Inspection on 31/05/05 for Chesterholm Residential Care Limited

This inspection was carried out on 31st May 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chesterholm Residential Care... 30/10/07

Chesterholm Residential Care... 18/12/06

Chesterholm Residential Care... 18/01/06

Similar services:

21 High Street

Vale House

Chestnut Walk

Dunwood Manor Nursing Home

The Old Vicarage

Excelsior

Cherwood House Care Centre

Durban House Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Chesterholm Residential Care Limited 10 Britten Road, Lee On Solent, Hampshire, PO13 9JG Lead Inspector Isolina Reilly Unannounced 31/5/05 10:00am 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Chesterholm Residential Care Limited Address 10 Britten Road, Lee On Solent, Hampshire, PO13 9JG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 02392 550169 02392 796812 Chesterholm Residential Care Limited Susan Stacey CRH 15 Category(ies) of DE- Dementia: 15 registration, with number DE(E)- Dementia ver the age of 65 years: 15 of places MD- Mental Disorder: 15 MD(E)- Mental Disorder over the age of 65: 15 Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1- Service Users in the categories MD and DE must be at least 50 years of age. Date of last inspection Brief Description of the Service: Chesterholm Lodge is a care home providing personal care and accommodation for up to fifteen male and female service users over the age of 50 years with various old age, dementia and mental disorder care needs. The home has two beds set aside for intermediate care beds and provides day care for one service user. Mrs Kay Moss owns the home and employs Mrs Sue Stacey as the registered manager. The home has recently been registered as a limited company. Chesterholm Lodge is situated in a quiet residential area within walking distance of the seafront and local amenities. The home is a two-storey domestic house in keeping with the local area. There is a mature garden laid mainly to lawn with a patio area and ample parking at the rear of the house. There is a chair lift providing level access between the ground and first floor. The home has nine single bedrooms of which five have en-suites and a further three double bedrooms without en-suite facilities. The home’s communal areas consist of two lounge/diners and a conservatory that is used as a smoking area. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The manager, staff and some of the service users spoken with preferred to be identified as residents rather than service users. This unannounced inspection took place over one day as part of the normal regulation and inspection programme, and to follow up on progress made in meeting previous requirement. The opportunity was taken to look around the home, view records, procedures and talk with residents and staff. The inspector also had the opportunity to observe the lunch period, and interaction between residents and staff. Thirteen residents and six relatives and four members of staff were spoken with who stated that they though the home is a good home. What the service does well: The residents stated that they felt that Chesterholm Lodge makes them feel are home within a homely environment and that they are extremely well looked after. The home has good process for admitting new residents with clear information regarding the service. The residents and relatives feel they are well looked after and respected by staff that seem to know what they are doing, are caring and helpful. They also all feel safe and comfortable at the home. The home has clear records that help staff to look after the residents as they wish to be looked after. The residents are also supported to use local health care services. The home encourages the residents to go out into the community and participate in activities of their choosing. The staff team is well trained and able to meet the needs of the residents. The real strength of the home is in the relationships that the staff have built with residents, their visitors and management. The home invests much time and money to ensure the staff have all the necessary knowledge and tools to provide the best care possible for the residents. The residents all stated that the meals in this home are very good with choice available if they don’t like what is on the menu and meals are nutritious varied and served in a pleasant setting. The home is able to cater for different dietary needs. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 6 The staff felt that the home promotes independence and increase confidence of the residents. 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. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 The admission process is well managed and residents are given clear information regarding the service. The home provides a two-bed effective ‘Intermediate Care’ service known as ‘step down beds’ under contract with social services. EVIDENCE: Some of the residents and relatives spoken with confirmed that they had been given sufficient informative to make an informed choose of home. All residents spoken with were aware of an initial trial period for them to decide if they like the home and wish to stay. The residents explained to the inspector that they were unable to visit the home before moving in but had met both the owner and manager prior to admission making the decision to stay during the trial period. In several cases the residents confirmed that their family had visited the home prior to admission. The inspector sampled the records for both step down residents and track a three further care plans. All individual files sampled had a current photograph of the resident. The ‘Step down beds’ records were informative and included assessment of needs likes and dislikes and care plan actions. A copy of the informative signed contracts of residency is held in each individual file. