Inspection on 16/11/06 for Country Court

This inspection was carried out on 16th November 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

Country Court 12/05/09

Country Court 18/02/09

Country Court 06/02/06

Country Court 17/10/05

Country Court 10/02/05

Country Court 29/10/04

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

CARE HOMES FOR OLDER PEOPLE Country Court Southcoates Lane Hull East Yorkshire HU9 3TQ Lead Inspector Janet Lamb Unannounced Inspection 16th November 2006 09:20 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 DS0000000843.V320434.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. DS0000000843.V320434.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Country Court Address Southcoates Lane Hull East Yorkshire HU9 3TQ 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) 01482 702750 Pearl Dusk Limited Susan Weldon Care Home 34 Category(ies) of Dementia - over 65 years of age (34), Old age, registration, with number not falling within any other category (34) of places DS0000000843.V320434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Exception statement - permitted to provide care for one named person under pension age. 6th February 2006 Date of last inspection Brief Description of the Service: Country Court is purpose built building, which provides care for up to 34 older people, who may also suffer from dementia. All accommodation is on the ground floor with all rooms providing single accommodation. Nine rooms have en-suite facilities. There is a large lounge available along with a dining room and a conservatory. A smaller lounge also has a conservatory attached. An inner courtyard is available and accessible for residents to use should they wish to sit outdoors. The home is situated to the East of the city of Hull, with shops, health facilities, community services and public transport all easily accessible. A small car park is available at the front of the home. DS0000000843.V320434.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Key Inspection of Country Court began at the beginning of August 2006 when a pre-inspection questionnaire was sent to the home requesting information about service users and their family members. The Commission received the requested information on 4th September 2006 and survey comment cards were then issued to all service users and their relatives, their GP and any other health care professional with an interest in their care. This information obtained from surveys and information already known from having had contact with the home over the last few months, was used to suggest what it must be like living there. A site visit was made to the home on 16th November 2006 to test these suggestions, and to interview service users, staff, visitors and the home Manager. Some documents were viewed with permission from those people they concerned, and some records were also looked at. A total of eight service users, three staff, and the Manager, were spoken to or interviewed during the site visit and all of the information collected was checked against the information obtained through comment cards and details already known because of previous inspections and contact with the home. What the service does well: Service users are well assessed on entry to the home and are provided with a good care plan for staff to follow. They are well supported with health care that meets their needs and their expectations. They are protected from possible harm due to taking the wrong medication, because they have their medication handled by the staff in the home, and the staff follow robust practices and procedures. Service users experience good levels of privacy, have their dignity maintained, and their right to make decisions respected. They are encouraged to maintain contact with family members and friends and enjoy visits from these people any time of the day, and they are encouraged to exercise choice and control over their lives. Service users enjoy good food, which matches their expectations and preferences, but also offers a satisfactory level of nutrition. They are confident their complaints will be listened to and acted upon. DS0000000843.V320434.R01.S.doc Version 5.2 Page 6 Service users are protected from abuse by robust recruitment and selection procedures and practices. Service users experience a safe, clean and well-maintained environment. The Manager runs the home in the best interests of the service users, safeguards their financial interests, and maintains their health, safety and welfare. 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. DS0000000843.V320434.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection DS0000000843.V320434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6, but 6 is not applicable to the home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home. EVIDENCE: Service users are fully assessed by their placing authority and also assessed by the home during their trial stay. Three service users gave permission for their files to be viewed and during interviews with four service users all except one DS0000000843.V320434.R01.S.doc Version 5.2 Page 9 of them could remember being included in the assessment process. One said “I can’t remember the information given to me, I left it to my family. My daughter would have done the assessment for me, my children got me in here.” Another said “My eldest daughter came with me to look at the home, we got some information, asked if there was a room with a toilet, and then I booked to come in.” Copies of the placing authority community care assessment documents and of the home’s own assessment documents are held on files. The Manager confirmed the assessment process and that care plans are generated from the information obtained. Care plans are comprehensive in the information they hold. Service users also have contracts on files and where possible all documents are signed by them or their relatives. There is information available in the form of statement of purpose and service user guide, for service users to make a decision about the home before they consider moving in. These documents are held in service users’ rooms and are labelled for easy recognition. Standard 6 is not applicable, as the home does not take service users for intermediate care. DS0000000843.V320434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive good health and personal care and support, so their needs are well met. They benefit from good medication administration and from good levels of privacy and dignity within the home, so their health care needs are also well met. EVIDENCE: Service users and family members are involved in the drawing up of care plans. Any restrictions on freedom of choice, movement etc. would be recorded in care plans. Permission to view care plans was given and all three seen had evidence of this involvement. Care plans are reviewed every six months on a formal basis, or sooner if necessary, and every month in respect of the paperwork being checked for continuing relevance. Dates of reviews are DS0000000843.V320434.R01.S.doc Version 5.2 Page 11 clearly entered on documents and all three service users spoken to confirmed they take part in their reviews. Observation of service users and staff during the visit showed they interact well with each other and there is a pleasant rapport and banter amongst some. Dignity is well respected, although staff observed coming and going were a little presumptuous about entering service users rooms. Because doors are left open onto the corridor staff must not be too familiar about entering a service user’s room without knocking, asking permission to enter or waiting to be invited, on every occasion. One service user that was interviewed keeps a jar of sweets by her chair and gives these out to all of her visitors. She said, “I go out with my son and buy sweets. I like giving them out. I get on with nearly everyone. It’s quiet living here though, sometimes