Inspection on 19/11/07 for Carlton Gate

This inspection was carried out on 19th November 2007.

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlton Gate 26/11/09

Carlton Gate 17/11/08

Carlton Gate 04/01/07

Carlton Gate 27/06/06

Carlton Gate 24/02/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Carlton Gate 10 Florey Lodge Admiral Walk, Harrow Road London W9 3TF Lead Inspector Tony Lawrence Key Unannounced Inspection 19th November 2007 09:45 Carlton Gate DS0000065285.V351061.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 Carlton Gate DS0000065285.V351061.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. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton Gate Address 10 Florey Lodge Admiral Walk, Harrow Road London W9 3TF 020 7289 2352 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 Westminster Society Mr Stephen Paul Golden Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2007 Brief Description of the Service: Carlton Gate is a registered care home providing personal care and accommodation for one man and three women with a learning disability. There are two vacancies. Westminster City Council leases the property from the health authority and care is provided by the Westminster Society, a voluntary organisation. The home is well located to enable residents to use facilities in the local community and is close to shops and transport links. The home is split into two flats, Florey Lodge and Barnard Lodge, each for three people. All accommodation is on the ground floor and the home is fully accessible to people using wheelchairs. Each person living in the home has a single room. Each flat has an assisted bathroom and accessible shower room. The flat in Florey Lodge contains the staff office. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on Monday 19th November 2007 from 09:45 – 15:45. Tony Lawrence, Regulation Inspector, carried out the inspection. He spent time talking with residents, the home’s Manager and Service Manager and staff on duty. Care records were checked to track the support received by two people living in the home. Nine members of staff and three residents returned confidential questionnaires sent out as part of this inspection and their views are included in this report. The weekly fee for the service is £1,545. What the service does well: 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. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 6 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 Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 7 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): 2 and 4. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Significant time and effort is spent making admission to the home personal and well managed. There is a high value on responding to individual needs for information, reassurance and support. EVIDENCE: The Society’s Service Manager confirmed that the home currently has two vacancies, following the sad deaths of two residents in the past year. All referrals to the home come from Westminster City Council’s Social Services Department and staff from the Society work with the council to identify people whose needs can be met in the home. One person has recently been referred to the home and the Inspector saw that staff had developed an excellent transition plan to enable the person to make an informed choice about whether or not to move into the home. The plan had been agreed with the person concerned and staff working with them in their current home. A senior Manager from the Society had completed a care needs assessment and information had also been provided by social services. The person had visited the home three times to meet residents and staff and had stayed overnight the weekend before this inspection. Another, two-night, stay had also been agreed with the person. Staff on duty when the person visited the home and stayed overnight had kept a detailed record of how the person had responded and the support that they had provided. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 8 It was clear to the Inspector that the person’s possible move into the home was being well managed, at the person’s own pace. Staff supported three residents to complete and return confidential surveys sent out as part of this inspection. All three people said that they had received enough information about the home to enable them to make a choice to move in. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff understand the importance of residents being supported to take control of their own lives. Individuals are encouraged to make their own decisions and choices. The care plans are person centred and are agreed with the individual. The plan is written in plain language, is easy to understand and looks at all areas of the individual’s life. EVIDENCE: During this visit the Inspector checked the care plan files for two residents. He felt that the Society and staff in the home have made very good progress on implementing a ‘person centred’ care planning system. There was clear evidence that people are involved as much as possible in developing their own care plan, involving other significant people, including relatives, advocates and social and health care professionals. The plans make excellent use of photographs to make information more accessible to people with communication difficulties and were written in the person’s voice. The plans identified important goals for each person and the actions needed to achieve each goal. One plan included an excellent goal to support the resident to go to an outdoor concert, together with all the factors that had to be considered to enable this to happen. The Manager confirmed that staff had supported the resident to go to the Proms in the Park, which he had greatly enjoyed. The Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 10 Inspector felt that this excellent standard of goal setting needed to be extended for this person and others living in the home. Nine members of staff who returned confidential surveys said that they were ‘always’ given up-to-date information about the needs of people they support. Both care plan files checked during this visit included a number of risk assessments that had been reviewed and updated at least once since January 2007. The assessments covered identified potential risks to the individual resident, including fire safety, manual handling, mobility, use of the assisted bath, transfers and other aspects of the person’s health and personal care needs. Health care professionals, including Speech and Language Therapists had been involved in completing risk assessments where individuals had difficulties eating or drinking. The Inspector saw the minutes of a house meeting attended by all the people living in the home that was held in August 2007. The meeting covered a range of issues about daily life in the home, including activities, menus, holidays and staffing issues. Good use was made of photographs to make the information more accessible to some people living in the home. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. 