Inspection on 02/03/06 for 62 Wright Street

This inspection was carried out on 2nd March 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

62 Wright Street 17/04/07

62 Wright Street 13/10/05

62 Wright Street 16/03/05

62 Wright Street 12/08/04

62 Wright Street 17/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 62 Wright Street Mencap Homes Foundation 62 Wright Street Horwich Bolton Lancashire BL6 7HY Lead Inspector Lucy Burgess Unannounced Inspection 2nd March 2006 09:15 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 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 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 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. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 62 Wright Street Address 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) Mencap Homes Foundation 62 Wright Street Horwich Bolton Lancashire BL6 7HY 01204 694286 www.mencap.org.uk Royal Mencap Society Ms Janice King Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th October 2005 Brief Description of the Service: 62 Wright Street is a domestic property providing support and accommodation for up to 4 people with a learning disability, each have complex and multiple disabilities. Staffing is provided throughout the day and night. The property provides 4 single bedrooms, living and dining rooms and kitchen. The home is internally connected to the bungalow next door. Additional aids and adaptations are provided throughout the home to meet the needs of the service users. The home is situated close to Horwich town centre and has good access to local shops and bus routes. There is a small front and back garden, mainly paved. Parking is available on the street. The home also has its own vehicle. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place during one day for a period of 3½ hours. The inspector took the opportunity to look round the home, view records as well as talk with staff and observe interactions with residents. A later discussion and feedback via telephone was held with the manager. The home is registered to provide accommodation for up to 4 people with learning disabilities. There were no vacancies. What the service does well: What has improved since the last inspection? The staff team has stayed that same offering stable support. Each member of the team has completed some of the training offered by Mencap. These have included medication, moving and handling, person centred planning, finances and adult protection. Staff feel able to carry out their role properly and feel fully supported by the manger. Each of the residents continue to have their health care needs fully met with support and advice from health professional so that the best possible care can be provided. Residents were settled and appeared well cared for. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 Page 6 The staff have spent a lot of time looking into suitable activities for people with complex needs. The team has managed to provide varied activities, which residents can enjoy both in and away from the home. Staff support is provided so that residents can take part fully in the activity. 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. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 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 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 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): 2 and 4 The system of assessing prospective residents as well as spending time with them prior to admission gives an assurance that a resident will only be admitted if the home can meet their needs. EVIDENCE: As identified within the report for 60 Wright Street the manager at 62 Wright Street would follow the same process of resettlement. At present the home is full therefore no recent placements have been made. Should a vacancy become available the manager and staff would follow the procedures set out by Mencap. This would involve assessment information being accessed from the funding authority and other relevant sources in relation to the individuals needs. Further information would also be gathered during meetings with prospective residents and their families. The home would encourage prospective residents to visit the home as well as over night stays. This enables both residents and staff to meet and spend time with each other, before making a decision in relation to the suitability of the placement. Once agreed, information gathered would be used to inform the development of the care plan. Placements are then reviewed following an initial settling in period. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 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): 6 and 9 Residents care plans and assessments clearly identify their support needs and how these are to be met ensuring their health and well-being is maintained. EVIDENCE: Detailed information is gathered with regards to the physical, emotional and social well-being of residents. Information was examined for one of the residents who has extensive support needs. The plan of care had last been reviewed and updated on the 10 February 2006. Information was provided in both written and picture form and provide a good overview of the person and their needs. The file starts with ‘what you need to know about me’, this includes personal care needs, activities, routines, likes and dislikes. Further information is held with regards to a health care action plan, this explores the needs of the resident with regards to medication, weight, mobility, care and communication. Information is comprehensive and easy to read offering staff clear direction with regards to meeting the needs of residents. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 Page 10 As the resident requires a peg feed, comprehensive information has been gathered along with a risk assessment identifying how this should be done. The community nurse team provides support and advice where necessary. All staff have received relevant training in this area. A further support and exercise programme has been developed by the physiotherapist, this outlines aims and preparation techniques. Information again has been provided in both written and picture form to demonstrate the movements ensuring practice is safe and the resident is protected. Risk assessments are also completed and focus on any area where a potential concern has been identified. Assessments have been completed with regards to epilepsy, personal care, using the vehicle, hoisting and bed guards. These too provide guidance for staff in ensuring the safety of residents. Further records are made with regards to daily reports, medication and finances, these are monitored on a regular basis. Regular reviews are carried out by the team as well as more formal reviews by the FAC’s reviewing team within the local authority. Dates had been identified for forthcoming meetings. Staff spoken with demonstrated a clear knowledge base with regards to individual needs and how they are to be met. Observations made found that staff communicated well with the residents and on an on-going making sure that they were aware of what support was being provided. The home continues to utilise the intercom system, which is provided in each of the residents’ bedrooms. This is used during the night shifts to monitor the health needs of residents. Risks assessments have been completed taking privacy into consideration. The home also has an on-call system in place, which offers support throughout the day and night. An on-call manager is also available should additional advice or assistance be required. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 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): 11, 13, 14, 15 and 17 Lifestyles vary depending on individual needs and wishes. A variety of opportunities are made available enabling residents to increase their independence. Residents continue to maintain contact with family. This is encouraged so that residents benefit from other relationships and friendships. Dietary needs of residents continue to be closely monitored ensuring their health and nutrition is maintained. EVIDENCE: The needs of residents vary in relation to the level of their disability. However staff continue to provide encouragement and support with each resident in pursuing activities of their choosing. Since the last visit further opportunities have been provided for individuals to take part in activities both in and away from the home. These include horse riding, aromatherapy, gateway club, hydro pool, rambles, swimming, football matches, theatre trips, sensory activity centre, hairdressers and shopping trips. Staff are also exploring options for summer holidays. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 Page 12 Sufficient staffing is provided so that each person is able to pursue his or her individual activities and interests. As well as outside activities residents also enjoy spending time relaxing within the home. Both the lounge and bedrooms have sensory lighting displayed to aid relaxation. Residents also have televisions and stereos, which they relax and listen to. One resident also enjoys doing artwork. This was observed during the visit. Due to restrictions in their mobility residents are fully supported by staff. The home has access to a vehicle, which enables residents to access the wider community more easily. Relationships with family and friends are also encouraged and maintained with regular visits taking place. Due to their complex needs support is available from physiotherapists, occupational therapists and the nursing team when required. Additional aids are accessed to assist in maintaining the health and well-being of residents. As already identified an exercise programme has been drawn up by the physiotherapist providing staff with guidance when supporting one of the residents. In relation to meals, full support is again provided by the staff team. The residents’ nutritional needs continue to be closely observed and regularly reviewed. Residents also enjoy meals out. Mealtimes are relaxed unhurried and flexible. Alternative arrangements are still being explored with regards to facilities where residents can be weighed regularly as part of their health care monitoring. As already identified one of the residents is feed through a peg. Training has been undertaken by the majority of the team in relation to peg feeds, further training is to be undertaken by the newest members of the team. Recording and monitoring sheets are completed each day. Each of the residents are offered support in meeting their dietary needs and where necessary soft diets are provided. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 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): 18, 19 and 20 Consistent monitoring and support has ensured that the health and well being of residents are fully met, this is assisted with input from specialist health services. A safe system of medication administration was found ensuring residents are protected and practice is safe. EVIDENCE: The physical and health care needs of residents are supported to a high standard. Due to the complex needs of the residents staff provide hands on support when meeting all personal care needs. Where necessary bedrooms and bathrooms are fitted with ceiling tracking hoists and assisted bathing so that the appropriate level of care can be provided. Additional support aids have also been provided, these include frames, hoists, and specialist beds and mattresses to the prevention of pressure sores as well as ensuring the safety and comfort of residents. Access to all health professionals is provided for each of the residents. Each are registered with a local GP as well as having additional support from other community health care provisions such as chiropody, dentist, hearing test, speech therapy, dieticians, district nurse, and incontinence advice, physiotherapy and epilepsy clinic are accessed as and when required. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 Page 14 One resident has been referred to a sleep clinic due to concerns that have been identified. Other referrals include repairs to specialised wheelchairs as well as fitting for suitable shoes. Comprehensive information has been collated in relation to health monitoring. Information clearly identifies the resident’s medical histories, medication requirements, input from health professionals and dietary needs. Additional assessments and programmes are also held on file with regards to input from physiotherapists and OT’s. Staff provide to supports to all appointments away from the home. Where visits take place in the home residents are seen in the privacy of their own rooms. The staff team consists of both male and female support therefore where possible same gender support is provided. The management of medication continues to be undertaken by the staff team. Relevant training is undertaken by all staff prior to them undertaking any support with medication needs. Several members of the team are currently completing further medication training on completion this will then be completed by the remaining members of the team. Specific training has also been provided by the local authority and nursing team in relation to peg feeds, medication and PRN epilepsy medication required by individuals who live at the home again ensuring the health and well-being of residents are fully met. Medication is supplied by BOOTS pharmacy using the monitored dosage system. A medication audit was carried out by the supplying pharmacist in October 2005, no issues where raised. The system of storing medication was found to be safe. Minor shortfalls were found to the records. It is advised that handwritten entries to the records are checked, date and signed by two members of staff and where information states ‘as directed’ this details the time and dose required so that the records clearly reflect what has been administered to the residents. Medication is reviewed regularly with health professionals. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 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): 22 and 23 Systems are in place with regards to the investigation of complaints and adult protection issues along with relevant training, ensuring that residents are listened to and protected. EVIDENCE: As previously identified Mencap have developed clear policies and procedures with regards to complaints and protection. The home also holds a copy of the Local Authorities Vulnerable Adults procedure and staff have received training in this area. Recording sheets are in place for should any concerns or complaints be raised. The visiting Service Manager also monitors this area as part of the monthly monitoring visits. No complaints have been raised with the CSCI or the home. Additional policies and procedures are held within the home with regards to ensuring the safety and protection of residents, these include dealing with whistle blowing, aggression, service users finances and missing persons. All staff have a Criminal Record Check in place. Information is also recorded with regards to the management of residents’ finances. Appointees are in place for each of the residents. The manager is currently responsible for 3 accounts. Records are made of all transactions and receipts are held. Regular checks are made by the staff on duty as well as the Service Manager. All correspondence regards bank statements and information in relation to benefits are also held on file. Monies held and records are all held securely. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 Page 16 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): 24, 25, 27, 29 and 30 Wright Street continues to provide a comfortable homely environment for those that live there. Aid and adaptation have been provided to enable the necessary support required in meeting the complex needs of residents. EVIDENCE: The accommodation provided at 62 Wright Street is the same as that offered within number 60. Both bungalows are adjoining and are supported by Mencap. The home is in keeping with the local community and is accessible to all local amenities and facilities. Accommodation comprises of a lounge, large open dining room and kitchen. There are four single bedrooms, 2 bathrooms and 2 separate toilet. The home also has a designated laundry area, which is shared with residents next door as well as a staff office/sleep-in room. Each of the bedrooms are decorated and arranged to meet the needs of the resident. Where necessary rooms have been fitted with ceiling-tracking hoist in order for staff to provide the appropriate support in meeting the needs of the residents as well as beds, which are adjustable and have fitted sides ensuring the comfort and safety of the resident. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 Page 17 Whilst staff at the home have tried to make improvements in the appearance of the home, the general environment and furnishings are of a good standard, several issues have arisen which have caused damage to the property or prevented the use of certain equipment required by the residents. As previously identified the individuals living at Wright Street have a high level of personal care needs and require a lot of support from staff as well as the use of relevant aids and adaptation. In meeting these needs refurbishment was undertaken last year with regards to a walk-in shower rooms and assisted bath which had been fitted with a rise and fall devise. However due to ongoing issues with the boiler and being unable to regulate the water temperatures, residents have been unable to use the facilities properly. Further areas requiring attention have also been identified. These include damage to the ceiling in the shower room and bubbled flooring in the large bathroom. These too have been reported to the Landlords. Staff have endeavoured to make contact with Irwell Valley, the landlords, to resolve the matter however have experienced some difficulties therefore issues are still unresolved. Further work has also commenced with regards to the refurbishment of the kitchen. Feedback received found that this had been going on for some time and that staff were unaware when workmen would be completing the work. This too has been raised with the landlord. Once completed the home will purchase a new fridge freezer, dish washer and cooker. It has been suggested to the manager that she and her Service Manager meet with the Landlords so that there concerns can be raised and a timeframe for completion agreed. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 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): 35 and 36 Continuous training and supervision is undertaken by all members of the team ensuring staff have the knowledge and skills needed in meeting the needs of residents. EVIDENCE: Staffing at the home has been consistent. Two new members have joined the team since the last inspection and are currently working through the relevant training offered by Mencap, this includes the LDAF induction and mandatory training. Additional training is to be completed with regards to the specific support needs of the residents living at Wright Street. Both existing and new members of the team are also undertaking additional training. This includes person centred planning, 1st aid, moving and handling, vulnerable adults, budget information, epilepsy and total communication. Information in relation to courses completed and dates for refreshers are held on individual files along with copies of the certificates. Six staff are also completing a medication course, once completed the remaining members of the team will undertake the course. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 Page 19 Further training is undertaken in relation to NVQ’s. The majority of staff have completed level 2/3 with a further 4 currently completing the course. Some members of the team have gained both level 2 and 3. Two staff have yet to commence. The Registered Manager has also recently achieved the Level 4 Registered Managers Award. Copies of the certificates have been received by CSCI. Staff also receive additional support through the supervisions system and team meetings, which are held on a regular basis. Staff spoken with confirmed that supervisions were held with the manager and that information was recorded. Minutes were also seen for the monthly team meeting. Items discussed include residents’ needs, health and safety, activities and training. Meeting are generally well attended. From discussions with staff, each expressed that they felt supported. Comments made included, we have a good team’, ‘we support each other’, everything works well, it’s all credit to the manager’ and ‘ we get good support from the service manager’. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 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): 37, 39 and 42 The overall management of the home is consistent and reliable for the people living there. Systems are in place for the reviewing of the service provision. Satisfactory arrangements are in place with regards to providing a safe, well maintained home so that residents and staff are safe from harm. EVIDENCE: 62 Wright Street is managed by the Registered Manager who has day-to-day responsibility in managing the home. She is supported in her role by the Service Manager. Monitoring visits required in line with Regulation 26 are completed by the Service Manager and copies of the reports forwarded to CSCI on a regular basis. The Manager has recently completed the Level 4/Registered Managers Award and copies of certificates have been received by the CSCI. Other training courses related to the needs of service users have also been completed ensuring that her practice is up-to-date. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 Page 21 As with other Mencap homes feedback from stakeholders with regards to the overall service provided is gathered in a number of ways. Feedback is sought from the staff during the periodic team meetings and supervisions. Additional comments are also received during the residents review meetings, which involve health and social care professionals and family members. As only one of the residents is able to verbally express her feelings, staff gather feedback from the other residents in various ways, for example vocalising, gestures or behaviours. Staff have developed a good understanding with regards to the needs and wishes of the residents. This information is used to inform plans/development within the home. In relation to health and safety, regular checks are undertaken ensuring the safety of staff and residents. Up to date certificates were in place for; • 5-year electric checks, • gas • fire appliances and alarm, • emergency lighting • small appliances. Staff within the home also complete regular in-house checks with certain staff has designated responsibilities for tasks. Checks are made with regards to the fire alarm, emergency lighting, and means of escape, vehicle checks and the general environment. Records showed that the water temperatures were not regulated to the correct temperature. As already identified earlier within the report this issue is being followed up with the landlord. Risk assessments are also completed with regards to Coshh and the environment. These had been reviewed and were up-to-date. No accidents or incident have been recorded. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 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 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 X LIFESTYLES Standard No Score 11 3 12 X 13 4 14 4 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 2 X 3 X 3 X X 3 X 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA20 YA20 Good Practice Recommendations That information records on the MAR sheets details the dose and times of medication as opposed to ‘as directed’. To ensure safety hand written transcript on the MAR sheets should be dated and signed by two members of staff ensuring information is accurate. 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 62 Wright Street DS0000009317.V280175.R01.S.doc Version 5.1 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. 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!