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Inspection on 03/11/06 for 197 Henwick Road

Also see our care home review for 197 Henwick Road for more information

This inspection was carried out on 3rd November 2006.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

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 care provided at the home revolves around the service users who live there, and the respect and consideration given to residents at all times is evident. The staff are committed to their role in giving support to service users, and in helping them to achieve as much as they can. The activity programme for each service users is extensive, and encouragement provided to do as much as they are able. The assessment and admission procedures produced by the organisation are satisfactory, and followed by staff when a new service user is admitted to the home. Records are completed to a good standard.

What has improved since the last inspection?

Many of the previous requirements and recommendations have been met Staffing levels have increased following the appointment of several new support workers and the care manager. The home has been without a registered manager for over two years. Some redecoration of the house has been undertaken, and the ongoing maintenance ensures that a high standard of accommodation is maintained in most parts of the house.

What the care home could do better:

Documentation should be reviewed regularly, to ensure that all the information is accurate and up to date. A more detailed record should be kept of all comments made about the service, specifically the compliments received, to give a more balanced view. Training should be provided for staff on all aspect of abuse and the protection of vulnerable adults. The application for registration of the new care manager should be sent to the Commission without delay. Proposals for improvements to the premises, specifically the kitchen and the garden, should be undertaken. An assessment of the need for specialised equipment should be done and items provided as necessary e.g. tracking for hoists. Fire precautions must be undertaken with the required frequency, to ensure the protection of service users and staff.

