Inspection on 14/05/07 for 121 Watley`s End

This inspection was carried out on 14th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

121 Watley`s End 20/04/06

121 Watley`s End 26/09/05

121 Watley`s End 05/05/05

121 Watley`s End 31/01/05

121 Watley`s End 11/08/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 121 Watley`s End 121 Watley`s End Road Winterbourne South Glos BS36 1QG Lead Inspector Melanie Edwards Key Unannounced Inspection 14th May 2007 09:00 DS0000020258.V336029.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 DS0000020258.V336029.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. DS0000020258.V336029.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 121 Watley`s End Address 121 Watley`s End Road Winterbourne South Glos BS36 1QG 01454 250232 01454 250994 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) admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mrs Carol Elizabeth Close Care Home 14 Category(ies) of Learning disability (14), Physical disability (14) registration, with number of places DS0000020258.V336029.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 14 persons aged 18 years and over with learning disability who may also have physical disability and who require nursing care Staffing Notice dated 20/07/2001 applies Manager must be a RN on part 5 or 14 of the NMC register Date of last inspection 20th April 2006 Brief Description of the Service: Aspects and Milestones Trust operate 121 Watleys End Road, which is registered to provide nursing care to 14 adults with a learning disability and a physical disability. The property is located in a quiet residential area, close to local shops and amenities. There are 14 single bedrooms of various sizes, all of which have sinks. There are parking spaces and grounds to the side and rear of the house. The fees that are charged for staying at the Home are £1500.14, a week. There are extra charges for chiropodist, hairdresser and the shared use and petrol costs of the minibus. DS0000020258.V336029.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Residents who live at the Home have multiple disabilities, and this makes it hard for them to express their views verbally. Time was spent talking to five support workers about their roles and responsibilities, training and development needs. The registered manager Mrs Close was also interviewed during the inspection. Staff were observed assisting residents with their range of care needs. A sample of records that relate to the day-to-day running of the Home, as well as care records were inspected. The Home was viewed throughout. The Home was operating within the required conditions of registration, which we impose. The conditions of registration set out the type of care and the needs of persons as well as the numbers of persons who may stay at the Home. What the service does well: What has improved since the last inspection? The care plan identified at the last inspection has been reviewed and updated. This demonstrates staff are making sure they know what residents needs are and also that they are still able to meet them. DS0000020258.V336029.R01.S.doc Version 5.2 Page 6 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. DS0000020258.V336029.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 DS0000020258.V336029.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. Quality in this outcome area is good. Residents have their needs assessed and well met. Residents’ representatives are given the information they need to help them make informed choices about the Home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Due to residents’ multiple disabilities it is hard for them to communicate their needs. To be able to support and understand residents the staff have developed a very good understanding and knowledge of their complex needs. Staff understand residents’ body language, gestures, and use long-term knowledge of the person to understand their needs. Staff were observed assisting residents and responding to their body language and facial gestures. Staff communicated with all the residents in a warm manner, and used humour and sensitive touch. In discussion with all the staff it was evident how fond of, and how close staff are to all residents. Staff conveyed that they work in a very person centred way. This means they treat each resident as a unique individual. This was noticeable throughout the inspection. The staff communicated with residents with respect, and in a way that showed warmth and friendship. This helps to ensure each resident is valued and treated with respect. DS0000020258.V336029.R01.S.doc Version 5.2 Page 9 To find out more about how residents’ care needs are assessed and how the care they need is being planned, two residents assessment records were looked at in detail. There have been no new people admitted to the Home since before the last inspection. However the assessment records of two residents who live at the Home were reviewed. The assessments included a range of information, and set out each resident’s range of complex care needs. The residents’ assessment records had been reviewed in the last six months by registered nurses and the support workers. This is good evidence demonstrating staff monitor residents’ changing needs to make sure they can still meet them. To find out how residents, and their representatives can find out about the Home a copy of the service users guide was reviewed. The guide includes information about the service provided, the qualifications of the staff employed, and the accommodation. The philosophy of the Home and how the service aim to meet residents needs is also included. The complaints procedure is also in the document so that residents know how to complain about the service. However residents would find it hard to read the document in its current form. The Home should think about devising a new guide that is in a more accessible, easy to understand format. DS0000020258.V336029.