 5UL 01772 323131 01772 322187 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) www.scope.org.uk SCOPE Michael Sharples Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only- Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD The maximum number of people who can be accommodated is: 5 Date of last inspection This is the first inspection of Hennel Lane. Brief Description of the Service: Hennel Lane is a residential service which can provide personal care and support for up to five people who have a learning disability. The service is operated by Scope, a national association, which specialises in providing services for people with a learning disability. The service provides transitional support where people are encouraged to develop independent living skills to enable them to then move on to supported living on a permanent basis. Information about the current fee level can be obtained from the manager of the service. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 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 that the people who use this service experience good quality outcomes. This inspection included an unannounced visit to the service. Information was provided by the manager of the service including the way in which the staff of Hennel Lane meet the needs of the people using the service, the training and support staff receive and data about health and safety at the service. Surveys were received from people who use the service and staff members. The people living at Hennel Lane, the staff, the manager and a visiting professional were spoken with during the visit to give their views on the support provided and day to day running of the service. Case records and documents relating to the support provided at the service were looked at. A tour of the premises took place. What the service does well: The people who gave their views during this inspection were satisfied with all aspects of the service provided. Their comments included: ‘Hennel Lane cares for young adults well, and there are regular meetings with staff.’ ‘The team works very well together which has a very good effect on the young adults. We have the best interests of the young adults at heart and try to involve them in activities that meet their needs and interests, giving them support and reassurance when needed.’ ‘The young adults go out doing all sorts of activities and lead a very full life. The manager and staff are totally committed to each young person and their welfare.’ ‘Hennel Lane provides a good home environment and enables young adults to access the local and wider community for social and educational activities.’ ‘The young adults and staff are treated well and with respect.’ There is a planned process of admission to the service, and good examples of people being supported through the transition from school and education to a more independent type of living. The people who live at Hennel Lane are able to maintain contact with their families, who in some cases live many miles away, by the provision of Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 6 accommodation which is owned by the organisation. The staff also help people keep contact with their families through regular up dates and contacts. The staff are committed to helping people widen their experiences and develop new skills. The people are involved in attending college courses, work experience, community activities and using local facilities. The people who live at Hennel Lane benefit from a high level of staffing. They are supported to direct their own care as much as possible. The staff have worked with the people at the service to establish effective ways of communication. Relevant professional advice is sought when needed. There are a range of people involved including physiotherapists, psychologist and communication therapists. Staff are recruited and the required checks are completed. All staff complete a four week induction as preparation for working independently. The staff benefit from regular informal and formal supervision, and team meetings. The staff receive regular and appropriate training opportunities. This includes safe techniques for managing behaviour. The staff benefit from locally organised training and from having opportunities through Scope to add to their skills. The staff are guided by Scope policies and procedures, and these include Equality and Diversity, Whistle Blowing and Sexuality and Personal Relationships Policy. The property has been furnished and decorated to meet the needs of the people who live there. The preferences of people have been taken into consideration. The property is spacious. There are regular routine health and safety checks. What has improved since the last inspection? What they could do better: The service met the minimum standards in all key areas. There are some ways in which improvements can be made on existing systems. The reporting of incidents when physical restraint has been used should be developed to allow for greater analysis of incidents, which may lead to a change in a persons support plan or highlight the need for staff training. The security of the medication held at the service should be improved by providing a more robust audit trail for access to the medication. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 7 The documents and recording at the service should be reviewed to ensure they are reflective of the statement of purpose of the service. References to students, on site and other such terms which have been continued from a educational based service should be changed to reflect the nature of Hennel Lane which provides supported living for young adults. 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. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 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 Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 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 moving to Hennel Lane benefit from a planned move in which they are involved, this allows them to be part of the decision making process and to become familiar with the service. EVIDENCE: All people coming to live at Hennel Lane are supported during a planned introduction to the service. This can include accompanied visits to Hennel Lane during which the new person becomes familiar with the house, the other people living there and the staff. There was evidence that this helps people become familiar with the service, and that staff are responsive to the choices of the person. ‘Social Stories’ which use photos and simple sentences explain what is happening. An example of this was seen in one person’s room where a ‘Social Story’ had been used to introduce a new person to the house. The case files seen showed that extensive assessments had been completed before people moved to the house. The assessments include a communication profile, an assessment of risks and vulnerabilities and a record of personal preferences and choices. Families and advocates are involved in the assessment and introduction process. