Inspection on 21/12/06 for Bradbury House, Salisbury

This inspection was carried out on 21st December 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bradbury House, Salisbury 15/01/09

Bradbury House, Salisbury 24/04/06

Bradbury House, Salisbury 15/11/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Bradbury House The Portway Salisbury Wiltshire SP4 6BT Lead Inspector Alyson Fairweather Unannounced Inspection 21st December 2006 10:00 Bradbury House DS0000064825.V326980.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 Bradbury House DS0000064825.V326980.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. Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bradbury House Address The Portway Salisbury Wiltshire SP4 6BT 01722 349144 01722 349166 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) Wiltshire County Council Jemma Louise Dowdney Care Home 10 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (2) of places Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 25th July 2006 Brief Description of the Service: The building is a purpose built residential unit offering respite care for up to 10 adults with learning disabilities. The building has 10 single bedrooms, some having hoisting facilities, several assisted baths and toilets, as well as equipment for people with a sensory impairment. There are two high dependency rooms and one room for emergency placements, as well as several lounges for communal use, a large dining room and a well-equipped kitchen. There is also a training kitchen which is used by service users hoping to increase their independence. It is envisaged that a respite period would not last more than 8 weeks, and an emergency placement would be reviewed after 48 hours. However, some emergency placements last longer than this if no appropriate accommodation can be found. Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day in December. Several service users and staff members were spoken to. Two service users, three family members and one community nurse responded in writing to our questionnaires, Various documents and files were examined, including care plans, the service user guide, risk assessments, health and safety procedures, staff files and medication records. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. A copy of the service users’ guide is given to all new residents. Fees vary from £50.40 to £94.45 per week for a respite stay at Bradbury House. What the service does well: Staff medication training, and the home’s procedures and practice are of a high standard. A designated staff member is responsible for ensuring that the home’s medication policies and procedures are known to all staff, and specific induction training has been set up for new staff. Medication is kept in a designated room and is kept in a locked cupboard in this room. Medication support is recorded on a Medication Administration Record (MAR) and is signed for by two members of staff. Records of medicines received, administered and disposed of, including those sent out with service users to day centres were examined, and seen to be in order. The community nurse who wrote to us said that the home’s medication is handled appropriately. Staff training records showed that staff had received training in substance abuse, manual handling, health and safety, fire safety, dementia, food hygiene, medication administration and autistic spectrum disorder. Some had also had training in mental health issues, palliative care and Makaton. One service user said: “As I am unable to do anything for myself, and am totally reliant on my carers at all times for all my needs, I am really thankful for the help and care that I get at Bradbury House”. The community nurse wrote that “staff demonstrate a clear understanding of the care needs of service users”. Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective clients and families are given information leaflets so that they can choose whether or not they wish to use the service. All service users have their individual needs assessed before they arrive, so that staff know how best to support them EVIDENCE: The home has a comprehensive Statement of Purpose and Service User Guide which give an overview of the service which will be provided. This is given to every potential service user, and also gives details of the organisation’s complaints procedure. The booklets are available in pictorial format. Of the two people who responded to the questionnaire, both felt that they had had enough information on the home prior to admission and one said “I received some paperwork and had a few visits with my parents”. Much of the information about new service users is gathered from the community care assessment which accompanies a referral, but staff also visit prospective service users’ homes or day services in order to get as much Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 9 information as possible so that they know best how to support people. The assessment includes such information as mobility, specific health needs and family circumstances. Details of any medication support needed is written down and agreed with the service user or a relative. Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans reflect the needs and personal goals of service users, who are supported to make decisions about their own lives. They are supported to take risks where appropriate, and encouraged to be as independent as possible. EVIDENCE: A great deal of work has gone into improving service users’ support plans, which include details of any personal care needs, medical and physical health, mental health needs, mobility and communication skills. The support plans also highlight people’s likes and dislikes, and what activities they like to take part in. Staff record residents’ activities well as their general wellbeing on a daily basis. Support plans are reviewed regularly, but can also be added to if there are any changes in the person’s situation. Manual handling assessments were in place for those service users who need them, and behavioural guidelines were also in place. Any restriction to stop self-harming behaviour is recorded in Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 11 the care plans, and guidelines on how to manage this are on the individual’s file. Service users are supported to make decisions about their own lives with guidance from the staff. Some are able to manage their own finances, but most have family involvement. As Bradbury House is a respite service, most of the service users carry on with the same daily routines which they follow at home. Of the two service users who responded to our questionnaire, both said they could choose what they liked to do at night and weekends, although one person said that they didn’t have much choice over what to do during the day. All three family members who wrote to us said they were consulted about the care of their family member where he/she was not able to make decisions. Risk assessments had been done for each service user and these included things such as mobility, bathing and travelling, and ways of minimising risks were identified. Staff place great emphasis on encouraging service users to be as independent as possible, while trying to minimise any risk to their safety. One service user was noted to need one to one support when bathing, and staff rotas had been adjusted in order to allow for this. Service user care plans are numbered, and risk assessments were said to be linked to these. Storage of these risk assessments varied from file to file, and it is recommended that any risk assessment is clearly linked to the appropriate care plan. Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social and leisure activities are varied and tailored to individual need, and use facilities offered by the local community. Service users can have as much or as little contact with family and friends as they wish, and are supported to do so by staff. They are offered a healthy diet, with their preferences taken into account. EVIDENCE: Service users are encouraged to develop and maintain their independence as much as possible and, if they are able to, can come and go as they wish. As Bradbury House caters for respite service users, many people already have outside activities which they enjoy, and they are supported to continue with these. One service user works for the Shaw Trust, and others attend college or day services or go hill walking. People also visit the local pubs, cafes, shops, Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 13 library and cinema. Some people use public transport, with the local park and ride scheme a few minutes walk away. Bradbury House has its own games room, with a pool table, skittles and a dartboard, and has supplied a Karaoke machine which has proved very popular. Service users can also have the use of a Sky DigiBox which enables them to access a number of extra-terrestrial TV channels. A member of the staff team has recently been designated as an activities officer, and is currently finding out what people’s interests are. He has gathered together leaflets about all the local activities, and is planning to support people with more outside activities. A new minibus is available for the house, as well as an amenities fund. One service user said “I like group activities and being out and about”. Friendships both inside and outside the home are encouraged, and staff support links between service users and their family and friends, although the frequency of contact varies depending on the individual circumstances. Because Bradbury House offers respite care to families, some do not choose to visit at that time. Service users are free to visit friends outside the house at any time, and can entertain and choose to see who they like either in the privacy of their own bedrooms or in the communal areas available. One relative who wrote to us said: “My daughter has only been using Bradbury House since March 2006 but I am happy with the care provided and feel very confident with all the staff who work there”. The menu supplied in the home is varied and nutritious, and is drawn up on a weekly basis. Breakfast usually consists of cereal & toast, with a cooked breakfast on Sundays. Lunch can be a cooked meal for those who stay in during the day or a packed lunch for those who go out. The main meal of the day is at supper time, and the menu for the week showed a good variety of dishes available. An alternative option is available for those who do not like the main meal. There was a good supply of fresh fruit and vegetables, and juices and yoghurts were also available. Staff have records of the food likes and dislikes of all service users, and of any feeding support necessary. One service user has a milk intolerance, and the kitchen assistant and other staff were clearly aware of alternatives which could be offered. The dining room is light and airy and comfortably furnished, so people can enjoy mealtimes together. Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ personal support needs are recorded in care plans so that they can receive this support in the way they wish, and their physical and emotional health needs are met. Service users’ are supported to self-medicate where possible, and are protected by the home’s medication policies and procedures. EVIDENCE: Bradbury House has various adaptations and pieces of equipment in place to help with service users’ physical needs, including hoists, grab-rails and assisted baths. All service users have support plans for any personal care required. The information contained in them is gathered from the initial community care assessment and from occupational therapists who visit each service user who needs the use of specialised equipment. If the families live locally, the person’s own general practitioner (GP) is used, and the home’s local GPs are used for those who live further afield. Medical professionals are seen as and when required. This varies according to the needs of individuals and the situations arising while having respite care. The home has good links Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 15 with the local learning disability teams, which enables an effective response to any crisis periods that may arise. All service users attend reviews on a regular basis, and the care plan may be amended at this time. One service user said “As I am unable to do anything for myself, and am totally reliant on my carers at all times for all my needs, I am really thankful for the help and care that I get at Bradbury House”. A great deal of work had been done by staff to improve the storage and recording of medicines. A designated staff member is responsible for ensuring that the home’s medication policies and procedures are known to all staff, and specific induction training has been set up for new staff. Medication is kept in a designated room and is kept in a locked cupboard in this room. Medication support is recorded on a Medication Administration Record (MAR) and is signed for by two members of staff. Specific training has been carried out for the emergency use of rectal diazepam and midazolam, which are medications to assist service users who may need emergency treatment in the event of a seizure. Records of medicines received, administered and disposed of, including those sent out with service users to day centres were examined, and seen to be in order. There are specific protocols in place for medicines prescribed ‘as required’, including a guideline on when they may need to be given for each individual. There are various risk assessments in place, including for those service users who wish to manage their own medicines. As the home takes respite and emergency admissions they need to be prepared for any situation, including controlled drugs. A policy is available and a record book has been obtained. Families using the respite service are made aware of the need to supply medicines in the correctly labelled containers. The home recently had an inspection from the Boots pharmacist, and this was seen to be very positive. The community nurse who wrote to us also said that the home’s medication is handled appropriately. Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel their views are listened to and acted on. The policies and procedures the home has in place try to ensure that residents are safeguarded from abuse and harm. EVIDENCE: The home has a complaints procedure in place, and this is given to service users and their families along with the service user guide. Staff keep a record of both minor and major complaints, and copies of any letters are kept on file. Several compliments have been received from the families of people who have had respite care provided in Bradbury House. The complaints record showed that all complaints had been investigated thoroughly, and the results discussed with service users or their relatives. Staff spoken to were clear that they wished the service to be run in the interests of the service users. Both service users who wrote to us said that they knew who to talk to if they weren’t happy and both said they knew how to make a complaint. The home has copies of the “No Secrets” document, as well as the organisational policy and procedure on responding to allegations of abuse. All staff members are encouraged to report any incidences of poor practice, and a “Whistle Blowing” procedure is available. There are guidelines in place for the management of challenging behaviour. Although the manager was said to have attended training in the Protection of Vulnerable Adults, there were no records Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 17 of this for the care staff team. The manager has therefore been asked to ensure that all staff have access to this training. Bradbury House DS0000064825.V326980.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a homely, comfortable and safe environment which is clean and hygienic. EVIDENCE: Bradbury House is a purpose built residential unit offering respite care for up to 10 adults with learning disabilities. The building has 10 single bedrooms, some having hoisting facilities, several assisted baths and toilets, as well as equipment for people with a sensory impairment. There are two high dependency rooms and one room for emergency placements, as well as several lounges for communal use, a large dining room and a well-equipped kitchen. There is also a training kitchen which is used by service users hoping to increase their independence. It is an attractive home, with large airy rooms and comfortable furnishings. There are large mature gardens at the rear and side of the house, which service users enjoy using. This garden is now fenced Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 19 off from the main road, making it safe for service users to access. Bedrooms are homely, containing individual personal items, and each person has an ensuite bathroom. There are policies and procedures in place for the maintenance of the building and although staff currently take responsibility for the cleanliness of the home, it is planned to employ a cleaner soon. Both service users who wrote to us said that they felt the home was always fresh and clean. Bradbury House DS0000064825.V326980.