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): 6,7,9. Quality in this outcome area is good. Residents needs are assessed and their care plans reflect how needs are met. Residents are supported to make decisions and to take risks in their daily lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: To find out how effectively residents are being supported to meet their needs, staff were observed assisting people throughout the morning. Residents were observed getting up at different times during the morning. This helps to demonstrate how their choices and preferences are respected. Staff were observed helping residents in a sensitive and calm manner. They were meeting residents’ needs in the way set out in the care plans. DS0000020258.V336029.R01.S.doc Version 5.2 Page 11 To check the quality of care residents receive, two residents care plans were read in detail. There was a detailed personal profile, completed for the residents. This included their personal history, information about their physical and mental health history, as well as a record of the important people in their lives such as family and friends. There was also an informative plan of care for each resident addressing their physical, mental, and social needs. The care plans aimed to promote independence for the residents in their daily lives. There was evidence that staff had tried to include what they think are the wishes and aspirations of the person. There was also evidence that the care plans had been evaluated and updated on a regular basis. Residents go out with staff in the minibus on a regular basis to a range of social and therapeutic activities. Day care staff, and staff from the Home go out nearly every day with residents in small groups, to places that residents enjoy in the community. This is good evidence of how residents are well supported to take risks in their daily lives. There was further helpful information written in care plans that showed how residents are supported to meet their social needs and to take risks in their daily lives. There was detailed information included in care plans that set out the potential risks the person may face, and any risk behaviours. The plans of care clearly recorded the preferred approaches staff should take. There was also information written in resident’s records that showed staff were aiming to support them to maintain their independence in their daily living. DS0000020258.V336029.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): 12,13,16,17. Quality in this outcome area is good. Residents are well supported to take part in a range of appropriate activities. They are further supported to be a part of the community and to have personal relationships. Residents are also provided with a varied and well balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff try and ensure residents do the sort of social and therapeutic activities they want to do. Care plans include detailed information that showed residents have very different likes and dislikes and are supported to attend a range of trips, events and activities that they enjoy. A small group of residents have recently returned from a holiday to Minehead. DS0000020258.V336029.R01.S.doc Version 5.2 Page 13 One of the residents showed the inspector some pictures of the holiday. The residents looked as if they had a very enjoyable time. Last week a small group of residents went to the Colston Hall in Bristol to see a ‘Three Degrees’ tribute band. The staff said that the residents had a really good time. They said that one resident kissed the staff on the cheek during the concert. This is the person’s way of saying how much they are enjoying themselves. On the day of the inspection two residents went to out for lunch to the local pub. One resident went out to the post office to post invites for their birthday party being held later in the week. Another small group of residents went to hydrotherapy for a relaxing morning. Other residents went out to day care activities with the support of staff. One resident was helping a member of staff to put out rubbish bags from the Home, the resident concerned looked very engaged in this activity. The staff team demonstrate a commendable level of commitment to ensuring residents lead meaningful and fulfilling lives. A copy of the menu was reviewed to check if residents are being offered a varied and well balanced diet. There was a range of dishes recorded as being available for each day. There was evidence seen that demonstrate residents likes and dislikes are included when menus are planned. There was a varied choice of meal options available for the residents. Meal options included a range of traditional, nutritional meals. A sample of the lunch meal was tasted to check on the quality of the cooking in the Home. The meal was a choice of cauliflower and broccoli bake, or freshly made vegetable soup and a selection of sandwiches. Staff were helping residents with their meals in a sensitive and discreet way. This shows staff make sure meal times are a respectful and dignified experience for residents. DS0000020258.V336029.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): 18,19,20. Quality in this outcome area is good. Residents are supported to meet their needs in the way preferred by them. The systems in place for the handling, storage and disposal of residents’ medication are safe. However residents could benefit if there were more robust systems in place for administering medication given, `as required’. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As has already been referred to earlier in the report, staff aim to communicate and understand residents by relying on their long-term knowledge of them. They also communicate with residents by reading their body language and the many different ways that they verbally express themselves. This means staff have to be very observant and knowledgeable about residents, to know if they are in pain or if they may be ill. This information was recorded by in-depth detail in residents care records. This helps all staff to understand residents and ensure their physical wellbeing is maintained. DS0000020258.V336029.R01.S.doc Version 5.2 Page 15 During the inspection, a GP came to the Home to attend to the physical health needs of four of the residents. This is all good evidence of how staff support residents to ensure their health is maintained by calling the doctor on their behalf if they are, or staff believe they may be, unwell. There was information in the daily records that staff monitor and observe the health of residents who use the service and call the doctor, if they were concerned about the person. There was information that showed that residents who use the service receive support and treatment as required from the specialist Psychiatrist. Staff conveyed in discussion that they monitor residents’ physical health as well as provide emotional support. This helps to demonstrate that residents’ health care needs are being met. There was information in care plans confirming residents attend regular appointments at the dentist. There was correspondence from the dietician, the occupational therapist, the physiotherapist and the speech therapists who all give advice and support to residents with their particular needs. As has been written in standard 6 of the report, there was detailed evidence in the care records that showed that the preferred day-to-day routine of the residents and particular likes and dislikes were recorded. This helps ensure residents’ needs are met in the way that is preferred by them. Staff who were consulted were familiar with the information in care plans, and how best to support residents with their care needs. The procedures and systems in place for administration, storage and disposal of medication were checked to monitor if the systems are safe. The medication administration charts of ten residents were inspected. There was a photograph of the person maintained with each record. This should ensure medication is administered correctly to the person named on the chart. The administration charts were up to date, legible and in good order. The staff had signed for medication administrated, or recorded the reasons for any omissions. However, there were no written guidelines in place to advise staff when to give prescribed medication that is ‘give as required’. This guidance would assist staff and ensure medication is administered when it is needed. The stock of medication held in the Home was satisfactorily organised. The medication administration charts were legible, up to date, and contained the signature of the dispensing member of staff; demonstrating residents’ medication is administered safely. The reasons for any omissions had also been written on the charts. Medication that was no longer required was being returned to the pharmacist. DS0000020258.V336029.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): 22,23. Quality in this outcome area is good. Residents and those who represent them are well supported to make complaints about the service. Also there are systems in place to protect Residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff were able to explain how they judged that residents wanted to make a complaint. As has already been written about in the report one of the key roles of staff is to get to know residents different ways of communicating their needs and wishes. Staff were able to give examples, such as when residents have not liked a particular meal. Staff have advocated on the residents behalf to make sure they are offered a dish that they do like. Staff conveyed that they frequently advocate for residents and ensure their views are made known to the manager. There are procedures and guidance information on the topic of ‘ the protection of vulnerable adults from abuse’. This helps to protect vulnerable adults who live at the Home if staff can access the necessary information to ensure their protection. The staff have attended recent training to help them better understand issues around the protection of vulnerable adults from abuse. Two of the support staff on duty were asked what actions they would take if they were made aware of an allegation of abuse of a resident. The staff were able to explain the procedure they would follow, and that they would report without delay all such allegations to the appropriate senior member of staff. DS0000020258.V336029.R01.S.doc Version 5.2 Page 17 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): 24-30. Quality in this outcome area is good. Residents live in an environment that is clean and satisfactorily maintained. The Home is suitable for residents to live in and suits their needs and lifestyles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 121 Watleys End Road is close to local shops and residents can easily access local amenities. It is a purpose built bungalow style property in a quiet residential area. The entrance of the building provides very easy access for wheelchair users and there is similar access to all areas. To assist residents who have disabilities there are grab rails positioned along the corridors and manual handling lifting aids in bathrooms and toilets. There are toilet and bathrooms located near to living rooms. There are specialist-adapted baths in each bathroom, as well as lifting aids. There are also walk in assisted shower rooms that residents with wheelchairs could use. DS0000020258.V336029.R01.S.doc Version 5.2 Page 18 All facilities were spacious in size, providing easy wheelchair access, and were clean and tidy when viewed. The bathrooms are spacious in size to provide easy access and the baths are specially adapted to assist residents. The standard of the decoration and the quality of fixtures and fittings is satisfactory. Since the last inspection the corridors have been enhanced with modern art works that help make the environment look more homely. Bedrooms had been furnished and decorated to reflect resident’s different interests. There were visual stimulation aids as well as relaxation aids such as wall lights and mobiles seen in many rooms to provide additional stimulation and relaxation for residents. Bedrooms were decorated in different colours and this helped to create an individual feel to rooms. The environment was clean, tidy and satisfactorily maintained in communal areas and bedrooms were satisfactorily clean. The full time domestic assistant was on leave. One resident was cleaning their room with the help of one the support workers. This is a good way for residents to be enabled to have a sense of purpose by staff helping the resident to clean their room, rather then staff doing this task for them. DS0000020258.V336029.R01.S.doc Version 5.2 Page 19 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): 32,34,35. Quality in this outcome area is good Residents are cared for by a sufficient number of staff who are well trained, and well supported in their work. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff duty record for shifts in two weeks of May 2007 was checked to review the number of staff on duty to support residents to meet their needs. There is a minimum of six staff on duty during the day, consisting of one registered nurse and five care staff and three staff at night consisting of one registered nurse and two support workers. Two new support workers have commenced working at the Home in the last four weeks. Both staff have been given a full induction into the Home. One of the new members of staff spoke very positively about the very good teamwork there is, and how this benefits residents who are very well supported by the team. DS0000020258.V336029.R01.S.doc Version 5.2 Page 20 Residents were observed being very well supported by the numbers of staff on duty. Residents went out into the community, and out for a drive in the Homes minibus. Staff were calm and patient in manner throughout the inspection and communicating well among themselves. Based on the evidence from the inspection the number of staff on duty at any time is the minimum number necessary to ensure peoples’ needs are being met. The staff said Mrs Close supports them with regular structured supervision sessions to assist them in their work and in understanding residents’ needs. The training records demonstrated staff had attended training relevant to the needs of the residents over the last twelve months. All the staff consulted spoke positively about the training opportunities they can take part in. This should help ensure residents’ needs continue to be met by the assistance of well-trained and knowledgeable staff. The recruitment procedures were not fully reviewed on this inspection. However the recruitment files of the two most recently recruited staff were seen. Both staff had completed Criminal Records Bureau checks carried out. This is a safeguard to protect vulnerable residents from the risk of harm or abuse. DS0000020258.V336029.R01.S.doc Version 5.2 Page 21 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): 37,39,41,42. Quality in this outcome area is good. Residents who use the service benefit from a stable and well-run Home. Residents’ health and safety is protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Close is a qualified learning disabilities nurse. Her career record shows she has a number of years of experience working with residents who use the service who have very complex learning disabilities. She is registered with us as the manager of the Home. This demonstrates Mrs Close is suitable and qualified to fulfil the role of registered manager. DS0000020258.V336029.R01.S.doc Version 5.2 Page 22 Residents’ records are kept in a locked metal cabinet in the office. The care records, and the records that were seen relating to the running of the Home were satisfactorily written, legible, up to date, and satisfactorily maintained. This helps to demonstrate residents’ confidentiality is being protected. It also shows that Mrs Close is keeping legal records required for the effective running of the Home in order. The monthly monitoring visits of the Home that must be carried out by a representative of Aspects and Milestones Trust are being undertaken as required by law. There are records of these visits being sent to the Commission. The records that have been seen, demonstrate that the designated individual responsible for the visits spends time observing residents being assisted by staff and also talking to staff. The Trust is carrying out detailed quality audits of all of its Care Homes. A copy of the audit ‘tool’ that is used was not available at the inspection, as the manager who had completed it had not yet handed over the completed audit document to Mrs Close. However Mrs Close said that the audit had revealed that the Home was providing a good standard of care and overall delivery of service. This demonstrates that the overall quality of the Home is being monitored on a regular basis. The environment looked safe and satisfactorily maintained in all areas viewed. Two members of staff were observed carrying out a health and safety check of the Home environment. This is a good way to demonstrate that the environment is safe for residents and staff. Staff are provided with regular training in health and safety matters including first aid, and moving and handling practices. This should help protect residents if staff are knowledgeable and trained in health and safety practices and principles. The fire logbook record was checked and showed the required weekly and monthly tests of the fire alarms and the fire fighting equipment were being carried out and were up to date DS0000020258.V336029.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 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 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 N/A 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X 3 3 X DS0000020258.V336029.R01.S.doc Version 5.2 Page 24 NO 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 YA20 Regulation 13.2 Requirement Residents’ medication records must include clear instructions setting out when medication needs to be given. Timescale for action 14/06/07 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 DS0000020258.V336029.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 DS0000020258.V336029.R01.S.doc Version 5.2 Page 26 - 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!