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Inspection on 14/05/08 for New Bassett House

Also see our care home review for New Bassett House for more information

This is the latest available inspection report for this service, carried out on 14th May 2008.

CSCI 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home it is very well managed by a competent, experienced and knowledgeable manager and management team. People spoken with expressed a very high level of satisfaction about the care that they receive. One person said that, "I wouldn`t change anything about the home". Several people said that when they were poorly staff were very caring and sensitive towards them. Staff will regularly sit with them, giving reassurance, as well as ensuring that the necessary health care is provided from outside professionals. Staff spoken with were very caring and dedicated. One staff member said, "it`s hard work but I love my job". The food provided was of a very good standard. Everyone spoken with was very satisfied with the quality of meals. New Basset House received a high number of compliments from the families of people living at the home. This included letters and cards thanking the management and staff for the good care that had been provided. Staff were keen to regularly remind people living at the home that it was their home and they could do as they wished and anything that they reasonably asked for could be provided where possible. The activities co-ordinator and staff worked hard to ensure that regular outings were organised and anyone that wished to could take part. The home benefited from having several male carers. This meant that anyone that requested a specific gender of carer for personal care could have this. It was evident from observations that there were very good relationships between people living at the home, visitors and staff. There was a good light hearted rapport between everyone, and it was evident that staff enjoyed their work

What has improved since the last inspection?

At the last inspection visit there were requirements made concerning uneven paving which have now been resolved. Some new furniture and redecoration has taken place to improve the home. Progression has been made concerning the use of the computer system to create care planning documentation.

What the care home could do better:

The underfloor heating system does not fully turn off in the hot weather making the home at times uncomfortably hot. Confidential information was not always stored securely. Care planning documentation was not always up-to-date, however there was no evidence that this had affected the quality of care provided.

