Inspection on 06/12/06 for Consterdyne

This inspection was carried out on 6th 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 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

Consterdyne 15/12/08

Consterdyne 03/02/06

Consterdyne 10/09/05

Consterdyne 11/03/05

Consterdyne 17/12/04

Consterdyne 25/02/04

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

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Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Consterdyne 6 Mason Road Kidderminster Worcs DY11 6AF Lead Inspector Dianne Thompson Unannounced Inspection 6th December 2006 10:00 Consterdyne DS0000037401.V318461.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 Consterdyne DS0000037401.V318461.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. Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Consterdyne Address 6 Mason Road Kidderminster Worcs DY11 6AF 01562 69525 01562 748693 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) www.worcestershire.gov.uk Worcestershire County Council Mrs Linda Joy Harradine Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is primarily for adults with a learning disability aged 18-65 but may accommodate service users beyond the age of 65 if their needs can still be met. The home may accommodate service users who have an additional physical disability, mental disorder, sensory impairment or dementia illness, as described in the statement of purpose. 3rd February 2006 Date of last inspection Brief Description of the Service: Consterdyne is a large, detached, Victorian building situated in a mainly residential area near to the ring road, approximately one mile from Kidderminster town centre. The building stands in its own grounds and is accessed by a private drive. The home is owned and operated by Worcestershire County Council and managed on a day-to-day basis by a competent and experienced manager, Mrs Linda Harradine. The home provides long-term care for 10 adults, both men and women, who have a learning disability and some degree of physical disability. Two of the service users are of retirement age. The main aim of Consterdyne is to provide a safe and comfortable home that, as far as possible, is a home for life, with staff endeavouring to meet the social, emotional, communication and health needs of all the service users. An outreach service for people with learning disabilities operates from an office adjoining the home. The office has its own separate access. The home and the outreach service have their own separate staff groups, although the outreach service is line managed by the manager of the home. The current fee for the service ranges from £62.35 to £94.45 per week. Charges which are additional to the fee include: • • • • • Personal toiletries, clothing and electrical items such as TV and music centre. Activities not covered by the allowance made by the provider or in the funding authority contract Holidays Major extra outings Hairdressing DS0000037401.V318461.R01.S.doc Version 5.2 Page 5 Consterdyne SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection that included an unannounced visit to Consterdyne. The main purpose of this inspection was to assess the service provided against key National Minimum Standards. Service user and staff records were examined, and a tour of the building was also carried out. Accumulated evidence from reports of monthly visits by the provider’s representative was used to inform this report. Time was spent with the staff on duty, service users and the home’s administrator. The registered manager was on annual leave at the time of the inspection visit. Seven service users were at home and three other service users were attending the local day centre. Service users, families and carers, and professionals have completed questionnaires about the home. Comments from these questionnaires will be included within the report. What the service does well: The home gives clear information to service users about the home. Before someone new moves into the home staff check that they will be able to give them the care they need. The home looks after people well and writes down what help everyone needs. Service users are given help and support to do the activities they choose. Families and friends are welcome to visit the home. Service users can choose what they like to eat from the healthy menu at the home. Service users are supported with their medical appointments and their health care. All staff are trained to give medication safely. Service users can talk to staff about any problems they may have. Staff are trained and know what to do if there are any problems. Consterdyne is homely, clean and tidy. Service users can decorate their rooms in the way they like. Staff are well trained. The home checks staff before they start working in the home. Worcestershire County Council checks the home to make sure that everything is being done properly. They check to make sure the home is a safe place to live and work in. Consterdyne DS0000037401.V318461.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. Consterdyne DS0000037401.V318461.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 Consterdyne DS0000037401.V318461.