CARE HOMES FOR OLDER PEOPLE
Abbey Court Nursing Home Heath Way Heath Hayes Cannock Staffordshire WS12 5XP Lead Inspector
Mr David Cowser Key Unannounced Inspection 6th June 2006 10:30 X10015.doc Version 1.40 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 Abbey Court Nursing Home DS0000022389.V297782.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 Older People. 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. Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Abbey Court Nursing Home Address Heath Way Heath Hayes Cannock Staffordshire WS12 5XP 01543 277358 01543 277876 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) Restful Homes (Cannock) Limited Miss Sarah Edwards Care Home 117 Category(ies) of Dementia (59), Mental disorder, excluding registration, with number learning disability or dementia (10), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (25), Old age, not falling within any other category (80), Physical disability (58), Physical disability over 65 years of age (35) Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. DE Minimum age 60 years MD Minimum age 55 years PD Minimum age 55 years Date of last inspection 10th February 2006 Brief Description of the Service: Abbey Court is a purpose-built care home, providing nursing and residential care, located within a residential area on the outskirts of Cannock. The home can accommodate up to 117 service users in the following categories; Dementia care (59), Mental disorder, excluding learning disability or dementia (10), Mental disorder, excluding learning disability or dementia- over 65 years of age (25), Old age not falling in any other category (80), Physical disability (58), Physical disability over 65years of age (35). Current scale of charges range from £290 - £575 per week. The home is on two floors and all areas have access via the stairs and/or passenger lift. Within the home there are a total of 13 lounges available, including a specific smoking lounge. There are four dining rooms and ample facilities in the home including two hairdressing salons. The home has an enclosed garden with a suitable patio area. The registered care manager (RGN) is in charge of the home. First level nurses (both RGN and RMN), and teams of care assistants, provide care. Local GP practices and a pharmacist service the home. Community nurses, health service professionals, and NHS facilities are accessed as and when required. Several local GP practices and a pharmacist service the home. Activities, hobbies and entertainment take place with transport provided as required. Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key unannounced inspection was made on the 06 June 2006 at 10:30hrs. The inspection was undertaken using the National Minimum Standards for Older People as a reference. The total time spent for the inspection, including pre and fieldwork, amounted to 12 hours. The registered care manager (RGN) was in charge of the home; accompanied by four first level nurses and two teams of eight care assistants (16 in total). The ancillary staff on duty included; housekeeper and five domestic workers, two laundry workers, two cooks and three assistants, three maintenance men and an activities organiser. The business support person and receptionist were also on duty. These staffing levels were adequate to meet the needs of current 106 residents in the home. The homeowners were also present for the inspection. There were a total of 106 elderly service users in the home, of which 39 general patients and 51 EMI patients were receiving nursing care, and 16 were receiving personal care for needs associated with old age or a dementia related condition. The age range of service users was 59 to 104 years. The inspection included the following elements; a tour of the building, observation and inspection of records relating to provision of care, discussions with six residents, discussions with all the staff members on duty, observation and sampling of other services provided such as catering and laundry, and an inspection of the managerial aspects such as staffing issues, quality assurance and health and safety. Since the last inspection on 10 February 2006; there had been no changes to the management of the home, no complaints had been received and no additional visits had been necessitated. What the service does well:
Residents and/or their representatives had been able to choose the home, following an assessment and an invitation to visit, prior to admission. Asking four residents and seven visitors, and inspecting the admission documentation, confirmed this. The above aspects had ensured that each resident had been suitably placed, and that the home had the ability to meet their assessed needs. Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 6 It was evident, from discussions with residents and staff, and an inspection of the relevant documentation, that the provision of health and social care had been addressed well. Service user plans seen had been well completed and regularly reviewed. The plans were based on the community care plans completed by social workers, and agreed by residents/representatives. There was a good safe system in place for the receipt, storage, administration and disposal of medicines. No errors were noted concerning medicines, and residents asked said that they had their right medicines on time. Privacy, dignity and choice aspects for residents were seen being upheld during the caring process. When asked several residents and relatives said that they were very happy with the health and personal care being delivered by the home. During the past 12 months the number of accidents and incidents in the home was low. Activities and entertainment had taken place, and were seen documented. Residents told the inspector that they had appreciated and enjoyed the