CARE HOMES FOR OLDER PEOPLE New Bassett House New Bassett House Park Avenue Shirebrook Nr Mansfield Derbyshire NG20 8JW Lead Inspector Jill Wells Unannounced Inspection 14th May 2008 09:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service New Bassett House Address New Bassett House Park Avenue Shirebrook Nr Mansfield Derbyshire NG20 8JW 01623 588000 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.derbyshire.gov.uk Derbyshire County Council Susan Ina Elsden Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th June 2007 Brief Description of the Service: New Bassett House is a home offering 40 places to older persons. It includes 2 places as part of an intensive assessment or intermediate care project. The home is built on one level and is situated in a residential area, near to the town centre of Shirebrook. Arranged on 3 wings the home offers a range of communal rooms to suit different purposes and access for persons with a physical mobility problem is assisted by wide corridors and an open central area. Facilities have been arranged with a domestic style in mind and there is access to the outside areas of the home. Access to outside professionals is routinely arranged and the home benefits from the active support of a local GP. Fees are £392.18 per week for permanent residents, with a range of prices for short term care residents. Additional charges, e.g. hairdressing, chiropody, are clearly identified in the home’s Statement of Purpose and Service User Guide. Copies of inspection reports are available. New Bassett House DS0000035586.V364429.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 the service is two star. This means the people who use the service experience good quality outcomes. The inspection visit was unannounced and took place over 7 hours. There were 30 people living at the home on the day of the inspection and two people for day care. 11 residents, 4 staff, 3 visitors, and the manager were spoken with during the visit. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. We also looked at all the information that we have received, or asked for, since the last key inspection on the 22 June 2007. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. • The previous key inspection report. • Completed surveys from people living at the home, relatives and professionals that visit. Records were examined, including care records, staff records, and minutes of relevant meetings. A tour of the building was carried out. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? At the last inspection visit there were requirements made concerning uneven paving which have now been resolved. Some new furniture and redecoration has taken place to improve the home. Progression has been made concerning the use of the computer system to create care planning documentation. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 7 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. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 and 6. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective people wishing to live at the home have the information and support that they need to help them make a decision about whether the home can meet their needs. EVIDENCE: The statement of purpose and service user guide were available for prospective people wishing to live at the home. These documents provided information that was necessary, but some information was incorrect or missing from the documents, for example the up-to-date information on staff hours, the new contact details of the Commission for Social Care Inspection (CSCI), room sizes and information concerning fees. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 10 We were told that a care manager from Social Services or the manager visits prospective residents at their home or in hospital as part of the assessment process. The majority of residents have visited the home for several periods of respite care or day-care. As a result they knew the home, making their decision to live at the home permanently easier for them. A day’s assessment or a weekend visit was offered for people that did not previously know the home. A person recently admitted to the home was spoken with and said that, it is a lot better than I thought care homes would be. One person wrote in our survey, I attended the home as a visitor, the impression I got was the deciding factor for me. Another person wrote, I did not have choice as it was the home that Social Services said we had to use, as it was their home, but I am happy with the home. Copies of assessments completed by care managers from Social Services were seen on peoples records. These were generally detailed and included information concerning each persons health and personal care needs, social interests, some relevant history and family involvement. One person that had been recently admitted for respite care had an assessment and care plan from their care manager dated 2006, which provided out of date information. The home has 2 places as part of an intensive assessment or intermediate care project. These were not being used at the time of the visit, and therefore not assessed. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples health and personal care needs are met and the principles of respect, dignity and privacy are put into practice. EVIDENCE: The care records of three people living at the home were seen. An initial care plan was completed by the care manager. A personal service plan was then completed by a manager at the home within six weeks of admission. Records included individuals preferences, as well as information about their health and social care needs. They were written in plain language, and were easy to understand. Individual records also included moving and handling plans, falls risk assessment, nutritional assessment and tissue viability risk trigger tools. Some risk assessments were not up to date, for example one person’s tissue viability risk assessment dated 11/4/08 stated review weekly. This had not been done, even though there were changes to the person’s health. However New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 12 action had been taken to ensure that pressure relieving care was in place as a result of these changes in their health. A risk assessment for falls prevention was not up to date as the person was now not mobile but this was not reflected in the document. A moving and handling plan had been completed for one person, but was stored on the computer and not available for care staff to read. Care staff spoken with were however aware of the individuals needs. Care plans were generally available for care staff to read to ensure that they were aware of each persons needs. Social history/significant events had not been explored with individuals and recorded in their file to assist care staff to provide good quality care. A care worker was spoken with and said that they were involved with peoples care plans and could give details of individual care required. The key worker wrote a monthly for each person living at the home, and the ones that were seen were detailed. Records, staff and people living at the home were all able to confirm that GPs and other health professionals were contacted and visited when required. One person said that, staff would call a doctor at the first sign of us being poorly. Medication in the home was stored securely. Either the manager or a deputy manager administered medication. Records showed that all had received medication training. The medication administration records were seen and were correctly completed. Controlled drugs were securely stored. The controlled drugs register had two errors where the balance of medication remaining was incorrect. On further checks it was found that staff had given one person’s medication to another person. As this was the same type and strength of medication, no one had been put at risk. There was a locked fridge for medication that required refrigeration. Care records did not show that individuals had been assessed or asked if they were able to self-medicate. One people had asked to keep their own medication and consent records were completed for this person, although there was no risk assessment. One person wrote in a survey that, The staff are very good with medical issues. However another person said that they were, Kept waiting at times for eye-drops to be applied. We were told that pharmacy audits were completed quarterly to monitor the standard of medication administration at the home. A recent medication error had been reported to CSCI and action had been taken to minimise this re-occurring. There were not photographs of people that had been admitted to the home for respite care in order to ensure identity before medication was administered. People spoken with said that they were treated with respect by staff. Care staff spoken with were very aware of the importance of respecting peoples privacy and could give examples of how they did this. One person said that, I know that they wouldnt offer a male carer to bath me as I wouldnt like this. People living at the home and observations confirmed that staff always knocked and waited before entering bedrooms. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The range of activities and standard of meals offered was good, which met the needs and wishes of people living at the home. EVIDENCE: There was an activities co-ordinator at the home working for 16 hours per week. There was a wide range of activities that people could be involved with. This included movement to music, quizzes, bingo, crosswords and singalongs. On the day of the inspection visit there was bingo taking place. Records were kept of activities offered. A person living at the home in our survey said , I choose not to take part.. Another person said we could do with more activities to keep residents more mobile. Staff said that outings were regularly arranged, although people living at the home were sometimes reluctant to go out. Residents meetings were held on a 3 monthly basis. Minutes of these meetings showed that people were consulted concerning trips out, entertainment and use of residents fund money. Garden furniture had recently New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 14 been stolen, and it had been agreed at a residents meeting that this would be replaced. Visits were planned to other local authority homes. A visitor commented in our survey that having the planned activities displayed would reassure families that activities were being offered. Staff told us that residents could go to bed and get up when they wished to do so. One resident said that, we can come and go as we please as long as we tell staff what we are doing . People were encouraged to bring their own personal possessions with them and bedrooms that were seen were comfortable and had been personalised. There was a choice of food at mealtimes. A menu was displayed. All the people that were spoken with said that the food was of a very good standard. One person wrote on our survey that there was a good varied menu. One person wrote that chips were not up to standard, the bacon was too salty, and some meals could be hotter. This information was passed to the manager. A visitor that completed our survey said that meals were always fresh and varied and that the home caters for everyones needs. One person said that, you cant fault the food, it is always very good. Fresh fruit and vegetables were used. Residents spoken with explained that staff came round the day before to see what they wanted to eat the next day. Tripe had recently been requested and this had been provided. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and are protected from abuse. EVIDENCE: There was one complaint recorded at the home since the last inspection visit. An apology had been given to the complainant and action had been taken to ensure that the issue did not occur again. The complaints procedure was in the entrance. This did not include the up to date address and telephone number of the Commission for Social Care Inspection (CSCI). People spoken with said that they would talk to staff or the manager if they had a complaint. One person wrote in our survey, if I had a complaint I would go to the office. There is a book to record it in. One person spoken with said, we are listened to here, thats what I like. Training records showed that care staff had attended training in safeguarding vulnerable adults and care staff confirmed that they had attended this training and were aware what to do if they suspected abuse of a vulnerable adult. They were aware of the importance of whistleblowing in order to protect people if they saw poor practice. There was a clear safeguarding vulnerable adults policy and procedure. Keeping people safe was given a high priority in New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 16 this service by good training and knowledgeable, caring staff. People spoken with said that they felt safe at the home but if they ever did not feel safe they would talk to a member of staff, the manager or a family member. There were clear financial records of each persons personal money. These were regularly audited in order to ensure that people were protected. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The home is a single storey building with 3 wings. There are 40 single rooms, all with a wash hand basin. A tour of the building showed that the home was clean and well maintained. People spoken with said that they were happy with the level of cleanliness at the home. A person living at the home wrote in our survey that, the home is spotless, the cleaners do a very good job another person was satisfied with the cleanliness of their bedroom but often found the communal toilets not fully clean. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 18 Information from the service was that there had been new furniture in the lounge and some bedrooms, and one corridor had been decorated since the last inspection visit. At the last inspection visit a requirement was made concerning uneven paving outside that was a trip hazard. Since this visit environmental risk assessments have been completed and flagstones have been reset. Trees have also been removed from the front of the building. Fencing was planned to improve the security of the premises. There was a loop system at the home to promote the independence of people with a hearing aid. There were several communal lounge areas including a quiet library and several spaces along corridors where people enjoyed sitting, birdwatching etc. There is a large TV with SKY available, which was much appreciated by people. One person said that the home became too hot in the summer months. This was discussed with the manager and it was explained that very old underfloor heating could not be completely turned off. This made the home uncomfortable in hot weather. There were sufficient numbers of bathrooms and toilets to meet peoples needs. There were grab rails and other aids around the home to assist people with disabilities and maximise their independence. A new hoist has been purchased. There was adequate storage areas to ensure that equipment etc was stored safely. There was a small hairdressing room, and the hairdresser visited weekly. People spoken with were satisfied with the laundry service, however minutes of staff and residents meeting showed that there had been some issues concerning laundry placed in the wrong bedrooms. Bedrooms that were seen were comfortable and homely. People had personalised their own room, with their name on their door. One person said that, my bedroom is small but adequate . There was a public telephone available for people living at the home to use. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment practices and staff training programme were good and ensured that people were protected by competent, well-trained staff. EVIDENCE: On the day of the inspection visit there was the manager, deputy manager and 4 care assistants, as well as domestic and kitchen staff on duty. The duty rota showed that this was usually the case, although there was times when there were 3 care staff on duty. The manager usually worked 9 a.m.