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent and qualified staff. They are protected by the home’s recruitment policies and their needs met by appropriately trained staff. EVIDENCE: The home has a designated shift leader on duty to ensure there is a senior member of staff on duty at all times. Recent recruitment has taken place, and it is planned that the new staff members will support the increased activity schedule. The home employs a maintenance person and is about to employ a cleaner, which means that care staff will not be taken away from the task of caring for service users. Eight staff members have an NVQ, with one due to start NVQ level 2 and another due to start NVQ Level 3. One staff member has started a first line management course as well as an NVQ assessor award. Various observations were made of staff interactions with residents. All staff were seen to be patient and good humoured, taking time to talk with residents Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 21 and encourage them to express their thoughts and opinions. Of the three relatives who responded to our questionnaire, all said they were satisfied with the overall care provided, and all said they felt there were always enough staff on duty. There were sufficient staff on duty to meet the service users’ needs on the day of the inspection. Staff recruitment is assisted by Wiltshire County Council’s human resources department. All staff have Criminal Records Bureau (CRB) checks and are checked against the Protection of Vulnerable Adults (POVA) register. Two written references and a medical declaration are also required. All the staff files looked at contained the appropriate documentation. Training records showed that staff had received training in substance abuse, manual handling, health and safety, fire safety, dementia, food hygiene, medication administration and autistic spectrum disorder. Some had also had training in mental health issues, palliative care and Makaton. One service user said; “I am very happy with the care and support received at Bradbury House. The staff are very helpful and professional in their work”. The community nurse wrote that “staff demonstrate a clear understanding of the care needs of service users”. Bradbury House DS0000064825.V326980.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home. They know that their views underpin the monitoring and review of care practice. The home’s policies and procedures, and the health and safety checks carried out, mean that residents live in a safe environment. EVIDENCE: The manager, Ms Jemma Dowdney, has been employed by Wiltshire County Council for over two years. She has previously worked in supported living as well as residential care, and with people with learning disability and mental health problems. She has a Diploma in Psychology, and an NVQ Level 4 in care, and is studying for her Registered Manager’s Award. She has had training Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 23 in recruitment and selection skills, but has not yet had any training in supervision skills. As supervision is a major part of supporting staff in residential care, the manager has been asked to ensure that this training is sought as a matter of urgency. A quality assurance questionnaire has been devised by the home for service users and their families, and they are asked if they enjoyed their stay and what might be improved on. Wiltshire County Council also conducts regular internal audits. All three families who wrote to us said that they were happy with the overall care provided at Bradbury House. Both service users who wrote to us said that the carers always listened and acted on what they said. One service user said: “My communication is very limited but I believe I am understood”. There were good health & safety records in place. Records show that staff have been trained in areas relating to health and safety, such as fire safety, manual handling and prevention of spread of infection. The home’s water temperatures are tested monthly by an external contractor, and the annual portable electrical appliance tests were completed in June 2006. The home’s fire extinguishers, hoists, tracking systems, supported bath and other equipment are serviced on regular contractual basis. A visit from the Environmental Health Officer (EHO) in July 2006 looked at the main kitchen, the training kitchen and the small kitchenette, as well as ensuring that both fridge and freezer temperatures were recorded. This visit was seen to be very positive, and the home had no recommendation to act on. A fire risk assessment is conducted annually, and was seen to have been done in June 2006. A copy of the new fire regulations was also available. Bradbury House DS0000064825.V326980.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 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X 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 4 X 3 X 3 X X 3 x Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA23 Regulation 13 (6) Requirement All staff must have training in the Protection of Vulnerable Adults Timescale for action 21/03/07 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 YA9 Refer to Standard Good Practice Recommendations All risk assessments for service users should show a clear link to their care plan. Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Bradbury House DS0000064825.V326980.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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