Inspection on 27/06/08 for Nelson`s Croft

This is the latest available inspection report for this service, carried out on 27th June 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Similar services:

Clover House

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Park Lodge

Mere Hall View

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Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Nelson`s Croft 71 Church Road Bebington Wirral CH63 3EA Lead Inspector Beate Field Unannounced Inspection 27th June 2008 10:40 Nelson`s Croft DS0000071509.V366876.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 Nelson`s Croft DS0000071509.V366876.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. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nelson`s Croft Address 71 Church Road Bebington Wirral CH63 3EA 0151 334 7510 0151 334 1762 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) Wirral Autistic Society Mrs Angela Kemp Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories 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 8. Date of last inspection Not applicable Brief Description of the Service: Nelson Croft was registered with the Commission for Social Care Inspection in February 2008 to provide care for eight adults with autism. Nelsons Croft is comprised of 2 large semi detached houses set in their own grounds. The home has three storeys. On the ground floor there are two lounges, two kitchens (one with a dining area) and a dining room. Bedrooms are single and are located on the ground and first floor. There is good access to toilet and washing facilities. The office and staff accommodation is situated on the second floor of the home. There are patio areas and a garden to the rear of the home. Parking is available on the main road. Nelson Croft is situated in Bebington a residential area of the Wirral, close to local shops and to public transport services. The home is run by Wirral Autistic Society who have several care homes for adults with autism in the area. Wirral Autistic Society provides a range of services and facilities, which are utilised by the people who live at Nelson Croft. Fees are negotiated at the time of placement and are dependent upon a number of factors including the amount of staff cover required. At the time of the inspection, the weekly cost for the service ranged from £1216.00 to £2483.00. A copy of the statement of purpose, which describes the services offered at Nelson Croft, is made available to relatives and social workers. The statement of purpose and the service users guide to the home is made available before a potential resident comes to live at the home and the content is discussed with them to ensure their understanding. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection took place over 5.5 hours and is based on a visit to the home, information received about the service since it’s registration, by an Annual Quality Assurance Assessment (AQAA) completed by the manager. Surveys returned by people who use the service. No surveys were returned by staff or professionals working with the people who use the service. During the site visit to the home time was spent in the office looking at a sample of records and policies and procedures and talking to the manager and staff. A tour of the home was undertaken. The inspector was not able to speak with the people who use the service or make observations of staff delivering care to them at this visit. What the service does well: The assessment process ensures that the service is only offered to individuals whose needs can be met at the home. Care plans are detailed and provide staff with the information they need to be able to appropriately support the people who use the service. The people who use the service are consulted about their everyday lives and are supported and encouraged to make decisions. The people who use the service take part in activities that provide opportunities for their educational, social and personal development. Links with the local community are promoted. The daily routines and arrangements for promoting relationships with family and friends support the needs and wishes of the people who use the service. The personal care and health needs of the people who use the service are well met. Staff training and policies and procedures are in place to ensure that the views of the people who use the service are heard and appropriate action taken. The people who use the service live in a safe and comfortable home environment. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 6 Staff are provided with training and support to enable them to carry out their work effectively. The home is well managed. The welfare of the people who use the service is supported by the quality assurance systems in operation and by the systems in place to promote health and safety. 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. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 7 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 Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 8 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): 1, 2, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process ensures that the service is only offered to individuals whose needs can be met at the home. The process of introducing a new individual to the home ensures that this is managed in a way that meets their specific needs. EVIDENCE: The home has a statement of purpose and a service user guide that provides information about the services offered at Nelson Croft. The documents are made available to prospective residents, their relatives and placing authorities. They provide information around the accommodation, qualifications and experience of staff and how to make a complaint. The service user guide has been made available in a format that would make it easier to understand for people thinking of using the service. A person who returned a survey to the CSCI said that they had been given enough information to help them to decide if the home was suitable for them. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 9 Records show that an assessment takes place before an individual is offered a service at the home. This involves gathering assessment information from the individuals’ social worker, other relevant health and social professionals and from the individual themselves and their family. Staff who undertake assessments are appropriately trained to do so. The initial assessments indicate the communication, religious and cultural needs of a prospective resident. One admission had taken place in an emergency. Although records showed that relevant information had been gathered to ensure that the placement was in the best interests of the individual this had not been recorded in an assessment document that clearly presented the individuals needs prior to admission. The manager reported that this is not the usual practice and would not occur at future admissions to the home. Admissions to the home only take place if the manager is confident that the staff have the skills, ability and qualifications to meet the needs of the assessed prospective resident. The staff at the home have received the training they need to appropriately support the people who use the service. The services of health and social care professionals are accessed, as they are needed. Prospective residents can make a number of visits to the home to get to know the service, meet the staff and residents. Records and a discussion with the manager and deputy indicated that prior to any new admission a plan is put in place with input from the individual themselves, family, health and social care professionals as to the most appropriate way of introducing the individual to the service. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal goals and individual needs of the people who use the service are well documented, providing staff with the information they need to support them. EVIDENCE: Care plans were examined and contained clear information to enable staff to provide appropriate support around day-to-day living and personal goals. The Annual Quality Assurance Assessment (AQAA) completed by the manager shows that reviews of care plans will be taking place on a 6 monthly basis or more frequently if needed. One individual’s records showed that a review had already taken place and that the resident, their relatives, key worker, social worker and other relevant individuals were invited to contribute. Work is currently taking place to provide more person centred care plans. Care needs Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 11 to be taken to ensure that care-planning information is clearly dated. Records show that the people who use the service are supported to take identified risks. The risk assessments seen provided clear guidance for staff. Care plans that detail specific behaviour management strategies are in place. All staff have been trained in non-violent crisis intervention training. An accredited trainer is providing this instruction to staff. The people who use the service are consulted about their everyday lives and are supported and encouraged to make decisions. They are also encouraged to contribute to how the home operates. For example, the people who use the service have been involved in choosing how their bedrooms are furnished and decorated; they choose the meals that are provided. Each person who uses the service has a key worker who is able to gain his or her views and contribute to the individuals care plan. There are regular residents meetings. The opinions of the people who use the service are also obtained at their 6 monthly reviews and through surveys. The results of a survey that had been sent to two of the people who use the service whose records were seen showed that they are happy at the home, like their bedroom, the food, know how to complain if not happy and are happy with support from staff. There is information available for staff on the communication needs of the people who use the service. The manager reported that she is in the process of introducing visual communication aids to assist the people who use the service to make more meaningful choices in their lives. Communication passports are to be developed for any people who do not have them. There is an easy read complaint procedure and survey form available and work is taking place around developing further information in more accessible formats. The people who use the service are encouraged to contribute towards the running of the household. They tidy and clean their bedrooms, go shopping and help with meal preparation in accordance with their abilities. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 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): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service are able to take part in appropriate activities that provide opportunities for their educational, social and personal development. EVIDENCE: The people who use the service have a range of activities available to them throughout the week. These activities have been drawn up in consultation with them and meet their needs, skills and individual preferences. All the people who use the service attend the Wirral Autistic Society’s day service, where a range of educational, practical and social development opportunities are available. People also spend days at home to concentrate on the development of certain skills or to pursue their interests. The manager is looking at Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 13 providing work experience and college courses for some individuals who will benefit from this. The weekly activities are reviewed to ensure that they continue to meet the needs of the people who use the service. Records and a discussion with staff indicate that there are opportunities for the people who use the service to become involved in the local community in accordance with their wishes. They visit the cinema, theatres, social clubs, local pubs and restaurants and places of interest in the area. The people who use the service have staff support at all times when in the community in line with agreed risk assessments. Records show the hobbies and interests of the people using the service and also indicate that the people using the service pursue them with the support of staff where this is necessary. Families are encouraged to remain an active part of their family members life and all the people who live at Nelsons Croft have regular involvement with their respective families. Discussions with the staff confirmed that the home’s routines are flexible as much as possible and fit in with the needs and wishes of the people who use the service. The records inspected indicate the skills and the support the people who use the service need in their daily lives in order to make decisions and encourage independence. A person who returned a survey to the CSCI said that they make choices and decisions about their daily lives. The people who use the service choose the meals at the home and are given guidance where needed around maintaining a balanced diet. A record of the meals provided is maintained and showed that they are varied and in general well balanced. Where a change to the meals provided is made care needs to be taken to ensure that this is recorded. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 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. 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 personal care and health needs of the people who use the service are well met. EVIDENCE: Records detail the support the people who use the service need with their personal care. Staff receive training on promoting privacy and dignity during their induction. Consistency and continuity of support for the people who use the service is provided through the key worker system. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 15 Records show that the people who use the service have access to medical/health care professionals as needed. The people who use the service are supported and facilitated to take control of and manage their own healthcare in accordance with their abilities. A medication procedure is available which provides clear guidance. Medication is stored securely. The training records show that staff have received training in the safe handling of medication. A selection of medication administration record sheets and corresponding medication were inspected and found to be in order. Accident records show that appropriate action is taken by staff following an accident at the home. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 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. 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. The people who use the service have their views listened to and they are safeguarded from abuse. EVIDENCE: Wirral Autistic Society has a complaints policy and procedure. A copy of the procedure is held in the home and is also detailed in the statement of purpose and service user guide. No complaints have been received by the Commission for Social Care Inspection since the registration of the service. No complaints have been made directly to the service. People who returned surveys to the home and to the CSCI said they are happy at the home but would know how to make a complaint if they needed to. Staff have access to appropriate adult protection procedures. Training records show that all staff that work at the home have received appropriate internal training on recognising abuse and of the action to be taken in the event of abuse being suspected. Referrals concerning safeguarding incidents have been managed appropriately at the service. Behaviour management plans show the action that staff are to take to support the people who use the service. Staff have received training in the management of challenging behaviour from an accredited trainer. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 17 Some people who use the service manage their own personal allowances with advice and guidance from staff. Some people’s personal allowances are managed by the staff. An examination of the financial records held at the home showed that some work is needed to ensure that the records appropriately reflect the amount of money held on behalf of the people at the service. Two records seen did not tally with the amount of money held (by a small amount) and the personal allowance record book for a further person could not be located. Following the visit the manager advised that this issue has been addressed. The manager should go through the systems in place to safeguard the finances of the people who use the service to ensure all staff are aware of the processes to follow. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service live in a homely, comfortable and safe environment. EVIDENCE: The home is well presented and decorated and furnished to a very good standard. The home was clean during the time of the visit. All bedrooms are single. The bedrooms seen had been personalised by their occupants. All bedrooms have an en-suite facility. There are four additional bathrooms situated on the first and second floors and an accessible toilet on either side of the ground floor of the home. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 19 There are two communal lounges, two kitchens (one with a dining area) and a dining room on the ground floor. There is also a large conservatory on the ground floor providing additional communal space on one side of the home. The basement area currently provides storage for the home and is not accessible to the people living there. The home has two separate patio areas with seating. Work is currently taking place to enhance the large garden at the home. The people who use the service have been involved in planting flowers and shrubs to enhance the outdoor areas. The premises are in general safe. Radiators have low surface temperatures, windows have restrictors in place to prevent them from opening too wide and hot water is maintained at a safe temperature. A tour of the home showed that storage arrangements are safe. A low level banister on one side of the home has been raised in order to prevent an accident occurring. At the time of the visit there was a low level banister at the other side of the home that could have presented a risk to the safety of the people using the service. Following the visit the manager confirmed that works to increase the height of this banister were carried out on 18th July 2008. As part of the registration process evidence was provided that the electrical wiring, gas and fire safety systems at the home are in good working order. At this visit the fire safety records were seen. Fire drills are carried out on a regular basis. The manager reported that the fire drills take place weekly and that the fire alarm and emergency lighting are also tested at the same time. The records seen did not indicate that checks of the fire alarm or emergency lighting had taken place. This information needs to be clearly recorded. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 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. 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. The number of staff available supports the people who use the service and the training staff have received ensures that they are well equipped to meet their needs. EVIDENCE: An examination of the rota and a discussion with the manager and deputy manager indicated that staff are appropriately deployed to meet the needs of the people who use the service. During the day there are 4 support staff and 4 – 6 support staff in the evenings. 4 people who use the service have 1:1 staffing and the high number of staff at the service reflects this. At night there is one sleeping in and one waking member of staff available. The manager works additional hours and is not included in the support staff numbers. There is a core staff team employed at the home. There is currently one 30 hour staff vacancy. Bank staff are used to cover absences. Bank staff have Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 21 been recruited to work for Wirral Autistic Society to cover absences in the homes if needed or to provide support within the day care service. The current staff team were recruited to meet the needs of the individuals living at the home. All the staff have spent time working with the people who use the service whilst they attended day services, before they moved in. This meant that they could get to know the individuals well, especially as some of the people who use the service have limited or no verbal communication. A comprehensive induction-training programme is provided to staff. This includes training around meeting the needs of individuals who have autism, health and safety, food hygiene, epilepsy management, the safe handling of medication, communication, safeguarding vulnerable adults, equal opportunities and first aid. Specialist training is provided to staff to assist them to support the people who use the service as appropriate. Staff are encouraged to undertake an NVQ in caring for adults with a learning disability. At present over 50 of staff hold this qualification. A member of staff spoken with said that they are given the training they need to meet the needs of the people who use the service and that they are supported by the management team in their work. The records of staff recruitment were examined and were found to be well managed and contained all the required information. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed. The people who use the service benefit from the quality assurance systems in place at the home and from the arrangements for staff support. EVIDENCE: Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 23 The manager of the home has had 14 years of management experience in residential care for adults with a learning disability. The manager has appropriate qualifications in care and management and has undertaken periodic training to maintain and update her knowledge skills and competence. The manager has applied to the CSCI to be the registered manager for the home. The manager provided a very comprehensive Annual Quality Assurance Assessment (AQAA), which provided clear information about how the service is operating, what is working well and plans to develop the service further. The staff member spoken with said that they are well supported by the manager and they consider their views regarding the running of the home are sought and listened to. They said that they receive regular supervision and that team meetings are held on a regular basis. There are a range of quality assurance systems in place. Wirral Autistic Society is accredited by the National Autistic Society which carries out an inspection of services provided. Wirral Autistic Society conducts an internal audit of the society as a whole every 12 months and on the basis of this prepares an action plan for the next 12 months. The organisations accounts are audited on an annual basis. A copy of the annual accounts have been made available to the CSCI, together with the annual review of the operation of Wirral Autistic Society. The views of the people who use the service are sought. There are plans to provide surveys to relatives to find out their views about how the home operates. Visits to the home by the representative of the registered provider are made. These reports are made available to the CSCI. The manager carries out a monthly house check of all reccords and the premises. The manager reported that questionnaires for health and social care professionals are in the process of being devised. Training around safe working practices such as manual handling, fire safety, infection control and first aid is made available to staff as part of their induction. There is a rolling programme of training opportunities provided and staff can access this when required. There are a range of policies and procedures available that promote safe working practices. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 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 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 3 28 3 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 3 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 Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 25 Not applicable Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23 (4) (C) Requirement The registered persons must ensure that a clear record is made of the checks of the fire alarm and emergency lighting in order to demonstrate that the fire safety systems at the home are in good working order. Timescale for action 27/06/08 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 YA23 Good Practice Recommendations The manager should go through the systems in place to safeguard the finances of the people who use the service to ensure all staff are aware of the processes to follow. Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North West Regional contact Team Unit 1, 3Rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 01772 730100 Fax: 01772 730176 Email: enquiries.northwest@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 Nelson`s Croft DS0000071509.V366876.R01.S.doc Version 5.2 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. 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