Inspection on 27/09/06 for 7 School Drive

This inspection was carried out on 27th September 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

7 School Drive 30/06/08

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 09/07/2008.

CARE HOME ADULTS 18-65 School Drive, 7 7 School Drive Bromsgrove Worcestershire B60 1AX Lead Inspector Dianne Thompson Unannounced Inspection 27th September 2006 09:30 School Drive, 7 DS0000066847.V313152.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 School Drive, 7 DS0000066847.V313152.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. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service School Drive, 7 Address 7 School Drive Bromsgrove Worcestershire B60 1AX 01527 874827 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 Julie Dawn Duggan Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24.02.06 Brief Description of the Service: School Drive is a purpose built bungalow located in Bromsgrove about a quarter of a mile from the town centre. The home provides personal care in an ordinary environment, for up to five adults with learning and physical disabilities. The home no longer provides nursing care; any such care needed by service users would be provided by the community health services. The home has a large lounge/dining area, five bedrooms, a bathroom with toilet, one separate toilet, a shower room, laundry, office area and fully fitted kitchen. The home is committed to helping service users to achieve valued and fulfilling lifestyles. The manager is Julie Duggan. Dimensions (UK) Ltd is now the care provider for the service, having registered with the Commission for Social Care Inspection on 1st April 2006. The current fee for the service range from £62.35 per week. Charges which are additional to the fee include: • • • • • Personal toiletries, clothing and electrical items (TV and music centre). Activities not covered by the allowance made by the provider or in the funding authority contract Holidays Major extra outings Hairdressing School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection that included an unannounced visit to School Drive. This was the home’s first inspection since Dimensions (UK) Ltd registered as the care provider. The main purpose of this inspection was to assess the service provided against key National Minimum Standards. Service user and staff records were examined, and a tour of the building was also carried out. Accumulated evidence from reports of monthly visits by the provider’s representative was used to inform this report. Time was spent with the registered manager and staff on duty. Two service users were at home unwell, and a relative visiting at the time of the inspection visit was asked for their views of the home. What the service does well: School Drive is located in a Bromsgrove, close to the New College and the Leisure centre. The home is a purpose built bungalow that adequately provides for 5 people who have learning and physical disabilities. The home is spacious with sufficient bathrooms, toilets and specialist equipment to meet the needs of service users. Detailed information is provided about the services offered at the home to help service users make an informed choice about whether they would like to live at School Drive and whether the home will meet their needs. Service users receive help and encouragement to lead active and interesting lives and are supported to access facilities within the wider community. They are also supported to maintain links with their families and to develop friendships. The home offers a well-balanced menu and promotes healthy eating for the welfare of all service users. Personal and healthcare needs are clearly identified in care plans. These plans provide information and make sure that care is provided consistently and in ways that service users prefer. The home has a clear medication policy and procedure, which is followed to make sure that all medication is administered and stored safely for the protection of service users and staff. Service users are protected by the home’s complaints procedure that is available in easy to understand format, giving information about how to complain, with appropriate information for staff provided. Staff support service users to express their views and any concerns they may have. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 6 School Drive provides accommodation for service users that suitably meets their needs and offers them a safe, spacious and comfortable home. The home is kept clean which ensures that good hygiene and infection control is maintained for the benefit of service users. Suitable staffing levels are maintained and staff receive relevant training to help them meet service users’ needs. The staff team understand their responsibilities and are committed to their role. They are well supported and work together to provide service users with consistent and good quality care. The home’s recruitment policy and practices make sure that suitable staff are employed and that all necessary checks are made to ensure the safety of all service users. The home is managed with an open and positive approach. Dimensions monitor the home in various ways to ensure that the service continues to develop as service users want and that the home remains a safe place to live and work in. What has improved since the last inspection? What they could do better: All service users are given a copy of their licence agreement. It is however, disappointing that these are out of date and have not yet been renewed by Dimensions, the new care provider. There are information plans in place if service users need to stay in hospital. These plans should be kept updated. A medication fact sheet gives details of all current prescribed medication. This information sheet should be dated when reviewed. The redecoration and the protection of walls and woodwork to the hallway, which was a requirement of the previous inspection remains outstanding. School Drive, 7 DS0000066847.V313152.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. School Drive, 7 DS0000066847.V313152.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 School Drive, 7 DS0000066847.V313152.