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 9 Within the individual residents’ files sampled a full admission assessment was recoded and reflected the care needs identified within the Community Mental Health Team assessments and/or social services care management assessment. The relatives spoken with said that the home asked many questions and looks after them very well. One relative stated that the ‘resident was extremely lucky to be so well cared for’. The manager confirmed that the home provide ‘intermediate care’ service rehabilitative short-term mental health type care for Social Services known as ‘step down beds’. The two designated beds are available in a shared room and the home has provides a rehabilitation programme in conjunction with health specialists encouraging independence, encouraging confidence in accessing the community and achieving self-care. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The residents are well looked after in respect of their personal, emotional and health care needs in such a way as to promote privacy and dignity. There is a clear and consistent care planning system in place providing staff with the information they need to meet residents’ needs. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure service users medication needs are met. EVIDENCE: The residents spoken with were all very complimentary of the care provided by the home. Stating that staff are very helpful, polite, appear to know what they are doing and look after them well. They also said that the staff are always respectful and mindful of their privacy and dignity. The six relatives spoken with also confirmed this. The inspector observed the staff interacting with the residents and found them to be attentive, pre-empting needs and professional. The three residents files were discussed with the individuals and all confirmed that the care instructions met their support needs. However, one care plan’s initial safety limitations are due to be reviewed with social services and community health care team due to the rehabilitation progress achieved by the resident. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 11 The cares plans contained written risk assessments, instructions to staff on how to look after the individual residents and are regularly reviewed. The records also included names of relatives, friends, health care professionals and social services care managers who are involved in supporting the client. A resent photograph was seen on all the files. There were also records of doctor and nurse visits and information on outpatient, dental, optician and chiropractic appointments. One resident stated that they had undergone recent ophthalmic treatment and the corresponding medical notes were present in the file. There was evidence of attendance at hearing aid clinics, optician assessments within the home and regular dentist and chiropodist services. The staff are good at following instruction and there is an ethos of training and encouragement for staff to use the care plans as a daily working tool. The home’s medication policy and procedures were found to be satisfactory. The home uses a ‘blister pack’ system from the local chemist and correctly stores medication that is currently in use within an appropriate cupboard. A copy of the Royal Pharmaceutical Guidelines for residential care was available. The receipt, administration and disposal records of medication were seen by the inspector and found to be satisfactory. One resident explained that they self administer their own medication and the corresponding risk assessments and care instruction were seen in the documentation. The community mental health care team had also completed a risk assessment that stated the resident is competent to self-administer own medication. The manager showed the inspector the home’s main medication storage cupboard and it was found to be secure, clean with medication stored correctly in date and in sufficient quantities. The care staff spoken with all informed the inspector that they have undertaken training in the safe handling of medication and many had attended an awareness session with the local pharmacist. It was noted that the home has samples of some staff signatures and initials. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 The residents experience a stimulating and varied life at the home with visitors encouraged, various formal and informal structured activities are made available. Links with the community are good and enrich residents’ social and cultural opportunities both within the home environment and external. The home is able to meet the cultural and religious needs on an individual preference. The meals in the home are good offering both choice on request and variety, catering for special dietary needs in pleasant surroundings. EVIDENCE: The inspector observed several residents reading large print books, magazines and daily newspapers. Each house has two lounge/dining areas. There are a two visiting dogs at the home that are very welcomed by the residents, who take pride in walking and enjoy the dogs’ company. The residents explained that they take part in several organised activities and enjoy the variety, although if they do not feel like it they are able withdraw. On the morning of the visit the inspector observed a ‘flip cart’ that had a completed word quiz. Two staff undertook an exercise to music including equipment like balls, home made pompoms the inspector observe positive interaction, participation and laughter. The home has invested in two staff that provide a variety of activities five days a week both in the morning and afternoon. Both staff have attended ‘Activities Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 13 for older persons’ run by Age