Inspection on 07/12/05 for 2 Cowley Way

This inspection was carried out on 7th December 2005.

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

Other inspections for this house

2 Cowley Way 23/02/07

2 Cowley Way 29/06/05

2 Cowley Way 15/02/05

2 Cowley Way 08/09/04

2 Cowley Way 01/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 2 Cowley Way, Bentilee Stoke-on-trent Staffordshire ST2 0RB Lead Inspector Irene Wilkes Unannounced Inspection 7th December 2005 10:15 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 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 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 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. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 2 Cowley Way, Address Bentilee Stoke-on-trent Staffordshire ST2 0RB 01782 596047 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) Choices Housing Association Limited Mrs Andrea Abbotts Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th June 2005 Brief Description of the Service: 2 Cowley Way is a detached purpose built domestic style property that is registered to provide 24 hour care for up to eight adults with a learning disability. The home provides accommodation on two floors, each for four gentlemen currently. The ground floor of the home comprises a lounge/diner, domestic kitchen, laundry, four single bedrooms each with a wash basin, and a shower room/WC and an assisted bathroom/WC. It has been designed throughout this level to meet the needs of people with a physical disability. The first floor is a replica of the ground floor, save for the absence of a laundry and there is a standard bathroom/WC. Grab rails have been fitted throughout the home as required. There is a small private garden and limited off road parking. The design and location of the building fit in well with the other surrounding properties. The home is on the edge of a large housing estate and there is good access to shops and a local supermarket. There is easy access to the main bus route to Hanley and Longton town centres. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a part day in December 2005. Eight gentlemen currently live at the home. There have been no changes since the last visit. A tour of the home was undertaken. Three service users talked to the inspector about what they think about living at Cowley Way and what sort of activities that they like to do. The staff helped the inspector to do this. The other five gentlemen were each spoken with but not in the same detail. The gentlemen’s records were then looked at to see if the staff provide support to them in the right way so that they can live their lives as they want to. The Trainee Deputy Manager and three other staff were on duty at the visit. The Trainee Deputy Manager discussed the home and the needs of the service users with the inspector, and another member of staff was questioned about the training that she had received and again about the needs of the service users. The way that the staff spoke to and assisted the gentlemen was looked at throughout the visit. Records for medication, food, residents meetings, staff rotas, complaints and maintenance were also inspected. What the service does well: All of the service users said that they were happy at the home. I’m satisfied with the place. I do what I want to do. I’m pretty pleased with the staff.’ was what one gentleman said. There is a relaxed atmosphere in the home and there was a lot of laughter. How the staff talked to the men was overheard and everyone got on well together. Some of the men talked about the things that they like to do, such as going to college for horticulture, cooking, going to see friends and helping around the home. Their records were looked at and these showed that they are all helped by the staff to do the things that they enjoy doing, and that they travel alone in taxis and on the bus when they want to do this, and it is agreed with them that it is safe to do. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 6 Each person sits down with a member of staff on a yearly basis to look at their health and to plan appointment for the dentist, chiropodist and such like. This is as well as staff taking the time to talk to the men to see if they have any health problems, and then a speedy appointment is made with the doctor or nurse for them to be checked over. In this way the home makes sure that the men stay well and happy as far as possible. The manager at Cowley Way is a qualified nurse and she has a lot of experience in caring and supporting people and managing staff. All of the staff have the training that they need to support the service users, and they all work together to make sure that they are supported and have everything and do everything that they want to do so that they enjoy their lives. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 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 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 There have been no new service users at the home since the last inspection visit, and for some time previously. Previous examination of compliance with these standards have evidenced that a thorough initial assessment would be undertaken prior to any prospective service user moving into the home. EVIDENCE: Evidence has been seen at previous inspections that all of the service users admitted to the home have received an assessment of their needs to allow an informed decision to be made as to whether their needs could be met at Cowley Way. Prospective service users have also had the chance to spend some time at the home as a visitor to see if they would enjoy living there. The Trainee Deputy Manager confirmed that this good practice would continue should a vacancy arise. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 Each service user has an individual plan that reflects their changing needs and from the records it is clear that they each make decisions about their lives, including the taking of risks. This means that the service users and their relatives can be confident that they have control over the way that they live, within a supportive framework. EVIDENCE: At the start of the visit six of the gentlemen were at home. The other two residents of Cowley Way were out, each separately with a member of staff. One person was assisting with the food shopping for the house, and the other gentleman was doing some personal shopping. Three of the gentlemen sat in the lounge and chatted to the inspector, with the support of the two other members of staff on duty. The personal files of the three men were later looked at as well to further confirm the discussions. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 10 Discussion showed that each person had some awareness of their personal plans and their content. Each of their individual files showed that there was a 24 hour support plan in place that had been recently reviewed and updated where appropriate. There were individual care programmes in place for areas of particular concern, such as epilepsy, eyesight, sunburn etc. The plans also showed how specialist requirements of the individuals are met by the home, including individualised procedures for managing potential or actual violence or aggression, communication support where required etc. The gentlemen indicated through discussion that they make decisions about the way that they conduct their lives, with the good support of staff. There was evidence seen in the Person Centred Plans (PCP) that staff support the service users well, by providing them with information and assistance to make decisions. A conversation about Christmas arrangements for a service user who wanted to go on holiday alone was held between him and a member of staff during the inspection, and the staff member was heard to present the issues that this might cause for the service user in a very professional and respectful way. The files each contained records of any risks related to the service users chosen lifestyles. For example, there were risk assessments in place relating to accessing the community alone, accessing taxis, etc. These risk assessments were all appropriate and very thorough in their analysis and the control measures put in place to minimise the risk. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15 and 16. The service users choose their own lifestyle and take part in a range of individual activities both in the local and wider community, and they are supported to maintain family links and friendships. EVIDENCE: The three service user mentioned previously chatted to the inspector about their lives and it was clear that each lives a valued lifestyle based on their interests. One of the younger gentlemen attends an adult day service on three days a week, and staff assisted him to tell the inspector about the things that he does there, such as cooking, music and sporting activities. An older gentleman attends a local college to do horticulture and he talked about his enjoyment of this and what it entails. Another gentleman at the home undertakes paid work for Choices organisation by assisting with the handyperson service. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 12 The service users also talked about their involvement in the local community. They clearly integrate into community life by going to the local shops, pubs, etc. All of the men access local transport either by bus or taxi, some of them independently. Their plans showed good recording of all their activities. Some of the PCP’s have recently been reviewed, and their was clear indication that the staff are doing their utmost to ensure integration within the community further, while at the same time increasing the range of life opportunities available to each person. For example, one person comes from a farming background, and plans were in hand, and also partly met, to visit a working farm, horticultural shows and local markets. Relationships with relatives and friends outside the home are encouraged. One service user spoke about his relatives visits and others talked about making visits to their families. Another gentleman talked about the friends that he visits in other Choices homes. The service users also attend coffee mornings and events in the locality. Service users confirmed that they choose their daily routines on an individual basis, as it suits. The three gentlemen talked to the most told of the time that they usually choose to get up and when they go to bed. The gentlemen were proud of the household tasks that they perform to help maintain an attractive and clean home, and these duties were clearly identified in each person’s individual plan. Service users have their own key to their bedrooms where they have chosen to do so. It was very clear from discrete observation throughout the visit that the service users are clearly treated with respect and their right to privacy is maintained. All of the staff discussions were linked to the needs of the service users when they were not actively engaged in discussion with them directly. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 Service users receive the support they require in personal care in a way that they wish, and their physical and mental health, together with their medication requirements is closely monitored, with prompt action taken should any issues of concern arise. EVIDENCE: The three care plans sampled showed that the service users are consulted about the personal care that they receive and about the way in which they prefer this support to be given. The gentlemen were seen to make their own choices about bathing etc, as one gentleman was having a long bath at the time of the visit. Other service users were prompted discreetly about personal hygiene. The gentlemen are of varying ages and each chooses their own clothes, hair style etc. Each person has a key worker who supports them in the purchase of clothes, toiletries etc. All of the men have an annual ‘OK Health Check’ that reviews their physical and mental health and identifies any health issues requiring attention. Full health records are maintained for GP, chiropody, optical etc. appointments and the outcomes recorded. Care plans are in place for any individual issues requiring care and monitoring, such as a skin problem, deteriorating eye sight, 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 14 etc. These are recorded and monitored and evaluated on a monthly basis with a more complete six monthly review. The service user’s health is monitored well, with prompt referral to specialists. One gentleman for example has had a number of falls in the home and the prompt action by staff has determined that there is deterioration in his field of vision. Appropriate information has been provided to staff as to how they can assist the management of this, and this has been acted upon. Medication storage and procedures have been inspected in detail at previous inspections and identified that all aspects of medication provision is sound. The manager is a qualified nurse. The staff team receive both internal and external medication training. At this visit it was seen that the same systems as before are in place for medication storage and procedures. The inspection this time was limited but a small sample check of MARS charts was undertaken which showed that they had been completed appropriately and that they tallied with the remaining medication in the dosette box. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 Service users know that staff listen to them about any concerns and staff have a good understanding about their responsibilities in protecting service users from any form of abuse. While seemingly being handled appropriately, an issue in the home between two service users requires further professional input so that the service user who is being affected is reassured that everything possible is being done to ensure his protection. EVIDENCE: The home has an appropriate complaints procedure and each service user has a copy of this in the service user guide. The service users understand about their right to complain. The complaints book was seen and this showed that one of the gentlemen had an issue with Choices organisation regarding finances. This was being addressed. Another complaint was from a member of the public regarding the behaviour of a service user, and it was considered again that the appropriate action was being taken. An understanding of abusive practice was discussed with a member of staff, who showed a satisfactory knowledge of this topic. She confirmed that she had received training about abuse during induction. Service users were asked about how staff treated them and in every case they confirmed that they had a good relationship with all of the staff. The service user handbook contains details in pictorial format about what service users should do if they are not happy at any time with the way that they are being 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 16 treated. A house meeting also takes place on a monthly basis, and the records showed that this topic had been discussed with service users. Records held at the home suggested some harassment of a service user by a fellow resident. This was further discussed with the Trainee Deputy Manager who advised the inspector of the actions being taken to address this issue. While these appear appropriate, a referral to the Specialist Behavioural Team for the service user in question is needed, to see if any further actions can be taken to further protect the other gentleman involved. This is a requirement of this report. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 Cowley Way provides a spacious, comfortable and safe but homely environment and is very clean throughout. This ensures that the gentlemen living there can enjoy living in a very pleasant home. EVIDENCE: All areas of the home are well cared for and furniture, fixtures and fittings are of good quality and meet the needs of the service users. The premises provide a very comfortable home in a domestic setting. A tour of the home was made, although service user bedrooms were not seen on this occasion. The gentlemen take part in household chores and all areas of the home were very clean. Appropriate hand washing facilities are in place, and sound systems were in evidence, including the use of protective clothing, for dealing with laundry to prevent the spread of infection. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32 and 34 Cowley Way follows appropriate recruitment procedures and has a stable staff team who possess the right competencies and qualities to support the service users living at the home. This means that they can be confident that they will receive the support that they want from staff who respect and understand them. EVIDENCE: The Trainee Deputy Manager was on duty in the home at the time of the visit with one other staff member, and two further staff were out shopping with two of the residents. Both staff spoken with within the home had a good understanding of the individual needs of each resident, and were able to talk confidently about these needs and the disabilities and specific conditions of the service users. The interaction between the staff and the service users was discreetly observed and listened to and it was clear that they were interested and committed to supporting each person in a genuine un-patronising way. The service users seemed very comfortable with the staff, and when asked directly what they thought of the staff the replies were positive. Choices organisation is committed to providing good training to its workforce, and the staff at the home are trained in understanding physical and verbal aggression as a way of communicating needs and frustrations, and the appropriate responses. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 19 The staff files were not available to examine on this occasion as the manager was not on duty, and no-one else in the home has access to this confidential information. However, the organisation’s approach to recruitment is known to be appropriate from discussions held periodically with senior managers from the organisation, and from evidence of inspection both at this home previously, and other Choices homes undertaken recently. A member of staff confirmed the recruitment process that she had undergone, and this supported this more general evidence. The standard relating to training was not examined in detail at this visit. It was inspected at the last inspection when all mandatory training and other specialist training was up to date. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 39 and 42 Choices organisation has sound procedures in place to maintain the health, safety and welfare of service users, and these procedures are closely adhered to by the home. This leads to a safe environment for the service users. EVIDENCE: The staff at the home seek the views of service users on a regular basis via monthly residents meetings when all aspects of life at the home and suggestions for improvements can be discussed and outcomes acted upon as appropriate. Each service user also has an annual PCP meeting and a further six monthly review to which significant others are invited to attend. Through the implementation of the PCP’s, the home can demonstrate year on year development for each service user. There is an annual development review of the home linked to budget planning. Issues for the development of the home are discussed with service users and staff and the home manager and principal officer then formulate the priorities 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 21 for the coming year. These priorities are then taken forward for wider discussion by senior management. Choices organisation undertakes a bi-annual audit of the services that are provided across all of their homes and schemes. Representatives of service users, staff and relatives together with outside representatives undertake this review. The next one is scheduled for November 2006. The standards require continuous self-monitoring of each home that involves the service users living there, with an internal audit being undertaken at least annually. The outcome of service user surveys should be made available to the Commission. The home falls short of this standard as there is no internal audit/service user survey undertaken just for Cowley Way at the required timescale. This is a requirement of this report. Sample checks of a limited number of areas relating to the maintenance of the health, safety and welfare of the service users were undertaken at this inspection. At the time of the visit, COSHH storage, fridge and freezer temperatures and food probing checks had all been maintained appropriately and no obvious problems were highlighted. Maintenance records were seen and these showed that any issues are reported to head office and that action is taken to resolve the problem. Examination of a sample of faults that had been reported showed that the issues had been timely addressed. Daily and weekly checks of the environment are undertaken which ensures that any issues are identified at an early stage. Risk assessments both for the environment and on an individual basis were in place and were very thorough and well thought through. Fire records were sampled and these showed that fire drills are held to meet the requirements that during a three monthly period all staff attend at least one fire drill. A full evacuation is made on each occasion, and it was reported that the service users had a good understanding of the evacuation procedure. Fire records were sampled and these showed that fire drills are held to meet the requirements that during a three monthly period all staff attend at least one fire drill. The home has experienced some problems regarding a faulty fire panel that the Housing Association who own the building had been slow to address. It was reported to the inspector that from the previous week the fire panel had stopped showing a fault. The contractor had been out and tested the smoke alarm in the bedroom where the fault had originally been showing, and the alarm had worked appropriately. The home will continue to monitor the alarm and will take action should any further problems present. 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 4 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 4 13 3 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 x 3 x x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 2 Cowley Way, Score 3 4 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x DS0000008213.V272113.R01.S.doc Version 5.0 Page 23 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 YA23 Regulation 13(6) Requirement Timescale for action 21/12/05 YA39 2 Make a referral to the Behavioural Services Team for the service user discussed at the inspection 24(1)(2)(3) Undertake a quality assurance review, involving the service users, and specifically for the home, on at least an annual basis. 31/05/06 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 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 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 2 Cowley Way, DS0000008213.V272113.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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