recent events and activities, and that they were able to choose whether or not to take part. Four visitors confirmed that links had been maintained with them and links had also been maintained with the local community. Catering aspects were very good and records seen showed that individual dietary requirements had been met. Residents spoke of choices and said that they were pleased with the food provided. The inspector sampled the main meal of the day, which met all requirements and was well presented. Assistance was seen being given to people with mental health or dementia care needs to help them to make a choice, by staff who had knowledge of the residents likes and dislikes. All of the above had assisted the residents in their daily living and social activities. No incidents or reports of abuse of any kind had been evidenced or recorded since the last inspection and policies and procedures seen covered these issues. No complaints had been recorded since the last inspection. Residents and relatives understood the complaints procedure. These aspects had contributed to the protection of service users. The home was fit for purpose, and provided a safe environment for the residents, staff and visitors. A homely atmosphere had been created and the premised were clean, warm and tidy. Adequate areas for residents were provided including; communal space, dining/activity space, bathing/toilet facilities, and bedrooms. Services and facilities including catering and laundry were adequately provided, and staffed. All residents asked stated that they were happy with the facilities and that they were comfortable with their surroundings. The registered care manager (RGN) and teams of nurses, both RGN and RMN, and care staff provided care. A good working relationship was evident with the local GP practices and pharmacist. NHS facilities and both community and hospital health professionals had been accessed when required. Community Psychiatric Nurses were also accessed to meet the mental health needs of service users. Staffing levels and skill mix had been adequate to meet the
Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 7 assessed needs of the existing residents. Recruitment of staff aspects was good. Staff training had been given a high priority, with induction training being followed by NVQ training. In addition to the trained nurses 54 of care assistants were qualified to NVQ level 2 or above. NVQ training and in house training in relevant subjects is on going. These aspects had contributed to the good standards of care being provided by the home. The registered care manager is sufficiently experienced. The general management and management of health and safety issues had been given a high priority, and no shortfalls were noted. The documentation seen evidenced that the premises were adequately maintained. Records had been correctly filed and stored. Assurances were given regarding the positive financial viability of the home, and that suitable accounting/business procedures were adopted. The current public liability insurance certificate was seen. There was a safe system of accounting for residents day to day monies and the ledger (previously checked) had reconciled with the money held. All the above had contributed to the protection and well being of residents in the home. Throughout the inspection the people who use, or have contact with, the home expressed only positive views. Many thank you cards and complimentary letters were seen from appreciative relatives. 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. Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 The quality outcome for the above standard is good. Residents had been correctly placed in a home of their choice, which had the ability to meet their assessed needs. EVIDENCE: The documentation seen, and a discussion with both residents and their representatives, evidenced that residents had been assessed prior to admission and they had been able to make a choice about the home. All had been given the opportunity to visit the home prior to choosing to stay. Two residents spoken to had visited the home, and had a meal prior to deciding to stay, and this was seen documented within the care plans. A full assessment of each residents needs had taken place before admission and this was seen documented. The community care plans provided by the social worker, as part of the individual needs assessment process, were seen within the service user plans. Residents asked confirmed that they had been fully involved and were in agreement with the assessments.
Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 10 All of the above had contributed to suitable placements and the residents needs being met. Intermediate care is not undertaken in this home. Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality outcome for the above standards is good. Individual health, personal and social care needs, as documented within care plans, had been adequately addressed with privacy and dignity afforded during the caring process. EVIDENCE: The service user plans and associated documentation seen were complete, reflected the current condition of residents, and had been regularly reviewed. Care aspects had been well recorded and were seen cross referenced to associated documentation such as accident book and incident sheets. Entries seen within the care plans were meaningful. Where appropriate assessment documentation should include cognitive and behavioural aspects, as discussed. Discussions with both residents and staff members evidenced that health and personal care needs were being well met. Several service users commented positively about the care being provided. A total of four care plans were examined in greater depth, with a check on all aspects of care starting at the pre admission/assessment stage.
Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 12 NHS facilities and professionals including community nurses, medical consultants and clinical nurse specialists had all been accessed when required, and these events were seen recorded. Local GP practices and a pharmacy service the home, and there is a good working relationship with them. Records of their visits and outcomes were seen documented. Currently five residents had a pressure area (three acquired elsewhere), which were being dealt with by the nursing staff and the clinical nurse specialist for nursing homes. Community Psychiatric Nurses were also accessed to meet the mental health needs of service users. The above attendances by visiting professionals were seen well documented. Death and dying aspects had been dealt with correctly in a sympathetic manner. Cards and letters were seen from thankful relatives. Staff when asked where knowledgeable on this subject, which was covered in their training. The medicines within the home, medication administration records, controlled drugs book and drugs returned book, were all checked and no errors were noted. It was observed that a safe system was in place, and that the comprehensive medicines policy documentation seen was being complied with. The documentation seen evidenced that only nursing staff administered medicines. No resident was ‘self medicating’, but locked facilities were available. During the inspection it was observed that privacy and dignity were being afforded to residents, and there was very good interaction with staff. Care staff were seen knocking on doors before entering. Two residents told the inspector that they were treated with respect, and that the staff were very kind. All of the above evidence satisfied the inspector that the individual health, personal and social care needs of residents had been addressed in the correct manner. Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality outcome for the above standards is good. Social contact had been maintained and the daily activities, along with autonomy and choice, had contributed to the resident’s lifestyle experiences meeting their expectations. Catering aspects were good and met individual needs and preferences. EVIDENCE: Several residents told the inspector that their views had been listened to, and that they had been able to influence some aspects of the running of the home e.g. mealtimes, menus. These comments had been documented along with the feed back from the resident/relatives questionnaires, and they had been acted upon. Contacts had been maintained, where possible, with relatives and friends and this was seen documented. Residents spoke of their visitors and their involvement with the home. One visitor attending the home during this inspection, told the inspector of the good links and communication with her. A dedicated member of staff coordinates and records the activities and entertainment provided. Several residents commented that this work had been appreciated. A discussion took place with the residents in one of the
Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 14 lounges regarding the past events and also the coming events. During the inspection an entertainer was singing for the residents on the EMI unit. Several residents spoke of their satisfaction with the meals and choices offered. The menus and catering records were examined and evidenced that the dietary requirements of residents were met, including residents’ needs with diabetes, and special diets. The menus had been changed with input from the residents and staff knowledgeable of their likes and dislikes. The cook when asked said that fresh good quality food from local suppliers was delivered on a weekly basis, the records seen confirmed this. Adequate supplies of fresh vegetables and fruit were also seen. The care staff spoke with each resident on a daily basis to establish his or her choice of food for the day, and this was seen documented. The inspector sampled the mid day meal and it was well cooked and presented, meeting all requirements. Two residents said that an alternative to these would be provided if requested. Several residents were unable to make a decision regarding choice of meal, due to their current condition, and the inspector saw them being assisted by staff who were knowledgeable of their likes and dislikes. Residents were seen being discretely assisted to eat in an unhurried manner. All the above had contributed to the daily life and social aspects meeting service users needs and expectations. Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality outcome for the above standards is good. An open culture existed where complaints or grumbles are listened to and acted upon. Residents are protected from all forms of abuse. EVIDENCE: An examination of the complaints records, the relevant policy and procedure documentation, and a discussion with staff and residents, evidenced that complaints and grumbles were listened to and dealt with. No complaints had been received since the last inspection. No additional visits to the home were necessitated. Many ‘thank you’ and complimentary cards were seen from appreciative relatives. No incidents of abuse of any kind had been evidenced or recorded. The policy documentation seen, and a discussion with staff confirmed that residents are protected from all forms of abuse. Documentation seen also evidenced that these issues had been discussed at length during staff induction, training and on-going supervision. All of the above had contributed to the protection of service users. Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The quality outcome for the above standards was excellent. The well designed and build home, was clean, pleasant and hygienic, and provided a suitable and safe environment for the provision of care. EVIDENCE: A tour of the buildings, and a check on the maintenance documentation, evidenced that the premises were fit for purpose, clean warm and tidy, and were being well maintained. The kitchen, laundry and sluice facilities were compliant. The duty rosters evidenced that adequate ancillary staff were employed. Staff when asked had knowledge on infection control, and referred to the relevant documentation. Adequate hand washing facilities, including hand gel, were available throughout the home. Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 17 The records evidence that maintenance of the premises was being given a priority. The redecoration of the home has continued, as programmed. The grounds and gardens were seen to be adequately maintained and were appreciated by residents spoken to. Hot water temperature checks, and emergency lighting/fire alarm tests were seen up to date and correct. Risk assessments were seen in place. There are no outstanding issues known from the Fire Prevention or Environmental Health departments. All the above had contributed to the comfort, safety and well being of service users. Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality outcome for the above standards is good. Adequate numbers of suitably trained and experienced staff are correctly employed to meet the assessed needs of residents. EVIDENCE: The registered care manager (RGN) was in charge of the home; accompanied by four first level nurses and two teams of eight care assistants (16 in total). The ancillary staff on duty included; housekeeper and five domestic workers, two laundry workers, two cooks and three assistants, three maintenance men and an activities organiser. The business support person and receptionist were also on duty. These staffing levels were adequate to meet the needs of current 106 residents in the home. The homeowners were also present for the inspection. The duty rosters seen, and a discussion with the manager and the staff, evidenced that adequate numbers of nursing and care staff had been on duty to meet the needs of the existing service users. Staffing rosters were checked and were in order. An examination of the rosters evidenced that in addition to the registered care manager the following care staff had been maintained or exceeded for the 106 residents: Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 19 a.m. 2 RGN & 2 RMN 16 Care assistants ( Care manager RGN for 5 days), p.m. 2 RGN & 2 RMN 14 Care assistants. nights 1RGN & 1 RMN 8 Care assistants. The care manager and her deputy also provide an on-call system. In addition to the above adequate ancillary staff had been rostered on duty throughout the week. Six residents asked stated that staff were available when requested, and that the staff were capable. The records seen evidenced that 62 care assistants were employed, of which 33 (54 ) were trained to NVQ level 2 or above. NVQ training is continuing with a further 12 enrolled on courses. Training had been given a high priority and the training records of individuals were seen. The records evidenced that care assistants had benefited from ‘in house’ and external training, which had covered the needs of the registered client group. Staff told the inspector that they had been afforded the time off and encouraged to study. The homes recruitment policy, procedures and documentation were examined and recruitment issues had been handled correctly. Staff had been subject to POVA/CRB comprehensive checks, and these were seen recorded. Staff asked stated that they had job descriptions and contracts of employment. The records seen and a discussion with the staff evidenced that, individually and collectively, they had the necessary experience and skills to meet the assessed needs of the current service users. All of the above had contributed the homes ability to meet the needs of residents and afford protection to them. Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The quality outcome for the above standards is good. An experienced registered care manager is managing the home, in the best interests of service users, and in an open an inclusive atmosphere. The home is on a sound financial footing, and has safeguards for the health and well being of residents’ staff and visitors. EVIDENCE: The registered care manager is well experienced and should complete level 4 NVQ qualifications, as agreed. An open, positive and inclusive atmosphere was observed during the visit and confirmed to the inspector by service users, staff and relatives. From observations made, discussions with service users and staff, it was evident that the home was being run in the interests of service users. Quality
Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 21 assurance, including feedback from residents and their representatives, was seen documented. The home has recently ISO 9001 2000 Quality Assurance via an External Auditor. Documentation seen evidenced that the views of visiting professionals had also been established, and included in the review process. Staff supervision sessions, six times per year, had all been completed and documented. A check on the records and a discussion with both residents and representatives evidenced that all service users had the opportunity to handle their own finances and residents and families had chosen to do so. Day to day monies of residents and the associated records were not checked, but previously had been found correct. Inventories of valuables and belongings brought into the home were seen recorded. No health and safety issues were noted during this inspection, including a tour of the home. The documentation seen for checks and examination of plant and equipment was correct and up to date, these included; electrical installation and portable equipment tests, gas testing, boiler servicing, water testing, fire alarms and equipment, Lift maintenance and examination, and maintenance/testing of lifting equipment. The homeowner gave assurances that the home was financially viable and that suitable accountancy and budgeting procedures were adopted. The current public liability insurance certificate was seen up to date and correct. All of the above aspects had contributed to the safety and well being of service users, staff and visitors. Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X X x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 4 Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 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 Refer to Standard OP31 Good Practice Recommendations The care manager should complete level 4 NVQ qualifications, as agreed. Abbey Court Nursing Home DS0000022389.V297782.R01.S.doc Version 5.2 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
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