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): 1,2,3,4 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides detailed information about the services it offers to help service users to choose to live at Consterdyne and to see if the home can meet their needs. EVIDENCE: The home’s statement of purpose provides up to date information about the home to help prospective service users decide if they wish to live at Consterdyne. The homes administrator said that copies of the Statement of Purpose and Service User Guide are accessible to all, including visitors to the home. All service users receive copies of relevant information prior to moving into the home, which is offered in preferred formats, such as symbols and pictures, audio and large print. An admissions policy and procedure is followed for all prospective service users. The assessment process is very detailed and service users care records show that the home obtains all information about prospective service users, their background, their needs, their likes and dislikes when they are referred for a placement. Information is gathered from a range of sources including Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 9 other relevant professionals, visits to previous homes or day services, and discussions with family members. Introductory visits and stays are arranged at the home prior to admission. During the introduction to the home prospective service users are given a copy of the Statement of Purpose and Service User Guide. Responses from the service user questionnaires confirmed that everyone had the opportunity to look around the home before they moved in. The home completes an accommodation form for each person. This form checks and records that all facilities are supplied as recommended in the National Minimum Standards (NMS). This is an example of good practice and ensures everyone is familiar with the standards. Consterdyne DS0000037401.V318461.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): 6,7,9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care plans provide staff with relevant information about users assessed needs. They include risk assessments that show how risks are to be reduced and independence promoted. Service users are helped to make choices and decisions in their daily lives and routines. EVIDENCE: Service user care plans are detailed and informative. Staff have information to make sure that all care is provided in a preferred and consistent way that encourages independence. Files for three service users were examined. Case tracking provides a view of how the home responds to the diversity of needs and how this is being managed and supported. This is particularly evident where health needs and disability requires greater input and support from all staff within the home. Relevant information and monitoring is provided in service user files to make Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 11 sure all staff have the necessary information to provide quality care. It is evident that care plans are now reviewed six monthly or as needs change. This meets the requirement of the previous inspection. Care plans are completed using signs, symbols and pictures to make sure that information is accessible to service users. Care plans contain a list of the likes and dislikes for each service user. Service users say they are able to make decisions about their lives. One service user said ‘ I make myself a drink, I watch TV, I wash up, I can do what I want’. The home completes risk assessments to promote safety and independence for service users. Those seen included risk assessments for choking, using the hoist, making hot drinks and nighttime needs. There is evidence that risk assessments are being reviewed, but some risk assessment reviews have yet to be completed. Each service user is allocated a key worker to oversee their care. Each key worker builds a closer relationship so they gain more understanding and knowledge of individual needs, goals and wishes. Staff sign to say they are fully aware of the plans and use them to guide their practice. Consterdyne DS0000037401.V318461.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, 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users receive help and encouragement to lead active and interesting lives and are supported to access facilities within the wider community. They are also supported to maintain links with their families and to develop friendships. The home offers a well-balanced menu and promotes healthy eating for the welfare of all service users. EVIDENCE: The home provides a range of activities for service users, both in-house and within the local community. All activities are organised to take into account individual needs and preferences, making sure that everyone has the opportunity to take part. Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 13 A weekly activity-planning sheet identifies various activities scheduled for the week and provides opportunities for service users to choose other options. In-house activities include baking cakes, music, knitting, watching television, games evenings, karaoke, craft activities and looking after the home’s dog. The home has a ‘job rota’ for daily household tasks that everyone is involved in. External activities include meals out, shopping, trips out, holidays, concerts, and the local cinema. Some service users attend the local day centres. The home was very busy throughout the inspection visit with some service users decorating the Christmas tree, and others hoovering or polishing the living rooms. The majority of service users were involved in the Christmas preparations, and included some impromptu carol singing. The home was preparing for a Christmas party for the following week. Service users will invite family and friends. Following a discussion at lunchtime, the home planned to have a disco this evening. Evidence shows that contact with friends and family is supported and maintained. Feedback from the relative and carer comment cards indicate that everyone feels welcomed to the home when they visit. The home provides well-balanced meals, with drinks and snacks available at all times. Food offered is varied, healthy and appropriate to individual needs. Service users are able to make themselves a drink of their choosing, and this was observed during the inspection visit. A choice of sandwiches was offered for lunch. Service users chose tuna and ham sandwiches, with jam tarts and mince pies to follow. The service users had made the jam tarts and mince pies. The mince pies were delicious. Evidence is available to show that choices are being made. The meal for the previous evening included a choice of pork chops, faggots or fish dishes. A record of all food chosen and eaten is maintained by the home. One service user said his ‘favourite meals are chicken dinner and spaghetti bolognaise’. A supper menu is also available, particularly for the more elderly service user. Light snacks are offered and encouraged. Consterdyne DS0000037401.V318461.