concern. The owner confirmed that the home had invested over £2,000 on equipment for activities including materials, reminiscing kit and a large parachute for communal activity of balancing balls and getting them down the whole. The manager and staff confirmed that this had created a very interesting activity with much hilarity. The home has a minibus available to take residents on outings or individual trips to town if requested. Several of the residents confirmed that they received their postal votes and two residents had attended the local poling station to vote in the Country’s general election. In the hallway there is an information pin board and a wipe board where the days menu is written. Several clients said that they enjoy going out for walks along the sea front and down to the local shops. The relatives spoken with feel the residents are very well cared for and that they are made very welcome and part of the home. The inspector observed that the relatives visiting that day were made welcome and there was a professional but friendly communication. All the residents stated that the day routine is flexible and a meal can be put aside should they wish. The inspector observed on arrival that one resident was eating a late breakfast. The residents spoken with confirmed that meals were flexible and could be put aside for later on request. The cook spoken with explained that residents are asked for their likes and dislikes with a view to offering choice on a one to one basis when the main meal is not to their liking. The residents all confirmed that there was always choice at all meal times and at the main meal one resident explained that often three different dishes to choose from. All of the residents and relatives commented that the food was excellent, with generous portions, varied with plenty of choice. The meal was observed by the inspector and found to be relaxed, unhurried and the food attractively presented. The records were sampled and it was evident that hot food probing and fridge/freezer temperatures are appropriately recorded. The manager confirmed that the home has implemented a different recording system as advised by the Environmental Health Officer during his visit in February 2005. The home’s four week menus were sampled and found to be varied and records of food offered are kept. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 14 The three cooks employed by the home have commenced a course on healthy eating and nutritional meals for older persons. The cook spoken with confirmed this saying the course was very interesting. One resident was encouraged to assist with baking and on the inspection the individual was observed enjoying decorating mini cakes for afternoon tea. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has a satisfactory complaints procedure that residents are able to use. The staff have an understanding of Adult Protection issues that protects residents from abuse. The home has an open and positive approach to listening to residents’ views and improving. EVIDENCE: All the residents spoken with stated that they would go straight to the manager if they had a concern or complaint. One resident was clear regarding the different stages of the complaint process. They all stated that the staff are very good and always listen to individuals concerns. The relatives also felt that the staff were patient, caring and always willing to listen. The home’s complaint procedure included the address for the Commission and that all complaints will be dealt with promptly within 28 days. There have been no complaints since the last inspection. There is a system for logging complaints should they arise and the inspector viewed a file with correspondence from relatives and clients complimenting and thanking the home for the care received. All the clients spoken with stated that they always felt safe at the home. The relatives spoken to also confirmed this. The staff spoken with confirmed that they have received some instruction and are aware of the protection of abuse of vulnerable adults. They have discussed issues of abuse at induction and staff meeting on recognising and reporting of concerns or suspicions. There has been no allegation of abuse at this home. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 16 The home has a copy of the Hampshire County Council ‘Protection of Vulnerable Adults’ policy and procedure and it’s own policy and procedure reflects the guidelines from Hampshire County council’s own policy. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home presents as a clean, homely, comfortable and suitable environment for the residents. The standard of the décor within the home is good with evidence of on-going maintenance and improvements. EVIDENCE: The residents stated that the home is always clean, warm and no offensive odours were detected. The inspector observed this during the visit. They also confirmed that there has been on going decorating including hallways and replacement of a vanity unit. The manager confirmed that one bedroom has been redecorated and carpet replaced, the staircase has been re-varnished and the hallways redecorated. Following advise given at the recent visit from the Hampshire Fire And Rescue Fire Officer the home has ordered new signs for doors around the home. The owner shared with the inspector plans to improve the communal area within the home by adding a small extension and conservatory. To convert a double bedroom into two single bedrooms with en-suite facilities and add an en-suite to the double room on the first floor. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 18 All residents’ spoken with stated that they liked their bedrooms and were able to make them feel like home. One resident confirmed that a cleaner always come into his room to clean seven days a week and that the home is always kept clean. Most of the bedrooms where seen on a tour around the home and were found to be clean, bright and warm, furnished to the individuals taste and many had been personalise. However, there was one bedroom were the resident chooses to keep their door locked when not in the room. All residents’ spoken with felt there were enough toilets and bathrooms or showers. During the tour of the home the inspector noticed that all the communal hand sinks have liquid soap for washing hands and disposable paper towels. There were gloves and plastic aprons available in the laundry rooms, toilets and bathrooms. The resident stated that they often see the staff using them. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The staff at the home are well trained, supported and employed in sufficient numbers to meet the residents’ needs. The home has an excellent ethos towards developing staff as individuals and this is reflected in the residents feeling safe and comfortable at the home. There are good recruitment procedures that are fully implemented ensure residents are not put at risk. EVIDENCE: The residents spoken with described the staff as ‘caring, friendly, helpful and there when they are needed.’ All the residents and relatives spoken with said there was sufficient staff around and that the staff know what they are doing. This was confirmed through the staff duty rotas that showed that a minimum of two care staff on duty each shift, on one waking night staff on duty each night. The home also employs cooks and cleaners. The staff spoken with felt that the recruitment process within the home is thorough. The inspector was able to sample three different staff records and found that they were detailed with the necessary checks taken to ensure staff are fit to work at the home. The staff spoken with stated that he induction programme run by the home was useful and very detailed. The files sampled held records of the individual staff home’s own induction’ training covering the key areas with the signatures of the staff member and trainer and evidence of each staff having completed a Skills for Care Council induction programme as well. The owner confirmed that they have introduced a new recording system for induction and on going training that meet the ‘Skills for Care Council’ national standards. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 20 The staff spoken with confirmed that the home continues to provide and support staff to achieve qualifications in care to National Vocational Qualification (NVQ) level 2 and 3. The home’s training records show that the home undertakes training both external and through staff within the home with specialist skills and qualifications. The staff confirmed that they undertake training regularly. There was evidence of a wide range of subjects for training that include safe handling of medication, moving and handling, care practices, fire safety instruction and drills, first aid, diabetes, dementia, infection control, promotion of continence and food hygiene. The home has a positive supportive ethos and staff training with a programme of one to one supervisions quarterly and annual appraisals. The home also holds regular staff meetings that are minuted. The staff spoken with confirmed this, the manager and records sampled. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 and 38 The home provides a safe and auditable recording system for managing and monitoring residents’ moneys. The residents’ health, safety and welfare are well promoted by the home with systems that ensure everyone is protected within the home. EVIDENCE: The residents stated that the home help them to look after their money safely and it is always available to them when they wish. The inspector observed the manager checking and giving a resident their money. The resident checked the amount balanced and both him and the manager signed for the money taken out. The manager explained that she was not an appointee for any client. All the staff, residents and relatives spoken with found the manager and owner very pleasant supportive and approachable. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 22 Six monthly risk assessments are undertaken and recorded to ensure that the safety within the home room by room were sampled and found to be satisfactory. The residents commented on the comings and goings of the home’s maintenance man. Records were sampled of maintenance undertaken on all equipment within the home. All the residents and relatives spoken with stated that they felt safe at the home and many confirmed that the fire alarms are regularly tested. The owner explained the new system for recording fires safety maintenance, training, evacuation and visual checks. The visual checks of all fire safety equipment has been record and undertaken at appropriate intervals to ensure the safety of the residents. The Hamsphire Fire And Rescue Service fire officer last visited the home in February 2005 who made various suggestions on how the home could improve signing and record keeping. The owner confirmed that the records sampled by the inspector were a result of those suggestions. Since the last inspection a comprehensive reference file for the Control of Substances Hazardous to Health (COSHH) information leaflets has been implemented for every chemical being utilised within the home. Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x 3 x x 3 Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 24 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 4th Floor- Overline House Blechynden Terrace Southampton Hampshire 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 Chesterholm Residential Care Limited H54 S64256 Chesterholm Lodge V229954 310505 Stage 4.doc Version 1.30 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!