Inspection on 06/02/08 for Copperdown

This inspection was carried out on 6th February 2008.

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

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Maple Lodge

Heathlands

Aston Court Nursing Home

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Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Copperdown 30 Church Street Rugeley Staffordshire WS15 2AH Lead Inspector Peter Dawson Unannounced Inspection 6th February 2008 09:30 X10015.doc Version 1.40 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 Copperdown DS0000069925.V355413.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 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. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Copperdown Address 30 Church Street Rugeley Staffordshire WS15 2AH 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) 01889 586 874 01889 572 600 Stoneleigh Care Homes Ltd Vacancy Care Home 28 Category(ies) of Dementia - over 65 years of age (3), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (28), Physical disability over 65 years of age (3) Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation (without nursing) for service users of both sexes whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 28 Dementia over 65 years of age (DE)(E) 3 Mental Disorder over 65 years of age (MD)(E) 3 Physical Disability ocver 65 yeats og age (PD)(E) 3 The maximum number of service users to be accommodated is 28. 2. Date of last inspection Brief Description of the Service: Copperdown is an established 28 bedded care home for elderly people. It was acquired by new owners in July 2007. The previous high standards of care are being maintained and further improvements made. The home is situated in a residential are of Rugeley very close to the town centre. There are 26 single and 1 shared bedroom, most have en-suite facilities and some en-suites have showers or baths. There is a shaft lift access and staircase to all floors. There are 2 lounges and 2 dining areas, a quiet room and large smoking area. All areas are furnished to a good standard, the home is well maintained and provides good facilities for residents. Health care support services are available with established positive working relationships with external healthcare professionals. There are high standards of hygiene/cleanliness throughout the home. The large landscaped garden has good seating providing a pleasant outside area during the summer months. The Statement of Purpose/Service users guide is presently being updated. The stated fees for Copperdown are £360-£385 per week. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. This key unannounced inspection was carried out on 8th February 2008 by one inspector over 1 day from 08:30 a.m. to 5.00 pm. The National Minimum Standards for Older People were used as a reference for the inspection. An AQAA (Annual Quality Assurance Assessment) was provided (legal requirement) prior to the inspection and completed by the former Registered Manager who left the home just prior to the inspection. Some information from the AQAA is included in this report. The home changed ownership in July 2007 and previously provided high standards of care. For the purposes of this visit the home is now classed as a “New Registration” and it was clear that the previous high standards were being maintained and further efforts being made to further improve those standards. The Acting Manager provided full and comprehensive information about the service and later the new owner/provider was involved also in the inspection, together they assisted greatly in information about the service in an open and helpful way. The Acting Manager is being interviewed in 2 weeks time by CSCI to become the Registered Manager. Most residents were seen and there were individual and some small group discussions with them. Three visitors were seen and spoken with and all staff on duty were seen and spoken with, making a positive contribution to the inspection. There was an inspection of the environment including all communal areas and a sample of bedrooms. Records relating to the inspection process were readily available and included care plans, risk assessments, medication records, staffing records, fire safety records and other documents relevant to the inspection. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Ownership of the home has changed since the last key inspection 4th January 2007. The new providers secured ownership in July 2007. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 7 The previously high standards of care and the environment have been maintained. The previous owner/manager left the home 2 weeks prior to this inspection. The former Deputy Manager taking over as Acting Manager pending interview and approval by CSCI as the Registered Manager. The Acting Manager intends to maintain high standards, has made some minor positive changes already and will seek to further enhance the standards and quality of life of for residents. What they could do better: The Statement of Purpose/Service Users Guide must be updated to encompass the changes made and also include the weekly fees. DNAR (Do no attempt to resuscitate) forms are inadequate and must be replaced with appropriate documents completed by GP/Consultant involving residents and relatives. There should be no input into this (no signatures) from staff at the home. Regular checks of hot water outlets in resident areas should be established and recorded. Water should be provided around 43C The door to the smoking room should be adjusted to ensure it closes onto the door frame to provide a smoke seal and therefore safety in the event of a fire. Social histories should be provided for as a further tool in assessing and meeting the social, recreational and emotional needs of residents. Further improve the risk assessments relating to the residents who smoke. Establish a pre-admission assessment form to record the assessment and inform care plans. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 8 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. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 – 5 were inspected on this visit. Quality in this outcome area is adequate. The Statement of Purpose/Service Users Guide requires updating to reflect the changes in the home. People are invited to spend time in the home prior to admission. Preadmission assessments are carried out but not adequately documented. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose/Service Users Guide must be updated to reflect the change of ownership and other changes in the home. This should be readily available for all residents and visitors and include also current fees. Written contracts/statement of purpose were seen on individual files sampled. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 11 Assessments are carried out prior to admission in the persons current environment. There is no written pre-admission assessment - one needs to be introduced to record the assessed needs of the person which will then inform care planning. Prospective residents are invited to the home prior to admission. A recently admitted resident said that she had spent 2 days in the home for lunch/tea which allowed her the opportunity to sample the service and facilities of the home allowing her to make an informed decision about admission. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 – 11 were inspected on this visit. Quality in this outcome area is good. Health and personal care needs are recorded individual plans. Health care needs are fully met. There is a safe system of medication in place. Residents are treated with respect and privacy upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of care plans for recently and long-term residents were seen and contained good information about personal and physical care needs. There was detailed information about medical diagnoses and the ongoing health care needs were well defined. There was good recording of nutritional needs and assistance with eating. There was regular weighing and recording for residents seen, where there was Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 13 weight loss referrals to the GP were recorded. One resident who does not eat well has had prescribed supplements and being closely monitored. There are no incidents of pressure damage in the home at this time. Preventive measures in the form of pressure relieving mattresses and cushions had been provided by the District Nursing Service following referral. Awareness of tissue viability issues are good. District Nurses are attending at this time only for routine tests/checks. Wound care/tissue viability needs are nil at this time. Care plans are reviewed on a monthly basis. New residents have a review after 6 weeks and then an annual review. There was no evidence of social histories being established for residents. These should be provided by, or with assistance from residents & relatives. Advice was given about obtaining this information. The care of some residents with dementia care needs were discussed. Needs were well documented with risk assessments in place for those who wander in the home and those with propensity for falls. There are risk assessments for the 2 people who smoke and use the designated smoking area. These could be improved with more detailed information. Forms for DNAR (Do not attempt to resuscitate) were seen. These had been signed by the relative and witnessed by care staff. These are inadequate and must be discussed with the GP/Consultant, resident and relative, provided on the appropriate form by the doctor without direct input from the home. In an instance seen the resident was aware of the instructions that were her wishes, but she had not been included in the final decision/documentation. The medication system was inspected and satisfactory. There is no self medication in the home at this time. All staff administering medication are Senior Carers having NVQ3 qualification and also medication administration training. MAR charts (medication administration records) were completed fully and accurately. The only area having a shortfall was medication prescribed with a variable dose – the actual dose given (e.g. 1 or 2 tablets) should be recorded. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 14 Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 – 15 were inspected on this visit. Quality in this outcome area is good. Residents are satisfied that their chosen lifestyles are known and met and have control over their lives. Food provision is good residents expressing high satisfaction. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the start of the inspection at 8.30 am 16 residents were up and had breakfast. This was further discussed pursued during the inspection. 