Inspection on 06/03/06 for Autumn Vale

This inspection was carried out on 6th 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 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

Autumn Vale 19/01/09

Autumn Vale 07/03/07

Autumn Vale 29/06/05

Similar services:

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

Ashley House

Ascot Nursing Home

Fountain View

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Autumn Vale The Circle 26 Clarendon Road Southsea Portsmouth Hampshire PO5 2EE Lead Inspector Wendy Mills Unannounced Inspection 6th March 2006 09:00 Autumn Vale DS0000062949.V254177.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 Autumn Vale DS0000062949.V254177.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 Older People and 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. Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Autumn Vale 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) The Circle 26 Clarendon Road Southsea Portsmouth Hampshire PO5 2EE 02392 826034 Lutchmy Care Services Mr Bhimsen Seedeehul Care Home 26 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (26), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (26) Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in MD category must be at least 30 years of age Date of last inspection 29th June 2005 Brief Description of the Service: Autumn Vale is a home providing care and support for up to twenty-six people, aged thirty or over, with a mental disorder. The property is a Grade II listed building that was designed by Thomas Owen. It is detached and has a courtyard garden to the side. It is situated close to the Southsea shopping precinct, Southsea common and the seafront. The registered providers, Lutchmy Care Services, took over the home a year ago. Mr Bhimsen Seedeehul is the registered manager. The residents refer to Mr Seedeehul as “Sandy”. Mrs Indira Seedeehul is the registered person for the home. Both Mr and Mrs Seedeehul are on the premises on a daily basis and are very involved in the care and support of the residents. Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection consisted of discussion with several of the residents, in-depth discussion with staff, the registered person, Mrs Indira Seeheedhul and the registered manager, Mr Bhimsen Seedeehul. Documentation was examined. This included care plans and staff files. A tour of the home was undertaken. Both direct and indirect observation was used throughout. At the time of inspection twenty-four residents were in the home. One resident had been admitted to hospital that morning for planned surgery and another was already in hospital. The residents, staff and registered persons are thanked for the welcome they gave and for their assistance throughout the inspection. What the service does well: The owners of the home have a clear sense of commitment to the residents. Both have extensive experience in the field of mental health, being qualified mental health nurses who maintain their continuing professional development. They use their knowledge and experience to support the residents to achieve more independence and improve their self-esteem. The home cares for the residents in a kindly and supportive way. This allows them to maximise their independence. Prompts are given with very discretely and with great kindness. Care plans show that several of the residents have made significant progress in the last year. The home works closely with GPs and Community psychiatric nurses to maintain the health of the residents. In the last twelve months they have made progress in ensuring the correct levels of medication for the residents. There is a good level of targeted staff training that goes on both within the home and externally. Training is tailored to staff needs and delivered in a way that is relevant to staff. In addition, several members of staff have either achieved NVQ at level II or above or are working towards it. The owners have a clear vision for the home and are working hard to make environmental improvements in a planned way. Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 6 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. Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards under this section were inspected at this visit. inspection showed that the home met these standards. EVIDENCE: The previous Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) 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, 8, 9 & 10 The home promotes the health, well-being and independence of the residents very well. Residents are consulted and there is positive interaction between the staff and the residents. EVIDENCE: Inspection of care plans showed that good records are kept of individual needs, goals and progress. Residents said that they are aware that records are kept about them and knew that these are stored securely. The residents were seen to move around the home with confidence and to interact well with the owners and staff. They were relaxed and friendly. Several residents said that they are much happier in the home since the new Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 10 owners took over. They said that they can come and go as they wish and that they can talk to the staff or the owners if they are worried about anything. Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) 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, 12, 13, 16 & 17 The home offers good opportunities and support for personal development. It encourages the residents to participate in the life of the local community when appropriate. The home manages nutrition well. Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 12 EVIDENCE: Care plans record the interests and goals of the residents. One resident is keen to move out of care and live independently. In preparation for this the home has encouraged her to prepare a “for and against” list and to talk to her care manager about her aspirations. The residents said that they go shopping locally. Some residents attend day centres. There is a relaxed and friendly atmosphere in the home. All the residents were clean and well dressed on the day of inspection and many had recently been supported to buy new clothes that are appropriate to their age. Indirect observation showed that the residents are confident in expressing their wishes and views to the manager and staff. Their views were listened to and taken into consideration. Appropriate responses were given and staff showed a great deal of patience with residents with anxiety. Residents said that they enjoy their meals and have plenty to eat. They said that the food has improved a lot since Mr and Mrs Seedeehul took over. Menus showed that there is a good variety and choice. The menus are seasonal and a good variety of fresh, dry and frozen food was available on the day of inspection. Residents are consulted about their likes and dislikes in respect of food and the home tries to ensure that everybody’s preferences are taken into account. Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) 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 & 21 Personal support is given in a way that respects the privacy and dignity of the residents. The home supports both the physical and emotional needs of the residents well. Medication is well managed in the home and there is a good awareness of the implications of aging and increasing disability. EVIDENCE: Records show that appropriate health care appointments, such as the dentist, chiropodist and optician, are made and kept. On the day of inspection one resident was due to be admitted to hospital for a planned operation but the transport did not arrive. The home therefore provided transport and a member of staff to accompany him. Medication is well managed and was stored appropriately. Discussion with Mr and Mrs Seedeehul and inspection of records showed that the home is working Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 14 with GPs, consultants and other healthcare professionals to ensure that the right levels of medication are determined for individual residents. Some residents have been on high doses of powerful medicines that have significant side effects. There was good awareness of these and every effort is made to minimise the side effects. As qualified mental health nurses, Mr and Mrs Seedeehul are well placed to do this. Discussion with Mr and Mrs Seedeehul showed that they have a good awareness of the aging process and of the problems of increasing disability and side effects of some medication with age. There are plans to alter a little used bathroom to make a shower room with good disabled access. They communicate well with staff and often include a short session of training about specific areas of care at handover time. For example, a resident was undergoing orthopaedic surgery and staff training and information had been targeted towards the reasons for surgery and the aftercare that will be needed. Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) 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 There is good awareness of adult protection issues and the residents’ views are listened to. This protects the residents from harm and enables them to make a positive contribution to the running of the home. EVIDENCE: There are clear adult protection and complaints policies and procedures. There is a good awareness of adult protection issues amongst the staff and the owners. Written evidence of staff training in the prevention of abuse was found in the staff room. Residents said that they could always talk to the staff or Sandy if they are worried about anything. Indirect observation showed that residents are listened to and appropriate explanations given, and actions taken, to allay their concerns. The only complaint that the residents had was that they would like to see improvements in the shower facilities. They were aware that there are improvements planned for nearly all the bathrooms and toilets. They felt that their concerns had been listened to and that action was going to be taken soon. Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) 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, 26, 27, 28 & 30 The environment of the home is clean and comfortable. The owners are aware that there are a number of environmental improvements needed and there is a plan for the necessary work. EVIDENCE: A tour of the home showed that there have already been a number of environmental improvements. New carpet has been laid in the communal areas and in some bedrooms. Some bedrooms have been re-decorated. At the beginning of the inspection a local builder had called to discuss the plans Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 17 for improvement with Mr Seeheehul. These plans are to improve the roof; extend the laundry to make it more efficient; to alter the layout of toilets to ensure there is more privacy; and to convert a little used bathroom into a shower room suitable for people with physical disabilities so that some of the residents who are now developing disability due to aging will be able to maintain their personal hygiene. The home is a Grade II listed building and this means that the council must also be consulted about the planned improvements therefore it was difficult for the owners to give definite timescales for the work. However, it is important to have some target dates, especially for the upgrading of the toilets. The residents said that they like their rooms and one said that he had “the best room in the house”. Rooms are homely and personalised. Shared rooms are laid out in such a way as to maximise space and give privacy. The residents said that they could have their personal things around them. Old furniture is gradually being replaced and residents can bring items from home if they wish, providing they meet health and safety and cleanliness standards. Communal areas are comfortable and homely. The home was clean and free from offensive odours. No health and safety hazards were noted on the day of inspection. It will be important for the home to maintain its continuous improvement programme and priority should be given to upgrading the toilets and showers. Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) 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, 32, 33, 34, 35 & 36 The residents are supported by a well-trained and motivated staff team. This means that their well being and independence is promoted. The home makes appropriate checks before appointing new staff to work in the home. This protects the residents from harm from unsuitable staff. EVIDENCE: Staffing rosters show that there are adequate numbers of staff on duty at all times. Both Mr and Mrs Seedeehul are in the home a great deal of the time and one-to-one supervision is established for all staff. Records show that supervision is both regular and recorded. Training needs are identified through the supervision process. There is a non-smoking staff room and articles about a variety of mental and physical health issues are available in this room. There is a notice board in the staff room and this is used to display bullet points in Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 19 respect of a number of areas of training such as the prevention of abuse, record keeping, management of aggression, self esteem, mood and nutrition and problem solving. Mrs Seeheehul usually leads short sessions to raise staff awareness of these issues at handover times. Several members of staff either hold an NVQ at level II or above or are currently undertaking NVQ training. The home also supports external staff training. The file of the most recently recruited staff member and other staff files were examined. Current CRB checks were in place and appropriate references had been taken up. The registered manager said that there is a rigorous interview process and that induction training covers the core areas of care such as prevention of abuse, fire training, health and safety etc. Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) 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, 38, 39, 42 & 43 The home is well run and the views of the residents are taken into consideration. There are sound quality assurance systems in place. This means that the residents benefit from a supportive environment that respects their views and promotes their health and independence. Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 21 EVIDENCE: Both the registered person, Mrs Seedeehul, and the registered manager, Mr Seedeehul, are registered mental nurses who have maintained their continuous professional development. Conversation with them showed that they have extensive experience and understanding in the field of mental health. In addition they both display a great deal of kindness and patience. They have gained the respect of both the staff and the residents. There are sound quality assurance systems in place and the residents views have been sought in a formal written questionnaire and informally in general conversation. There is a clear vision for the home in respect of environmental improvements and in the care of the residents. There is a good awareness of health and safety issues and regular checks are carried out to ensure fridge temperatures are at the correct level, fire systems are in place and that there are no new maintenance issues. No health and safety hazards were noted on the day of inspection. The owners stated that the home is financially viable but that some residents have increasing needs with the aging process. It will be important that the home obtains the appropriate level of funding to meet these increasing needs. Autumn Vale DS0000062949.V254177.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. Where there is no score against a standard it has not been looked at during this inspection. 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 X 3 X 4 X 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 3 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 3 38 3 39 3 40 X 41 X 42 3 43 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Autumn Vale Score 3 3 3 3 DS0000062949.V254177.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 YA27 Regulation 23 Requirement A plan of outstanding improvements needed to the environment to be sent to CSCI. The plan to include target dates for work to be completed and to be very specific about the work to be carried out on improving the toilets and showers. This requirement is outstanding from the last inspection and is given an extended timescale Timescale for action 30/06/06 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 YA43 Good Practice Recommendations The registered manager should ensure that he negotiates adequate funding as the dependency levels of some residents increase with age. Autumn Vale DS0000062949.V254177.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. Autumn Vale DS0000062949.V254177.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. 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