-5 p.m. The deputy managers on duty were expected to undertake some care duties. People living at the home were satisfied with the level of care provided. There were three male staff working at the home. This meant that male residents could receive care from a male carer if they chose to. One person wrote on our survey in response to the question about whether staff were available when needed, that, staff were always busy but were there for you. Staff were also described as very helpful and very attentive. One person said that, staff always find the time to be helpful and cheerful and have lots of patience, it is a happy home. A visitor said that the staff work very hard, but always seemed to find time for the residents . One visitor did say in our survey that additional staff would New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 20 improve the home. Staff spoken with were concerned about the level of staffing, particularly when there were people living at the home with high needs. One staff member said that, there is not enough staff on duty, it causes us to go out on our hands and knees sometimes another staff member said that, no one is a risk but staff are shattered. One person said that, its hard work but I love my job. The manager was not assessing dependency levels in order to decide the staffing levels that were needed. It was evident from discussions and observation that all staff work hard, put residents first and worked very well as a team. Staff records that were examined showed a safe recruitment procedure. Application forms were being completed, references and criminal record bureau (CRB) checks were being done. There was an induction programme in place that met the Skills for Care standards and included first aid, food hygiene, moving and handling, hoist training, dementia care, safeguarding adults and bereavement. The manager described a well-developed training programme, with training records to support this. Staff had achieved 80 , which was above the minimum requirement of 50 care staff with National Vocational Qualification, (NVQ), at level 2 or 3. All new staff and managers received training in equality and diversity, and staff spoken with had an understanding of this subject. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very well managed, with systems in place to ensure that people are listened to and action is taken to improve any concerns that are brought to the manager’s attention. EVIDENCE: The manager has the Registered Managers Award (RMA). It was evident from discussions and observation that the manager is competent, knowledgeable and a good leader. The management team consisted of the manager and 4 deputy managers. Regular management meetings were held and the minutes showed good communication between managers. A staff member said that, New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 22 the manager is very professional, tough when she needs to be but very approachable The service manager responsible for the home visits to support the manager. People spoken with said that all the management team were friendly and would listen to you. There was an annual quality assurance survey given to people living at the home and their families. The results were evaluated and sent out to the home by an external manager. It was of concern that this information was not been received by the home for up to 9 months after surveys had been completed. This meant that the home always had out of date information displayed. The last information displayed was dated October 2006. Information from these surveys provided immediately after the inspection visit showed a high satisfaction rate from families and visitors. It also showed that staff were very satisfied with the training and supervision provided. People funded by Social Services had yearly reviews of their care involving a care manager from Social Services. This gave people living at the home and their families an opportunity to address any issues. Residents meetings were held to discuss how the home should be run, discussing menus, outings, activities and any concerns. People are asked if they would like any changes made. Supervision of care staff was taking place, which was recorded, however records showed that one-to-one supervision was only offered on average twice per year for some staff. Regular staff meetings took place to ensure good communication. On the morning of the inspection the inspector found the empty office with an open door and an open filing cabinets with confidential information on display. This does not protect the confidentiality of people living at the home. Regular health and safety checks were being done. This included testing water temperatures, call systems and fire equipment. Chemicals were securely stored and staff spoken with were aware of relevant health and safety issues. Staff were observed using gloves and aprons where appropriate. One staff member said that, we always try and follow the policies to keep everyone safe. Accidents were recorded and the manager reviewed whether any further action needed to be taken to minimise risks. Information received from the service was that all policies and procedures were in place and had been reviewed. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 2 3 New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 24 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. 1. Standard OP9 Regulation 13(2) Requirement The controlled drug registered must show an accurate balance of the medication remaining in order to minimise errors. The heating system must be reviewed to ensure that the building is not too hot on days when heating is not required. This is for the health and safety of people living at the home. Timescale for action 28/05/08 2. OP25 23(2) (p) 01/09/08 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. 2. Refer to Standard OP1 OP3 Good Practice Recommendations The statement of purpose and service user guide should be amended to give people information that is up to date and accurate. The initial assessment and care plan provided by a Social Services care manager must be up-to-date so that staff have all the information in order to meet individuals needs. New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 25 3. OP7 Care planning documentation stored on the computer should to available for all staff to ensure that staff have up to date information on residents current care needs. Individual risk assessments should be kept up to date to ensure residents safety. There should be a record of consultation and assessment of each persons ability and wishes concerning selfadministration of their own medication in order to offer independence where possible. A photograph of new people being admitted to the home including people for respite and day-care should be available so that staff administering medication can check that they are giving medication to the correct person. Dependency levels of people living at the home should be assessed and used to ensure that there are the correct number of staff working to meet everyones needs. The complaints procedure displayed at the home should include the up-to-date address and telephone number of CSCI to ensure that people can contact us if they wish to. Confidential information should be stored securely at all times to ensure the confidentiality and security of peoples records. The outcome of the annual quality assurance surveys should be provided for the home in a timely way to give the manager the opportunity to work on an action plan and people completing the surveys receive feedback. 4. 5. OP7 OP9 6. OP9 7. 8. 9. 10. OP27 OP16 OP37 OP33 New Bassett House DS0000035586.V364429.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 New Bassett House DS0000035586.V364429.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. 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