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. People who use services are involved in meaningful daytime activities of their own choice and according to their individual interests and capability; they have been fully involved in the planning of their lifestyle and quality of life. EVIDENCE: ‘I have set goals’. (Comment from a resident). ‘The service does well by fully supporting the service users by helping them to meet all their needs and goals and stay comfortable where they live’. (Comment from a staff member). ‘We give opportunities for service users to make everyday choices. We promote independence and give people opportunities to go out into the community’. (Comment from a staff member). During this visit the Inspector checked the care and support provided to two people living in the home. Both people had a weekly programme of activities, including planned sessions at local day services and activities in the home and the local community, supported by staff from the home. When the Inspector Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 12 arrived, one person had already left for their day service. The second resident was unwell and staff from the home and the District Nurse were supporting them. The two other people living in the home went out with two staff to a local café for a drink and lunch. Each person’s care plan identified their likes, interests and aspirations. The Inspector felt that more work is needed to identify specific goals, but where this had been done, staff had supported people to achieve them. One person’s care plan included their enjoyment of sensory stimulation sessions. These had been planned with the Speech and Language Therapist and the daily care notes completed by staff recorded when these happened. The Inspector was pleased to see that staff were also recording the resident’s reaction to each session and individual elements of the session. The daily care notes also included details of occasions when residents had been offered choices about aspects of their lives and what choices they had made. Care plans included details of residents’ relatives, friends and other significant people. Plans also included details about how staff supported residents to keep in touch with other people. Daily care notes included details of the food eaten by residents at each mealtime. These showed a variety of nutritious meals was provided. Two residents told the Inspector that they enjoyed the food provided in the home and the meals and snacks they had in local cafes and restaurants. All three residents who returned confidential surveys said that they were able to make decisions about what they did each day and they could do what they wanted during the day, in the evenings and at weekends. One person added that they could not always do what they wanted at weekends and it was ‘sometimes not possible when short of staff’. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each resident’s plan. Personal support is responsive to the varied and individual needs and preferences of the people who live in the home. EVIDENCE: The two care plan files checked by the Inspector during this visit included detailed information about each resident’s personal and health care needs. The plans also included clear information about how identified needs would be met in the home or elsewhere. The Manager confirmed that the home’s policy is to provide same gender support with personal care wherever possible and this was happening on the day of this inspection. Residents’ preferences about the support they receive with personal care were also well recorded as part of their care plans. One of the two people whose care was reviewed by the Inspector had significant health care needs and these were well recorded as part of their care plan. The other care plan checked also included detailed information about the person’s health care needs and there was good evidence in both files of joint working with health professionals, including GP’s and the local multidisciplinary Learning Disability Services. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 14 Both care plan files included a Health Action Plan (HAP) completed with the resident and involving other significant people and health professionals. One HAP had been reviewed and updated in June 2007. The other plan had been written in September 2006 and the resident was due to visit their GP the day after this inspection for the review. The Inspector checked the medication records for two people living in the home. All prescribed medication is securely stored in lockable cabinets in each flat. The Medication Administration Record (MAR) sheets checked were well completed, although they had not been signed on the morning of this inspection, although medication had been given to one resident. Staff must make sure that they always sign the medication records when they give medication to residents, not later in the shift. Incident records also showed that there have been a number of medication errors in the past six months. Staff had taken appropriate action on each occasion, they recorded mistakes that had been made and issues had been discussed in team meetings and individual supervision. The home’s Manager confirmed that all staff had completed medication training as part of their induction and refresher training was also being provided. It is a recommendation of this report that the home informs the Commission about any medication errors that occur. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. 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. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. The home understands the procedures for Safeguarding Adults and will always attend meetings or provide information to external agencies when requested. EVIDENCE: Information provided by the home’s Manager in the Annual Quality Assurance Assessment (AQAA) is evidence that there have been three formal complaints since the last key inspection. The home has a complaints procedure and complaints recording form that have been produced in accessible formats for residents. Two complaints were upheld and all three complaints were resolved within the Society’s agreed timescales. In response to a complaint from one resident, a new dining table was bought for one flat. Accidents and incidents were recorded centrally and managers check these during monthly monitoring visits to the home. Managers and staff working in the home are aware of the local safeguarding adults procedures and report incidents to the local authority and the Commission when necessary. Evidence from the AQAA is that there have been no safeguarding adults referrals or investigations since the last key inspection of the home. All three residents who returned confidential surveys said that they knew who top speak to if they were not happy and all said they knew how to make a complaint. All nine members of staff who returned confidential surveys said that they knew what to do if a resident, relative or advocate had concerns about the home. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. People who live in the home are encouraged to personalise their bedrooms. All the home’s fixtures and fittings meet the needs of the individuals and can be changed if their needs change. EVIDENCE: The home is split into two flats, Florey Lodge and Barnard Lodge, each for three people. All accommodation is on the ground floor and the home is fully accessible to people using wheelchairs. Each person living in the home has a single room. Each flat has an assisted bathroom and accessible shower room. The flat in Florey Lodge includes a small staff office. The home is well located to enable residents to use facilities in the local community and is close to shops and transport links. During this visit the Inspector saw all communal areas of the home and three residents’ bedrooms. Some work has been completed since the last inspection to redecorate hallways, replace flooring in the bathrooms and provide a new assisted bath in one flat. The Manager confirmed that further work is planned to replace the carpet in one lounge / dining room and relocate the washing machines in both flats. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 17 Although all parts of the home seen by the Inspector during this visit were clean and hygienic, some communal areas and bedrooms will need further redecoration works in the next financial year. The Society’s Service Manager confirmed that a work programme for the home would be agreed in January 2008 and this work should be included. All three residents who returned confidential surveys said that the home was ‘always’ fresh and clean. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. 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. The staffing structure is based around delivering outcomes for the people using the service, and is not led by staff requirements. EVIDENCE: When the Inspector arrived for this visit the home’s Manager was on duty with three care staff. During the day, one resident went to day services; a member of staff went with another resident to hospital and two staff took two residents to a local café for lunch. Three staff who returned confidential questionnaires said that there are ‘usually’ enough staff on duty to meet residents’ individual needs. Five staff said there are only enough staff ‘sometimes’. One person said there are ‘never’ enough staff. Three staff said that if a team member is sick, they are not always replaced and it is not possible to provide two members of staff in each flat. The Inspector discussed with the manager and Service Manager the need to make sure that sufficient numbers of staff are available at all times to support residents. The Manager and staff team worked well together during the day to make sure that residents’ care needs were met, but the manager also had an appointment that would have prevented him acting as the fourth carer. The Service Manager confirmed that interviews had taken place to fill the three staff vacancies in the home. Residents living in the home had been Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 19 involved in the formal interviews and it is hoped that appointments will be confirmed shortly. The Society is aware of the need to make sure that the staff team reflects the gender and ethnicity of the resident group. The Inspector found the staff rota difficult to interpret and there is a need to make sure that an accurate record of shifts worked by staff is available in the home. The home operates a rota system that enables staff to be scheduled to work at short notice to support residents’ activities, but the manager must also make sure that an accurate staff rota is kept in the home. The Manager confirmed that a record is kept in the home of the Criminal Record Bureau (CRB) Enhanced Disclosure numbers of each member of staff. The home has achieved the 50 standard for care staff who have completed their National Vocational Qualification (NVQ) training. Information provided in the home’s AQAA is evidence that 75 of care staff will be NVQ qualified when staff currently undertaking the training complete their courses. Nine members of staff who returned confidential surveys said that the provider had carried out all the required employment checks before they started work. Four staff said that their induction training had covered everything they needed to know about the job ‘very well’. Five staff said that their induction ‘mostly’ covered what they needed to know. One person added ‘there was no time for a proper induction’. Another person said ‘the Society provides all the relevant training’. All nine members of staff said that they received training that was relevant to their role, that helped them understand and meet residents’ care needs and kept them up to date with new ways of working. One person added that they would like to do their NVQ Level 3 or 4 training but ‘there was no opportunity at present’. Five members of staff said that they met ‘regularly’ with their manager to get support and discuss how they were working. Four staff said they met ‘often’ with their manager. One person added ‘I do not get criticism so I don’t know what I do wrong or should do better’. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41, 42 and 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has the required qualification/s and experience and is competent to run the home. The manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. EVIDENCE: The Commission has registered the home’s Manager as a fit person to manage the care home. He has a good knowledge of best practice and policy developments to make sure that standards in the home are monitored and improved. There is evidence of good support from the Westminster Society. Regular monitoring visits are made to the home and copies of reports are sent to the home and the Commission. The Society has also provided the Commission with a copy of the home’s annual quality audit and this involves the views of people living in the home and other significant people. Residents and the Manager confirmed that regular house meetings are held to enable residents to be consulted about the day-to-day running of the home. Residents are also involved in interviewing new staff and their views are taken Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 21 into account as part of the recruitment process. A group of residents from services managed by the Society have also developed a list of ‘Top Ten Tips’ to inform potential new staff of the qualities that residents are looking for in people who work with them. The Service Manager confirmed that the Society is looking at ways of incorporating the residents’ tips into person specifications for new staff. The Society has developed all of the required policies and procedures to meet these Standards. Information from the AQAA is evidence that the policies and procedures are regularly reviewed. During this visit the Inspector checked a selection of care records kept in the home, including care plans, daily care notes, medication records and incident reports. Standards of recording in the home are generally good. No health and safety issues were noted during this visit. Carlton Gate DS0000065285.V351061.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 4 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 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 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 2 3 3 X 3 3 3 3 3 Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 (2) Requirement Timescale for action 31/12/07 2. YA33 18 (1) (a) Staff must make sure that they always sign the medication records when they give medication to residents, not later in the shift. The manager must make sure 31/12/07 that an accurate staff rota is kept in the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA20 YA24 Good Practice Recommendations The home manager should inform the Commission about any medication errors that occur. Redecoration works in communal areas and bedrooms should be included in the home’s maintenance programme for 2008 – 2009. Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Carlton Gate DS0000065285.V351061.R01.S.doc Version 5.2 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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