CARE HOME ADULTS 18-65 Henwick Road, 197 197 Henwick Road St John`s Worcester Worcestershire WR2 5PG Lead Inspector R McGorman Unannounced Inspection 3rd November 2006 2:00 Henwick Road, 197 DS0000018659.V317829.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 Henwick Road, 197 DS0000018659.V317829.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. Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Henwick Road, 197 Address 197 Henwick Road St John`s Worcester Worcestershire WR2 5PG 01905 429915 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.dimensions-uk.org Dimensions (UK) Ltd Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Home is primarily for younger adults with learning disabilities but may accommodate one person over the age of 65 The Home may also accommodate people who have an additional physical disability. 30th January 2006 Date of last inspection Brief Description of the Service: 197, Henwick Road is registered to provide residential care for up to four service users who experience a learning disability, who may have a physical disability, and whose needs are diverse. The home is also able to accommodate one person over 65 years of age. The range of fees varies between £1,100 & £1,250 per week The premises is a large bungalow, situated in the St. Johns area of Worcester, approximately 1 mile from the city centre, with easy access to public transport and a range of amenities and facilities. The home is owned and run by the New Era Housing Association Ltd., and is part of the New Dimensions Group, which, as the parent company, provides strategic direction and a range of functional support services. The stated purpose of the organisation is, to work with people with learning difficulties, supporting them to make choices and to exercise control over their lives, and the main aim of the home is, to deliver a person-centred response to the needs and aspirations of the people we support. Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this routine key inspection was to monitor the care provided at the home, to assess how well the service meets the needs of the people who live there, and to follow up previous requirements and recommendations. The visit was unannounced and took approximately 3 hours, when some time was spent with service users, observing their interactions with the people who support them, as they are unable themselves to verbally communicate their views. During conversations with staff, positive comments were made about what it is like to work at the home and also to be employed by the organisation. They assist service users in completing a survey entitled, ‘Have Your Say,’ – which provides information about what they think about the care and support they receive. Written comments are also requested from relatives, and any visitors or professionals are spoken with at the home during the inspection. Everyone expressed their satisfaction with the standard of the care provided. The care records of service users were seen, and discussion held with staff about the content. One was inspected in detail for case tracking purposes. A tour of the building was undertaken, and the records kept in respect of the maintenance of equipment and safe working practices were also checked. The care manager Ms Sue Hickley was not on duty on the day of the inspection. She has been appointed to the position of manager at 197 Henwick Road within the last two months, and the need for an application for registration to be submitted to the Commission in the near future has been discussed with the area manager. What the service does well: Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 6 The care provided at the home revolves around the service users who live there, and the respect and consideration given to residents at all times is evident. The staff are committed to their role in giving support to service users, and in helping them to achieve as much as they can. The activity programme for each service users is extensive, and encouragement provided to do as much as they are able. The assessment and admission procedures produced by the organisation are satisfactory, and followed by staff when a new service user is admitted to the home. Records are completed to a good standard. What has improved since the last inspection? What they could do better: Documentation should be reviewed regularly, to ensure that all the information is accurate and up to date. A more detailed record should be kept of all comments made about the service, specifically the compliments received, to give a more balanced view. Training should be provided for staff on all aspect of abuse and the protection of vulnerable adults. The application for registration of the new care manager should be sent to the Commission without delay. Proposals for improvements to the premises, specifically the kitchen and the garden, should be undertaken. An assessment of the need for specialised equipment should be done and items provided as necessary e.g. tracking for hoists. Fire precautions must be undertaken with the required frequency, to ensure the protection of service users and staff. Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&4 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Appropriate documentation is in place to enable prospective service users to make an informed decision about their future care needs. The assessment process is both detailed and thorough, to ensure that an appropriate decision is made, both by the home and the service user. EVIDENCE: The Statement of Purpose and the Service Users Guide, provide detailed information for residents and their families, about the services and facilities available at the home, although this is due to be reviewed and updated. The documentation is produced in an appropriate format, and retained by the service user, if this is their wish. Documentation is reviewed regularly, to ensure that it accurately reflects specific aspects of the care that can be provided. The admission procedure includes extensive assessment by staff from the home, and was implemented appropriately for a service user admitted to the home earlier in the year. Henwick Road, 197 DS0000018659.V317829.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 This judgement has been made using available evidence including a visit to this service. The service users plan of care is based on the initial assessment, which clearly identifies their assessed needs, and how these will be met. The key-worker system ensures that service users living at the home are supported in making choices in all areas of their lives. Risk management strategies are in place to enable a responsible approach to the risks associated with the various activities of daily living. Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 11 EVIDENCE: An individual plan of care is produced for each service user, based on the initial assessment undertaken during the admission process. These plans, which are retained by the service user, are very comprehensive, detailing their specific needs, and how these are to be met. One care plan was checked in detail during the inspection. The needs and individual preferences of every service user living at 197, Henwick Road are identified, and their participation in the daily life of the home, is constantly encouraged as far as they are able. Staff demonstrated an in-depth understanding of the wishes of service users who are unable to express these verbally. Two key-workers are assigned to each service user, and have responsibility for ensuring that appropriate care is provided. Monthly meetings are held, ongoing assessment is undertaken, changes are monitored over a period of time, and any amendments made when necessary. Risk assessments are completed, in relation to the premises, to the activities undertaken, and any restrictions imposed, and also in respect of the many aspects of the life of each service user. Risk assessments are included in the plan of care for each service user. Henwick Road, 197 DS0000018659.V317829.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 & 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The opportunities made available to service users, enable them to live as fulfilling a life as possible. The involvement of each individual in their proposed activities, both within and outside the home, ensures that everything revolves around them. The health and wellbeing of service users is promoted by the provision of a nutritious and wholesome diet. Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 13 EVIDENCE: Service users living at the home are encouraged to follow an ‘ordinary’ life style as far as possible, by using the same facilities as other members of the community, and being involved in a wide range of leisure activities. Limited communication skills preclude involvement in paid employment or educational opportunities, but social activities are provided, and these may be undertaken in-house or in the community, and include, shopping, cookery sessions, swimming, visits to the snoezlan, Jacuzzi, hydro, and attending a disco. Music making is very much enjoyed by some service users, and in-house entertainment is also arranged from time to time. Links with family and friends are promoted, with a high degree of support provided by staff, to both the family and to the service user. The support of volunteers or an advocate is sought in the absence of family involvement. The arrangements regarding the provision of food reflect the individual preferences of service users. Staff are aware of the specific likes and dislikes of service users, and any food allergies are recorded in the care plan. Two service users require their food to be prepared in a semi-solid form, and all service users need assistance with eating. Henwick Road, 197 DS0000018659.V317829.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 This judgement has been made using available evidence including a visit to this service. Procedures are in place to ensure that the personal and health care needs of service users are appropriately met. Advice and guidance is requested from the primary healthcare teams, and other professionals, to ensure that the health needs of service users are fully understood, and that appropriate responses are made. Arrangements for the safe administration of medication are in place at the home. Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 15 EVIDENCE: The personal and healthcare needs of service users, which are extensive, are well documented, and there is evidence to show how staff understand and respond to them in an appropriate way. Personal care is provided in privacy. The health of service users is closely monitored, and additional specialist support and advice is sought from health professionals, when necessary. The dentist and optician visit the home on a regular basis, while the nails of service users are usually attended to by staff. The service users are all unable to walk independently, but the high standard of physical care provided has ensured that the skin integrity of each individual remains intact. There is also the need for intrusive treatments to be undertaken by staff from time to time e.g. administering suppositories, but relevant staff are given the appropriate training. Health Action Plans have been implemented for all service users living at the home. The HAP plan of the service user most recently admitted was seen, and contained very detailed information regarding his extensive health care needs. The Medication Administration Records were seen, and had been completed to a satisfactory standard. A detailed profile, together with a photograph was completed for each service user, and guidelines were in place for the administration of ‘PRN’ (as required) medication. A quarterly report was issued by the pharmacist regarding procedures being followed at the home, indicating that these were satisfactory, but staff expressed concern about the standard of service provided by the supplier. These issues are being investigated by the area manager. Henwick Road, 197 DS0000018659.V317829.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 adequate This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure is followed at the home, and the views and opinions of relevant people are encouraged. Training for all staff regarding the procedures relating to the protection of vulnerable adults, will ensure that service users are safeguarded from abuse. EVIDENCE: A clear procedure for the investigation of complaints has been produced and any issues are dealt with immediately. The document has been produced in a format that is understandable to service users. Staff were reminded of the need to record all comments about the service, including compliments. There has been one complaint to the home, since the last inspection, which was partly upheld, although mainly to do with the support provided to a service user while in hospital. An appropriate procedure is in place relating to the many aspects of abuse and the protection of vulnerable adults. Staff are able to demonstrate a clear understanding of the issues, and also to their individual role as an advocate for service users, although the need for specific training in the protection of vulnerable adults was identified. Henwick Road, 197 DS0000018659.V317829.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 This judgement has been made using available evidence including a visit to this service. The premises are suitable for their purpose. They are comfortable and clean, and ensure as far as possible that the safety and wellbeing of service users is promoted. The standard of the accommodation is good. The décor and furnishings are well maintained, and provide service users with an attractive and homely place to live. Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 18 EVIDENCE: The premises at 197, Henwick Road, which is a large, detached bungalow, provides a safe and well-maintained environment, and is suitable for its purpose. A dormer area has been developed which includes the office and sleeping area for staff, a bathroom, and also some storage facilities. The communal areas of the house are homely, nicely decorated and comfortably furnished. Sensory equipment is provided for the benefit of service users. There are three communal rooms, which include a pleasant lounge with a conservatory, and also a large kitchen/dining room. Proposals for improvements to the kitchen are to be implemented in the near future, which should enhance facilities for service users. The gardens, which are extensive, had been given considerable attention previously, although plans for further work to be undertaken in the Spring did not materialise. The proposed patio area will greatly improve facilities for service users, therefore further consideration should be given to progressing this work. Several areas of the house are fitted with overhead tracking to assist with moving service users, although the design of the existing equipment has raised some issues in regard to health and safety. A review of the suitability of the present provision was to have been undertaken, but remains outstanding, although new tracking has been provided for a service user admitted to the home earlier in the year. The home has not received a recent visit from the Fire Safety Officer. The Fire Log Book was seen, and appropriate checks have been undertaken with the required frequency. The Fire Risk Assessment was reviewed in March 2006. The records indicated that a fire drill has not been undertaken since December 2005, therefore this situation should be rectified urgently. Fire awareness training was provided for staff during a recent staff meeting, the inspector was told, although this was not recorded. Henwick Road, 197 DS0000018659.V317829.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): 34 & 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Appropriate recruitment procedures ensure that service users are supported and protected by staff. The training programme available to staff ensures that they are effective in their work, and therefore able to provide appropriate care and support to service users. Specific training on issues relating to protection from abuse should ensure that service users are fully safeguarded. Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 20 EVIDENCE: Dimensions provides relevant information for staff on joining the organisation, and also keeps them updated on new developments and any changes that take place. Each member of staff is given a Welcome Pack that contains details about the organisation, and its aims and objectives, an Employee Handbook that provides information about terms and conditions of employment and policies and procedures, and an Induction Checklist covering the first three months of employment. A thorough recruitment and selection procedure has been produced by the organisation, and includes a commitment to equal opportunities. Criminal Record Bureau checks are completed prior to an appointment being confirmed, and verbal and written references are also obtained. Three new support workers have joined the team in the last six months, which has improved staffing levels and enabled greater opportunities for service users. In addition a manager has also been appointed during the last few weeks, following the resignation of the previous acting manager. One member of staff remains on extended sick leave. A training programme is in place at the home that includes Induction and Foundation training, (known as ‘Welcome to Our Team’), the Learning Disability Award Framework (LDAF) accredited training, and the NVQ training. The training needs of staff are regularly reviewed, and care related courses attended. A training record is maintained in respect of each member of staff. The need for specific training on the Protection of Vulnerable Adults was identified. Henwick Road, 197 DS0000018659.V317829.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 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The care management arrangements have recently been addressed, and should now provide appropriate leadership for staff, and ensure that the needs of service users are met. The policies, procedures and records maintained at the home, comply with legislative requirements and therefore help to safeguard the rights of service users. The health, safety and welfare of service users is promoted and protected in respect of all safe working practices. Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home has been without a registered manager for an extended period of time, although the responsibility for the day-to-day running of the home is currently being undertaken by Ms Sue Hickley. An application for registration is to be submitted to the Commission in the near future. There was clear evidence of effective person centred care being delivered, and the positive interactions observed between staff and service users were pleasing to observe. An annual development plan is produced which involves the whole Home, and forms part of the quality assurance programme of the Organisation The team identifies where they are at, and where they would want to be in 12 months time. The plan also identifies who they will need to help them to get there, the building bricks and the strengths required, and who will do what. Reviews of achievements take place every 3 months, and the outcomes will then be measured. A comprehensive health and safety policy has been produced, staff are trained in safe working practices. The Organisation employs an officer to advise on health and safety matters, and the home has a Health and Safety representative. Risk assessments in respect of all safe working practices are completed. The home is clean and free from offensive odours. Procedures are in place in regard to the control of infection. There are no outstanding requirements following the last visit of the Environmental Health officer in March 2006. The records checked during the inspection have been completed to a satisfactory standard, with the exception of the recent fire awareness training. Routine maintenance and servicing of equipment undertaken, and temperature checks are recorded. The accident book was seen, and appears to be in order. Notifications are made under Regulation 37, which requires reports to be sent to the Commission of death, illness or other events in the home. Regulation 26 reports, which relate to visits made to the home by or on behalf of the registered provider, are also submitted on a regular basis. Henwick Road, 197 DS0000018659.V317829.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 X 2 3 3 X 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 x Henwick Road, 197 DS0000018659.V317829.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 YA23 Regulation 13 Requirement Timescale for action 31/12/06 2 YA24 23 3 YA37 8 Training must be provided for staff on all aspects of abuse and the protection of vulnerable adults Arrangements must be made for 31/12/06 staff to receive fire drills and practices at suitable intervals – at least every six months The care manager must apply for 31/12/06 registration with the Commission for Social Care Inspection without delay 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 Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 25 1 YA1 The Statement of Purpose and Service Users Guide should be reviewed and updated as necessary Consultation with the local pharmacist should be undertaken regarding the standard of service provided to the home A record should be maintained of the fire awareness training provided to staff Consideration should be given to the proposals for upgrading the kitchen Further development of the garden area should be undertaken The provision of overhead tracking for hoists should be reviewed 2 YA20 3 YA24 4 YA28 5 6 YA28 YA29 Henwick Road, 197 DS0000018659.V317829.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Henwick Road, 197 DS0000018659.V317829.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. 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!