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Detailed information is provided about the services offered at the home to help service users make an informed choice about whether they would like to live at School Drive and whether the home will meet their needs. EVIDENCE: The home’s statement of purpose has been amended to provide up to date information about the home to help prospective service users to decide if they wish to live at School Drive. The service user guide is being updated and evidence was seen to demonstrate this. A copy of the completed Service User Guide is to be sent to the Commission for Social Care Inspection (CSCI) on completion. The registered manager said that copies of the revised Statement of Purpose and Service User Guide would be accessible to all, including visitors to the home. All service users receive copies of relevant information prior to moving into the home, which is offered in preferred formats, e.g. symbols/pictures, audio and large print. There are no vacancies at the home, but an admissions policy and procedure is in place should a vacancy arise. The home’s assessment process is very detailed and the manager and service users care records demonstrate that the home receives full information about prospective service users, their School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 10 background, their needs, their likes and dislikes when they are referred for a placement. Information is gathered from a range of sources including other relevant professionals, visits to previous homes or schools, and discussions with family members. Introductory visits and stays are arranged at the home prior to admission. During the introduction to the home prospective service users are given a copy of the statement of purpose and service user guide. All service users are given a copy of their licence agreement. It is however, disappointing that these are out of date and have not yet been renewed by Dimensions, the new care provider. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 11 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, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Care plans provide staff with relevant information about users assessed needs. They include risk assessments detailing how risks are to be reduced and independence promoted. Service users are enabled to make choices and decisions in their daily lives and routines. EVIDENCE: Service user care plans are detailed and informative. The plans show monitoring of identified goals, and how these are to be facilitated and achieved. Staff have information to make sure that all care is provided in a preferred and consistent way that encourages independence. A person centred care plan (PCP) approach is being developed and the careplanning format shows service users will be appropriately involved in planning and reviewing their own care and are enabled/supported to express their wishes and goals. A Path map has been completed for the home and for the service that is being provided. The Path map process has given staff knowledge and experience to support service users in completing their PCP’s. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 12 Staff said they found this experience very beneficial. The training and completion of the home Path gave them an opportunity to explore, share ideas and take responsibility for specific areas of work. Individual path days for service users are planned to during October through to January. The home is looking to use off site venues to complete PCP’s, in an uninterrupted and impartial environment. Files for two service users were examined. Case tracking provides a view of how the home responds to the diversity of needs and how this is being managed and supported. This is particularly evident where health needs and disability requires greater input and support from all staff within the home. Relevant information and monitoring is provided in service user files to make sure all staff have the necessary information to provide quality care. Of the two files examined a photograph is included for one service user on the profile form, but not on the other file. The registered manager confirmed this would be rectified. An emergency hospitalisation profile to accompany a service user should they become hospitalised demonstrates an example of good practice. This profile should however, be reviewed in keeping with care plans to make sure it is kept updated. Each service user is allocated a key worker to oversee their care. Each key worker builds a closer relationship so they gain more understanding and knowledge of individual needs, goals and wishes. Plans are reviewed regularly or as any changes in need occur. Staff said they are fully aware of the plans and clearly use them to guide their practice. A parent who was visiting at the time of the inspection confirmed that care and support for her son is provided in a very caring and welcoming home environment. During the inspection visit, the registered manager was completing a review of all risk assessments using the new Dimensions format. Risk assessments include using the home’s vehicle, wheelchair use, hoist and choking interventions. There is now an action plan in the event choking occurs to accompany the risk assessment. This meets the requirement of the previous inspection. The home completes risk assessments as part of individual eating and drinking skills assessment. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 13 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): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Service users receive help and encouragement to lead active and interesting lives and are supported to access facilities within the wider community. They are also supported to maintain links with their families and to develop friendships. The home offers a well-balanced menu and promotes healthy eating for the welfare of all service users. EVIDENCE: The home employs facilitators to support service users in the home where they are unable to access day care placement or work opportunities. The home provides a wide range of activities for service users, both in-house and within the local community. All activities are organised to take into account the individual needs and preferences of all service users, seeking to ensure everyone has the opportunity to participate. Activities are recorded in individual diaries providing a clear record of individuals’ lifestyles. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 14 External activities include cinema, shopping, Snoezelen, swimming with Redditch Otters Club, Padstone day centre, music sessions (fortnightly), Amber centre for percussion sessions, lunch out, bowling, day trips to places such as Weston Super Mare, Cannon Hill Park, and folk festivals. The home plans to go to the Ballet and to see Disney on Ice during October. Activities within the home include watching TV and video’s, listening to music, involvement in daily routines, e.g., being present during the cleaning of bedrooms although service users may be unable to do the physical task; receiving foot spa and hand massage. Evidence was seen which demonstrates that regular contact with friends and family is supported. One parent who returned to the home after taking her son out for the day spent some time with the inspector. She said she was really happy with the way the home was run and with the friendliness of the staff. She felt she was treated like one of the staff and is always made very welcome. The home provides well-balanced meals and special diets for individuals where required. Food charts are kept in the kitchen to allow for easy access by staff preparing meals and drinks. Information includes menus, alternative options, special diets and preferred choices. Records of all food and drinks taken are transferred into individual care plans. This includes a chart for service users requiring additional food supplements. There is evidence that probes are used to check the temperature of all cooked meats and the relevant information is recorded. Food offered is varied, healthy and appropriate to individual needs. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 15 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, 20 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Personal and healthcare needs are clearly identified in care plans. The plans provide information and promote consistency of care and support for all service users in a way that takes into account their preferences. The home has a clear medication policy and procedure, which is followed to make sure that all medication is administered and stored safely for the protection of service users and staff. EVIDENCE: Service users’ care records and plans provide detailed information about their physical and mental health and the support needed from staff to maintain their good hygiene and health. The care plans sampled contain information about service users preferred personal care routines. Individual mobility and handling guidelines, in a pictorial format that includes a risk assessment, are completed for each service user. This ensures that all staff are informed and work to preferred and agreed procedures. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 16 Staff said they are able to communicate with service users verbally and, in certain cases, with the additional use of gestures, sign language, and using objects of reference. Records of all physical checks are completed where service users have particular health related issues e.g. weight and fluid intake. In this way the home is able to closely monitor and respond to changes or obtain appropriate medical input whenever necessary. Service users and the home are well supported by medical services, which includes GP’s, audiologist, ophthalmologist, epilepsy consultant, Speech and Language Therapist, psychiatrist, dentist, community learning disability team, occupational health, and dietician. Arrangements are in place for preventative health services, e.g. dental checks and annual health screening. Staff on duty and the registered manager said that all personal care is given in private to promote dignity for all service users. The manager is very aware of the specialist services that could be needed to support service users and how to access them. The home has a medication policy and procedure in place. Medicines are suitably and safely stored and there is appropriate storage for controlled drugs, should they be required. Medication storage and records were checked and all was satisfactory. Information is available to advise staff about prescribed medication together with any possible side effects. A medication information fact sheet is provided both in individual files and in the medication file for each service user and gives details of all current prescribed medication. This information sheet should be dated to indicate the date of review. Consent to treatment forms have been completed. The registered manager confirmed that the organisations policies and procedures would be followed should any medication error occur. Additionally these would be reported to CSCI. Information is available regarding service users and their families’ wishes on death and dying. Information includes funeral arrangements and the choice of hymns where a religious ceremony is preferred. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 17 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, 23 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Service users are protected by easy to understand information about how to complain, with appropriate information for staff provided. Staff support service users to express their views and any concerns they may have. EVIDENCE: During the inspection visit staff were observed engaging with service users in a supportive and respectful way. The home’s complaints procedure is available in widget signs and symbols for service users. The complaints log was examined and there are no records of complaints made to the home or to the CSCI since the previous inspection. A parent who spoke with the inspector feels able to voice any concerns that she might have and feels confident the manager and staff would listen and respond. The home has relevant policies for service users’ protection. Policies and procedures are available which advise and guide staff in protecting service users. Service users are now supported to retain their own finance in their rooms with a support plan available in the office to advise staff. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 18 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, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. School Drive provides accommodation for service users that meets their needs and offers a safe, spacious and comfortable home. The home is kept clean which ensures that good hygiene and infection control is maintained for the benefit of service users. EVIDENCE: The inspection visit included a tour of the home. School Drive is a purpose built bungalow, with a large lounge/dining room, five bedrooms, one bathroom with toilet, one shower room, a separate toilet, laundry, office and fully fitted kitchen. There is an enclosed rear garden and small front garden. Specialist equipment is available as required. This includes a specialist bath, overhead and manual hoists; stimulatory equipment in service users bedrooms such as lamps, projectors, mobiles, rope lights, and wind chimes. A CD player supplies relaxing music to the bathroom. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 19 The lounge and dining area is comfortable and well furnished. There is a ramp from the patio door to the garden that provides easier access for all service users. A new cooker, dishwasher and worktops have been installed in the kitchen. New overhead hoists and tracking have been installed, and this meets the requirement of the previous inspection. One hoist has weighing scales fitted that ensures accurate and secure weight checks can be maintained. The redecoration and the protection of walls and woodwork to the hallway, which was a requirement of the previous inspection remains outstanding. The walls and woodwork are damaged and look unsightly. The premises are clean and tidy. Policies and procedures for infection control are in place and staff are provided with disposable gloves and aprons. Communal bathrooms have paper towels and liquid soap available and there are suitable arrangements in place for the disposal of clinical waste. All cleaning materials are stored in locked cupboards in the laundry room. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 20 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): 32, 34, 35, Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Suitable staffing levels are being maintained and staff receive relevant training to help them meet service users’ needs. The staff team understand their responsibilities and are committed to their role. They are well supported and work together to provide service users with consistent and good quality care. The home’s recruitment policy and practices make sure that suitable staff are employed and that all necessary checks are made to ensure the safety of all service users. EVIDENCE: The registered manager said that staffing levels have increased since the last inspection. The manager also said that the change over to Dimensions (the new provider) has been relatively smooth, and that the service users and staff team have coped with this very well. Staff complete the mandatory health & safety training such as fire safety, first aid, food hygiene, moving & handling and infection control. Other training courses include communication, safe handling of medicines, abuse, working School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 21 with people we support and managing challenging behaviour. Other training such as epilepsy is arranged as required. Staff said that the recent Path training day was effective as a team building exercise, particularly with Dimensions as their new employer/care provider. All newly employed staff undertake the LDAF Induction Course. The Induction process also includes new staff being supported by senior staff to familiarise themselves with the home, service users and safety matters. The registered manager conducted a probationary supervision with one new member of staff during the inspection visit. A sample of staff records was examined. The manager confirmed that all prospective staff complete an appropriate application form and that required references are obtained including one from their most recent employer. An enhanced CRB/POVA (police) check is undertaken before their appointment is confirmed. All staff are required to work a probationary period at the home. Evidence was seen from the staff supervision overview form that all staff receive regular structured supervision from the management team. Staff meetings are held regularly. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 22 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, 42 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. The home is managed with an open and positive approach. Dimensions monitors the home in various ways to ensure that the service continues to develop as service users want and that the home remains a safe place to live and work in. EVIDENCE: The registered manager, Julie Duggan is a registered nurse (RNLD) and an NVQ Assessor. Julie has undertaken a range of relevant training courses that includes Our Approach (including quality outcomes), Our Purpose (including listening and enabling), Equality and Diversity, and Fire Training for Managers course. Julie completed the NVQ Care Management Award in July 06. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 23 Management responsibilities in the home are also shared with a deputy manager. They are all involved in organising day-to-day activities, health & safety promotion, staff supervision and induction. Staff confirmed the manager is approachable and supportive. In respect of management support from the provider, Dimensions has Training and Human Resource Officers who are available to advise and support the home. Service manager meetings are held monthly and the manager confirmed that she and the home are being supported. The provider’s monthly visits are one of the ways that Dimensions monitors the service and how the home is being run. These visits include interviews with staff and service users and also include an audit of relevant aspects of the service, including records, environment, complaints received, finance and safety. Any actions that may be needed to address shortfalls are specified. The resulting reports are also part of the home’s quality assurance and monitoring system and are intended to form an annual development plan for the service. This report will include service users, stakeholders and interested parties views on the service provision. Records show that monthly checks of the fire safety system & equipment, water temperature & storage, fridge, freezers and electrical appliances are completed. Staff are undertaking all mandatory health & safety training topics. Generic risk assessments are in place that includes the home’s vehicles. The home now has a computer installed in the office. Staff are accessing this, as was observed during the visit. The registered manager has completed the home’s fire risk assessment, and fire drills are being fully recorded when completed. Annual fire training was completed May 06 and meets the requirements of the previous inspection. School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 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 3 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 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 3 3 3 X X 3 3 School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 25 Yes 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 YA29 Regulation 2 (b) Requirement The registered manager must ensure that the premises are of sound construction and kept in a good state of repair externally and internally. Specifically, this refers to redecoration and the protection of walls and woodwork. Previous timescale not met 30/04/06 Timescale for action 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA5 Good Practice Recommendations The registered manager should provide each service user with an up to date, written and costed contract/statement of terms and conditions between the home and the service user. The emergency on–call/hospitalisation profile should be reviewed in keeping with care plans to make sure it is kept updated. All service user medication information fact sheets should be dated to indicate the date of review. DS0000066847.V313152.R01.S.doc Version 5.2 Page 26 2. YA19 3. YA19 School Drive, 7 School Drive, 7 DS0000066847.V313152.R01.S.doc Version 5.2 Page 27 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: 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. 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