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 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 are supported in line with their individual preferences and aspirations and are encouraged to express their opinions and be in control of their own life. EVIDENCE: Each young person has a plan which details the support and assistance required to promote independence. The plan includes the views and preferences of the young person. The plan contains guidance and advice about how the persons needs are best met, for example one communication assessment seen contained analysis of the communication needs of the person and gave suggestions about how to promote development in communication and the type of activities that should be used. Some of the people who live at Hennel Lane need support to manage their behaviour. All staff are trained in the use of safe techniques that may be Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 11 needed to prevent a person from harming themselves or others. There was evidence of the emphasis on proactive intervention and identifying ways in which behaviour can be positively managed. On the occasions that a restraint is used this is logged and monitored in a number of ways; it is understood that this approach is only used when all other approaches have been tried. The reporting of incidents when physical restraint has been used should be developed to allow for greater analysis of incidents, which may lead to a change in a persons support plan or highlight the need for staff training. Each young person has a key worker. The staff have to apply for this role. The key worker is responsible for ensuring that the support plan is regularly reviewed and up dated, they also complete a monthly summary which documents the progress made in implementing the support plan. The summary recognises the achievements of the person during the month and identifies any areas where further action is needed. The summary is sent to the person’s family and this ensures that they continue to be aware of the progress being made by and are involved in the lives of their son or daughter. The staff have devised a number of ways to involve people in decision making. One example of this is the use of digital photography to present options of activities to a person. This helps people express their choices and demonstrates that their choices will be respected. The approach to the person is based on an understanding of their individual ways of communication and levels of understanding. The manager is aware of the Deprivation of Liberty Safeguarding process, which has been introduced to ensure that people who may lack capacity in some areas of their lives have their rights protected. Any restriction which may be used as part of a persons support plan is considered in light of this new legislation. There were a number of risk assessments and behaviour management programmes seen on individual files. There is an initial assessment of Risks and Vulnerabilities and this highlights areas which may require risk management. The need to balance individual rights to independence and freedom with a person’s health and safety is understood by staff. There was evidence of staff supporting young people to take risks as part of an independent life style, for example by encouraging people to manage their own finances in line with their understanding. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 12 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): This is what people staying in this care home experience: 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 are supported to be involved in occupations and activities, and maintain links with their family and friends; this enables them to lead a fulfilling life in and outside of their home. EVIDENCE: The young people who live at Hennel Lane have the opportunity to become involved in a range of work and leisure activities. Currently one person attends work experience at Blackpool Zoo and attends a local college, another person is gaining work experience at a local leisure centre. Staff support the young people in line with their needs to make good use of the local community for example by using public transport, visiting the local library and leisure facilities and by using local clubs. The people living at Hennel Lane have a range of hobbies including horse riding, football and playing computer games. During the visit to Hennel Lane the staff were actively supporting the young people to each to follow their own daily plans. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 13 The people living at the service keep close contact with their families. This can be by phone, letters and email. Families are able to visit when they like and the young people are supported to visit their parents. Scope is able to offer accommodation locally and this is a great benefit for parents who live some distance away. The families of people at the service receive regular updates on what their relative has been doing and significant events. The staff support people to develop personal relationships and friendships. The service has a Sexual Health and Relationships policy and has engaged with specialist advisors to help people understand their feelings and how to express these in socially appropriate ways. The daily routines of the house promote independence and respect personal choices. Staff respect people’s bedrooms as their own private space. Some people at the service have their own keys. Bedrooms can be locked. People are able to spend their time where they like; this may be in their own room, the lounge, kitchen or garden. The people at Hennel Lane are involved in the planning and preparation of their own meals. The people supported have varying levels of independence, and each person is assisted in the best way to promote their independence. People can choose to eat together or on their own. When necessary staff can consult with relevant health professionals with regard to dietary needs and will monitor dietary intake and weight as required. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 14 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. 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. People are supported to meet their health and personal care needs by a staff team who are flexible, consistent, reliable and responsive to their changing needs. EVIDENCE: Personal support is provided in ways which promote independence and respect personal choices. The people living at Hennel Lane receive additional specialist support as required. On the day of the visit a health professional was spoken with, who confirmed that she found that staff listened and followed the advice given. She was confident that this was done consistently and she had seen good progress being made by the person she was supporting. The staff team is stable and the staff members spoken with felt they were acting as part of a team. The people at the service each have a key worker and this is a person who they are comfortable with. The records relating to each person at the home show that they are supported in their individual interests and activities, by staff who are able to offer consistent and responsive support. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 15 The records seen during the visit demonstrated the active involvement of a range of health professionals to meet the assessed needs of the people living at Hennel Lane. These included the physiotherapist, Communication Therapists, Consultants, and Psychologist input. All the young people are registered with local GP and dental services. The staff are aware of on going health conditions and seek treatment for any new health issues. The staff are trained in the safe administration of medication. People are able to self medicate if it is safe to do so. The medication administration sheets seen had been completed correctly and accurately. The security of the medication held at the service should be improved by providing a more robust audit trail for access to the medication. There was evidence of the regular review of medications. The manager is encouraging ways of supporting people which will help improve their access to appropriate treatments, for example by encouraging nursing staff to come to the house to carry out an injection or to take a blood sample, there has been greater success as the people supported can be agitated and anxious in an unfamiliar setting, and feel less anxious in the familiar surroundings of their own house. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 16 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. 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. People are protected by the policies and procedures of the service and are supported by staff who have relevant training to safeguard their welfare. EVIDENCE: The service has a complaints procedure which is given to parents and representatives as well as to the young people. There have been no formal complaints. The young adults are encouraged to make their views known, when a person is not able to fully express their opinion they may be supported by an advocate, to ensure their rights are upheld. Key workers regularly liaise with family members to keep them informed and help resolve any issues. The staff spoken with during the visit understood the complaints procedures and would also attempt to resolve any concern if they were able. The staff understand safeguarding procedures. Scope also provides support in safeguarding matters. People at the service are safeguarded from staff that may be unsuitable to work with vulnerable adults by the employment checks carried out by the organisation which includes a check of the Protection of Vulnerable Adults (POVA) register. Some of the young people have challenging behaviours. All staff are trained in safe physical intervention methods. This training is regularly refreshed. Two staff members are accredited trainers. All situations where physical intervention is used are recorded. As mentioned previously in this report, Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 17 incident reports could be developed further to give more information and consideration of the circumstances in which the physical intervention was necessary. The manager is aware of the Mental Capacity Act Deprivation of Liberty Safeguard guidance. He has consulted with the Local Authority about the need to implement this for some people at the service. At present it is not seen as necessary to apply this process. The young people have access to their own personal monies. The manager does not act as an appointee. Any expenditure on behalf of a person at the service is accounted for. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 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 live in a safe and well maintained building, which provides a pleasant place to live. EVIDENCE: Hennel Lane is a detached property situated in a residential area of Lostock Hall. There are five single bedrooms, two of which are fitted a shower ensuite. There is one ground floor bedroom. There are two communal bathrooms one situated on the ground floor which has a shower, while the first floor bathroom has a bath and shower cubicle fitted. There is also a room for a member of staff to sleep in, which is situated on the ground floor. The home has a large lounge, a separate dining room and a conservatory. The kitchen is large and equipped with all necessary appliances. All rooms are decorated and furnished to a high standard. The people who live at Hennel Lane are encouraged to Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 19 arrange their rooms to their liking, and have been involved in choosing colour schemes and furnishings. All rooms on the first floor have window restrictors in place and radiators are fitted with guards. In addition water outlets are fitted with thermostatically controlled valves and the organisation has procedures in place for checking these on a monthly basis. There are a number of routine safety checks which are carried out by the staff to ensure the environment remains hazard free and safe including a Maintenance Log and Fire Log Book. The service has sufficient laundry facilities, which are domestic in style, in keeping with the purpose of the service to encourage independence. The staff have received training in infection control and good practice to prevent the spread of infection. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 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 are supported by trained and competent staff, recruitment practices are robust and this safeguards the welfare of people living there. EVIDENCE: The service is staffed in accordance with the needs of the people living there. The staff spoken with during the visit and who completed surveys felt well supported in their job roles. The staff are aware of the individual plans for each young person. There are good communication systems in place which ensure that all staff are kept informed of developments and events. The recruitment practices at the service ensure that the required references and Criminal Record Bureau Disclosures are obtained. The manager has the support of Scope Human Resources department for advice. The recruitment checks carried out include a Criminal Records Bureau enhanced disclosure, a right to work in the UK check and Occupational Health Check. The staff files seen contained the required documentation. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 21 All staff complete an extensive four week induction. New staff members are allocated a mentor and have regular meetings with their line manager. The induction covers all aspects of working at Hennel Lane and the policies and procedures of the organisation. Records were seen of completed induction on staff files, and the staff spoken with confirmed they had completed this process and had found it to be very useful. All staff have their own induction file which they can keep for reference. The staff receive regular training in relevant topics. Over 50 of staff hold a National Vocational Qualification in Care, this is the recommended qualification for people working in the social care field. All staff have training in behaviour management. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 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 at Hennel Lane benefit from a well run service, which is managed in an inclusive way. EVIDENCE: The manager is experienced and has completed relevant training. People living and working at the service consider the manager to be approachable and very supportive. The manager is supported by two deputy managers. Scope, the company which operates Hennel Lane, also provides supervision and support for the manager. The manager monitors the quality of care and support provided, through informal and formal means. There is high level of day to day contact between Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 23 the manager, staff and people using the service. The service is monitored by Scope who have a quality assurance process, part of this involves regular visits to the service by a representative of the company. A copy of the outcome of these visits had been provided to the manager and was seen during this inspection. In this way the company demonstrates that it is aware of the quality and standards within the service. Staff receive training in safe working practises. Required health and safety checks are completed. Accidents are recorded and monitored. The manager confirmed that the required maintenance checks are carried out. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 24 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 3 13 3 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 Version 5.3 Page 25 Hennel Lane DS0000072705.V377832.R01.S.doc N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 26 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northwest@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. Hennel Lane DS0000072705.V377832.R01.S.doc Version 5.3 Page 27 - 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!