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, 20 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Personal and healthcare needs are clearly identified in care plans. These plans provide information to promote consistency of care and support for all service users in a way that takes into account their preferences. The home has a clear medication policy and procedure, which is followed to make sure that all medication is administered and stored safely for the protection of service users and staff. EVIDENCE: Service users’ care records and plans provide detailed information about their physical and mental health and the support needed from staff to maintain their good hygiene and health. The care plans sampled contain information about service users preferred personal care routines. Some service users at home at the time of the visit said they liked living at Consterdyne and that ‘it is better than where I lived before’. Those service users unable to communicate appeared to be comfortable and at home in their environment. Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 15 Records of all physical checks are completed where service users have particular health related concerns such as weight. In this way the home is able to closely monitor and respond to changes or obtain appropriate medical input whenever necessary. It is good practice to specify the frequency of weight checks to make sure these checks are carried out consistently. Service users and the home are well supported by medical services, which include GP’s, clinical psychologist, podiatrist, community learning disability team, continence advisor, dietician and epilepsy consultant. Arrangements are in place for preventative health services, such as dental checks and annual health screening. Staff on duty said that all personal care is given in private to promote dignity for all service users. Behaviour-monitoring forms are completed where objectives have been agreed Feedback from one of the relative and carer comment cards indicate that their relative ‘ is always well and happy when I visit’. Another comment stated that their relative ‘has never been happier or better looked after’. The home has a medication policy and procedure in place. Medicines are suitably and safely stored and there is appropriate storage for controlled drugs, should they be required. The administration of lunchtime medication was observed and appropriate procedures were followed. The staff on duty said they would follow the organisations policies and procedures should any medication error occur. Additionally these would be reported to CSCI. Information about prescribed medication is included in care plans for all service users. Pictures and easy to understand symbols and language is used to make information accessible. Consterdyne DS0000037401.V318461.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, 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are protected by easy to understand information about how to complain, with appropriate information for staff provided. Staff support service users to express their views and any concerns they may have. EVIDENCE: The home has procedures in place for the protection of vulnerable adults. Worcestershire County Guidelines on abuse and a copy of the Department of Health ‘No Secrets’ guidelines are available in the office. Some staff have received training in understanding abuse and managing challenging behaviours. The home’s complaints procedure is available in widget signs and symbols to make it accessible for service users. The administrator and staff confirmed that there has been no complaints made to the home and no complaints have been made to the CSCI since the previous inspection. Staff were observed interacting with service users in a supportive and respectful way throughout the inspection visit. Service users said that they would ‘tell a relative’, ‘talk to staff’, or would ‘speak to their key worker’ or ‘manager’ if they were unhappy or wanted to make a complaint. Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 17 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, 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Consterdyne provides accommodation for service users that meets their needs and offers a safe, spacious and comfortable home. The home is kept clean which ensures that good hygiene and infection control is maintained for the benefit of service users. EVIDENCE: Consterdyne is a large, detached, Victorian building situated in a mainly residential area near to the ring road, approximately one mile from Kidderminster town centre. The building stands in its own grounds and is accessed by a private drive. There are three lounges and a dining room situated on the ground floor. Additionally, on the ground floor there is a staff office, kitchen, outreach office, laundry, toilet and bathroom. Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 18 There are eight single bedrooms and two have en suite facilities. There are three single bedrooms on the ground floor occupied by older service users with mobility problems. There is one double bedroom on the first floor. The inspector was given a tour of the home, which included two service users bedrooms. Both rooms are individually decorated and furnished in ways that promote independence. A statement is held on individual files where equipment or facilities are not provided in service users bedrooms, such as locked cupboards. Consideration should be given to the installation of a banister rail to the back staircase to provide additional support, particularly where the staircase is used as an emergency exit. The premises are clean and tidy. One service user commented that they ‘wouldn’t live here if it wasn’t’. Policies and procedures for infection control are in place and staff are provided with disposable gloves and aprons. Communal bathrooms have paper towels and liquid soap available. All cleaning materials are stored in locked cupboards in the laundry room. Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 19 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, 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Suitable staffing levels are being maintained and staff receive relevant training to help them meet service users’ needs. The staff team understand their responsibilities and are committed to their role. They are well supported and work together to provide service users with consistent and good quality care. The home’s recruitment policy and practices make sure that suitable staff are employed and that all necessary checks are made to ensure the safety of all service users. EVIDENCE: The home has an established, effective staff team which is most beneficial for the service users. The home has a bank of relief staff and uses agency staff from one agency to maintain continuity and familiarity for service users. Staffing details and rotas for two weeks was submitted to CSCI prior to the inspection. The staff rota shows that sufficient staff are available for each shift. The home also has one volunteer. Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 20 Staff training details were submitted to CSCI prior to the inspection. Staff complete the mandatory health & safety training such as fire safety, first aid, food hygiene, moving and handling, and infection control. Other training courses include communication, safe handling of medicines, and abuse. Specialist training such as dementia awareness, sensory impairment and epilepsy is arranged as required. All newly employed staff complete the Learning Disability Award Framework Induction (LDAF) Course. The manager and some staff have attended a refresher course in moving and handling. This was a requirement of the previous inspection. The training information shows that six members of staff have NVQ level two or three, five members of staff have completed LDAF Induction and Foundation training, and two staff are working to complete their NVQ. This is well above the recommended figure of 50 and highly commendable. Feedback from the relatives comment cards indicate that the ‘staff are very nice’, that they ‘are always most helpful’ and that ‘the home and staff are excellent’. Comments confirm that there are sufficient numbers of staff on duty. The staff on duty and the administrator confirmed that all prospective staff complete an appropriate application form and that suitable references are obtained including one from their most recent employer. Service users are supported to be involved in staff recruitment. An enhanced CRB/POVA (police) check is undertaken before their appointment is confirmed. Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well managed with an open and positive approach. WCC monitors the home in various ways to ensure that the service continues to develop as service users want and that the home remains a safe place to live and work in. EVIDENCE: The registered manager, Mrs Linda Harradine has 26 years experience working with people with learning disabilities. Linda gained her CSS qualification in 1986 and RMA in 2005. Linda has completed regular training relevant to her role as the manager of Consterdyne. At the time of the inspection visit the registered manager was on annual leave, but service users, staff on duty and the homes administrator competently supported the inspection process. Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 22 Management responsibilities in the home are also shared with a deputy manager and two senior assistants. They are all involved in organising dayto-day activities, health & safety promotion, staff supervision and induction. Staff confirmed the manager is approachable and supportive. In respect of management support from the provider WCC has Training and Human Resource Officers who are available to advise and support the home. The provider’s monthly visits are one of the ways that WCC monitors the service and how the home is being run. These visits by the provider’s representatives include interviews with staff and service users and also include an audit of relevant parts of the service, such as records, environment, complaints received, finance and safety. Any actions that may be needed to address shortfalls are specified. The resulting reports are also part of the home’s quality assurance and monitoring system and are intended to form an annual development plan for the service. This report will include service users, stakeholders and interested parties views on the service provision. A quality assurance programme has been introduced to the service by WCC. The audit has been completed and a review of the findings is to be completed. Records show that monthly checks of the fire safety system & equipment, water temperature & storage, fridge, freezers and electrical appliances are completed. Staff are undertaking all mandatory health & safety training topics. Generic risk assessments are in place. Fire drills are completed monthly. Details of all persons present during fire drills should be recorded to provide an accurate record of training. Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 23 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 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 233 3 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 4 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 4 4 3 X 3 X 3 X X 3 X Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA29 Good Practice Recommendations Consideration should be given to the installation of a banister rail to the back staircase to provide additional support, particularly where the staircase is used as an emergency exit. Details of all persons present during fire drills should be recorded to provide an accurate record of training. 2. YA42 Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Consterdyne DS0000037401.V318461.R01.S.doc Version 5.2 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. 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