5/6 people were up at the staff change of 7.00 a.m all were early risers. Residents spoken with all said that there was a policy of natural waking and that they had control over the time they rose from bed. This was supported by information seen in care plans and discussions with staff during the day. In contrast to the 8.30 scenario, residents were seen rising later throughout the morning coming to the dining room for breakfast. One person had her breakfast in her bedroom and came to the lounge at 11 a.m. – her normal Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 16 preferred routine. The call system was readily available in bedrooms (with extensions where needed) and clearly used regularly by a majority of residents. There was evidence of flexibility of routines to fit residents choices and preferences seen throughout the inspection. Residents were accessing their bedrooms as they wished throughout the day. Residents meetings are now regularly held on a 3 monthly basis rather than previous 6 monthly meetings. Many residents were spoken with both together and separately during this inspection. All residents spoken with said that food provision was good. There was choice of well-cooked and well presented food, they stated their likes and dislikes were known and taken account of. Visitors were seen arriving during the day. Welcomed by staff with friendly, warm exchanges. A visitor spoken with said that she was “highly satisfied” with the care of her father, she is a regular visitor and is kept informed of any changes in his health or welfare. Another daily visitor expressed similar high satisfaction with the care provided saying she had looked at 11 homes before deciding to place her father at Copperdown. She praised staff highly and said “one of the most important things is, that staff talk to people in this home”. She visits daily and at varying times – always finding the same high standards of care. Activities are initiated by staff and include the usual indoor activities. There is external entertainment occasionally which the home intend to extend. Visits to the nearby theatre are arranged when possible. The home was adequately staffed on the day of inspection and there was observed ongoing good dialogue between residents, staff and visitors. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 – 18 were inspected on this visit. Quality in this outcome area is good. There is a satisfactory complaints procedure in place, known to residents and visitors. There has been training and staff are aware of the procedures for reporting suspected or actual abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure available in the home for residents and visitors which is clear and concise. No complaints have been received by the home or by the Commission in the past year. There is also a comments book in the reception area to record any issues raised. None have been recorded. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 18 Residents spoken with said that they were aware of the complaints procedure and knew how to make a complaint. Some said they would speak to their relatives if they had any complaints. The complaints procedure is discussed/reinforced at residents meetings also. All staff completed training in the Protection of Vulnerable Adults in March 2007. The Acting Manager was aware of the implications of the Mental Capacity Act for the home. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 – 26 were inspected on this visit. Quality in this outcome area is good. A high standard environment which is safe, well maintained and comfortable. There are good assisted facilities and equipment in place to enable daily living. Bedrooms are comfortable and well personalised. Standards of hygiene are particularly high with good cleaning routines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Building work is presently in process for an additional en-suite bedroom. The environment is good. There is adequate communal space and a sample of bedrooms showed that rooms were well-furnished and maintained. Most are Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 20 en-suite and several en-suite areas have walk-in showers or baths – although not generally used as residents need/prefer assisted facilities. Bedrooms were all well personalised reflecting individuality with many examples of furniture brought from home – a 101 year resident had brought full large wardrobe/dressing table which had been accommodated in the room. There is only 1 shared bedroom – occupants having made a conscious decision to share, both expressing a preference to be with someone else. Facilities are good. There are 2 bathrooms both assisted, one with Parker Bath, the other with bath lift – in addition to the shower/baths in en-suites. There is a very large smoking area (currently 2 smokers) whilst bright with good ventilation the peripheral cushions look a little tired and dated but the carpet has been replaced and several cigarette burn marks already present. The room is fairly clear of objects & furniture, with seating around the perimeter only minimising the fire risks. The door to the smoking room did not close automatically onto the door rebate and this must be adjusted to provide a good seal and protection in the event of fire. Hot water temperatures in a bathroom exceeded the safe limit of around 43C and will be rectified immediately. Regular checks of the hot water outlets also need to be carried out and recorded. There were very high standards of hygiene throughout the home, the AQAA stating that there was a daily checklist and cleaning schedules in place. This was certainly confirmed. There are also regular audits of the environment any maintenance needs are recorded and acted upon. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 21 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27-30 were inspected on this visit. Quality in this outcome area is good. The numbers & skill mix of staff are adequate and ensure the safety and wellbeing of residents. Recruitment procedures similarly protect residents. Staff training is good and ongoing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care staffing levels in the home for the 3 shifts are 4:3:2 plus the Manager during the day and ancillary support staff. This is adequate for the perceived dependency levels of the resident group. Night staffing levels were discussed and felt to be adequate for the needs of residents at this time. The Acting Manager said that she could (and does) provide an additional night carer if needed (e.g. someone ill etc) – this was later also confirmed by the provider who said he left the issues of care and staffing to the Manager, he would not question the need for this. More regular staff meetings are now being held on at least a 3 monthly basis, sometimes monthly if needed. This has facilitated the smooth transition of change of ownership of the home. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 22 A sample of 3 staff files were seen and contained all required documentation including references, POVA/CRB checks. Recruitment procedures are good. New staff are interviewed now by 2 people. A staff training matrix was seen and all required training had taken place with regular updates/further training planned as needed. More that 50 of staff have received NVQ training which is ongoing and available to all staff. There is a very relaxed and homely atmosphere in the home with good, natural engagement between residents and staff. Staff were keen and responsive to the inspection, giving positive accounts of the support they gave to residents and morale was high. Visitors are seen to be welcomed warmly by staff with good established dialogue. Visitors and resident spoken with both positively confirmed this view. Many staff have worked at the home for a long period and made positive comments about the changes of ownership and management of the home over the past months. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 23 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31-33 and 36-38 were inspected on this visit. Quality in this outcome area is good. The Acting Manager is providing a good service and active leadership in the home. There is evidence that the home is run in the best interests of residents. Staff are well-motivated and supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager who was also owner of the home left her post recently, having stayed following the purchase of the home by another provider in July 2007. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 24 The former Deputy is now the current Acting Manager and awaiting interview by the Commission for Social Care Inspection on 21/02/08 for approval as the Registered Manager. She has worked at the home for 9 years. Her appointment has/will provide continuity in the home. She is presently studying for the Registered Managers Award and should complete the course later this year. She is keen to maintain high standards and further expand and improve the levels of service delivery. She has good knowledge of the needs of residents. The new Provider was present for a large part of the inspection and it was helpful to discuss the transition of ownership, current and future plans. The main objective has been to ensure a seamless service to residents during the ownership change and this has been successful. Residents confirmed they have not been affected by the changes that have been kept to a minimum. Regular visits by the provider are made on a weekly basis and residents clearly know and have access to him. There was a good and open dialogue with/between the Provider and Acting Manager during the inspection. The provider has appointed a Company Office Administrator. The Provider owns 2 other homes and this appointment will give additional support to Managers in all 3 homes. The Acting Manager has a Company credit card for purchase of any items needed. Large or major items of expenditure would be discussed with the provider prior to purchase but the Manager has authority to purchase any items for the home if they are needed. Questionnaires have previously been sent to residents, relatives, GP’s & other professionals. These were seen and all were positive. The home received a further Investors in People award in September 2007, have applied for approval under ISO9000 which is being assessed soon. The Provider and Acting Manager are keen to maintain the high standards of care established in the home. Staff are all supervised on a regular basis and there is an annual staff appraisal. Two requirements are made in relation to Safety: The hot water in a bathroom area exceeded the required maximum level. Regular checks of the hot water in resident areas need to be established and recorded to ensure the temperature does not exceed 43C. The door to the smoking room did not close onto the door rebate to ensure an adequate seal. This will be adjusted. Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 25 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 2 Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 26 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 OP8 Regulation 12(1)(2) & 13(1)(b) 13(4) Requirement DNAR forms are inadequate. Decisions must be made by GP/Consultant with resident and relative involved & on the prescribed form. Establish regular checks of hot water outlets in resident areas. Temperatures should not exceed 43C Fire door to smoking room must close onto the door rebate to provide adequate smoke seal & protect residents in the event of fire. The Statement of purpose/service users guide must be updated to reflect the changes of ownership and also current fees. Timescale for action 29/02/08 2 OP38 09/02/08 3 OP38 23(4) 09/02/08 4 OP1 4&5 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Copperdown Refer to Good Practice Recommendations DS0000069925.V355413.R01.S.doc Version 5.2 Page 27 1 Standard OP3 Establish a pre-admission assessment for to record outcomes of pre-admission assessments and inform care plans. Provide more detailed risk assessments for residents who smoke. Provide social histories for all residents to inform care plans and ensure a comprehensive service to residents. 2 3 OP7 OP7 Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Copperdown DS0000069925.V355413.R01.S.doc Version 5.2 Page 29 - 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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