I wish there were more people to talk to.” Another said of the service received, “You always get help when you buzz. Everything is good. They cater for everyone and everything. Me and my family are very happy with the home.” Service users are satisfied with the levels of care they receive and the arrangements for their medication to be administered to them. Staff spoken to about medication handling explain that only senior carers, trained to give out medication, actually administer it. Hull City Council and Boots Chemist provide the medication administration training to staff. Administration of medication was not observed on this visit, but systems were discussed with the Manager who confirmed there have been no changes to medication storage, handling, administration or disposal since the last inspection, and that staff continue to follow a robust medication administration trail. All service users spoken to are satisfied with the arrangements for health care visits etc. and are confident a doctor will be summoned at their request. Records show they receive the appropriate assistance or treatment necessary for their continuing good health. DS0000000843.V320434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Outcomes for service users regarding daily life and social activities are good so they enjoy doing the things on offer, see visitors regularly, make their own decisions as much as possible and are positive about the food provision. EVIDENCE: There is a general activity plan held in the home, devised by staff after consulting service users about their likes and preferences. All planned activities are listed for the week and advertised in the main entrance hall for service users and visitors to see. Service users spoken to were satisfied with the pastimes on offer and all commented on the previous night’s singers, one saying, “We had the Potteril Players last night and my son stayed to listen, he knows them and one of them DS0000000843.V320434.R01.S.doc Version 5.2 Page 13 sang to him.” She also said, “We went to Bridlington last summer on a trip. Everything is good, they cater for everyone.” Another said about making her own choices that she decides when to put the television off and to go to bed. “I need help getting ready for bed, usually around 9.30pm. I can stay up if I want to watch anything, I decide. If I ask to go anywhere they get someone to go with me. I enjoy days out. We are going for Christmas lunch soon. We go to East Park in the good weather and have picnic teas.” The staff maintain individual activity records for each service user, showing where they have been or what they have done etc. The home’s newsletter, published approximately three times a year, also recalls outings and activities as well as advertises future events. Some service users were observed watching television in their room or listening to the radio, while those in the main lounge received visitors or made good use of the hairdresser on the day of the visit. There were several visitors throughout the day and brief discussion with two of them revealed they are generally satisfied with care and with pastimes. Contact with family and friends is good according to those service users and staff spoken to. Interaction between service users and staff was considered to be good, friendly and caring, but staff need to be mindful that they are entering a service user’s ‘home’ when they enter their room, as mentioned in the section above. Relatives generally come and go at will and service users decide whom they wish to see, within reasonable hours. Service users confirmed this in conversation, and diary notes showed evidence of contact and visits from their family and acquaintances. Most service users handle their own finances or have family members that do so. Some have a small amount of money held in safekeeping and records are maintained to ensure transactions are properly carried out and recorded. Service users made no adverse comments about their financial arrangement. Service users consider the provision of meals within the home to be satisfactory. Those spoken to said they liked the meals and enjoyed the variety on offer. One service user said, “The food’s alright, it suits me. It’s nicely cooked and the pots are clean. I can’t grumble.” Another said, “The food is quite reasonable, we have a set menu every day, but they have recently introduced more fish, which I like. At the last residents’ meeting the staff suggested some different dishes and we agreed to try them.” A third service user explained there had been some changes in the menus over the last month or two and that meals had improved. One relative that visits every day said the meals are alright. Some service users require assistance with feeding and usually staff manage to help them. One relative questionnaire received had made a comment that DS0000000843.V320434.R01.S.doc Version 5.2 Page 14 in their opinion there were not enough staff to assist service users that required this help. No one spoken to made any adverse comments about the arrangements for assisting with feeding, but staffing levels are discussed in the section on staffing and a recommendation to meet residential staffing forum requirements is made. Staff made general comments about shortages that impact on care in other ways and this is discussed in the staffing section. Menus on view, and each service user receives a copy, show no set alternative meal, but those spoken to do not consider this to be a problem. No service user spoken to shows any reservation about making particular requests if they do not like what is on offer. There is a choice of foods on offer for the teatime meal and the cook was observed asking each service user what they wished to have for tea that day and making a note of it. DS0000000843.V320434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaint management and protection of service users are good, so service users are listened to and they are confident they will be protected. EVIDENCE: Service users that were asked about their need to make complaints and if they knew how to make one were very relaxed in their responses. “I have no grumbles, the carers are very nice, some nicer than others. I cannot remember any information being given to me but I do know how to complain, I would talk to the manager or the deputies.” Another said, “If I had a complaint I would tell my daughter, she would go straight to the office. I am not frightened to go and tell someone myself. I have two nosey daughters and they always check I’m ok.” There are complaint and protection policies in place, staff that have not completed vulnerable adults training are booked to do a course on 20th November or 4th December 2006 and all staff have seen a video on abuse. The fact that training in vulnerable adults issues has been slow to arrange may be the reason staff were unable to confidently explain their understanding of protection and whistle blowing in questionnaires. Discussion with staff DS0000000843.V320434.R01.S.doc Version 5.2 Page 16 revealed they are aware of their responsibilities to pass on information to the Manager or the Registered Provider if necessary, and to inform them of their colleagues’ poor/abusive performance. They confirmed they were waiting to do the vulnerable adults training. Staff are not confident they can contact the appropriate social services department about any concerns or allegations they may come across, and the information that they can directly inform social services was given to them. Service users are not totally aware of the protection procedures, but did express a willingness to speak up about any injustice they may experience or see. Those spoken to said, they would talk to their relatives if they felt unhappy about anything. There was a recommendation at the last inspection to consider developing the complaint-recording format to ensure confidentiality. This has now been changed to meet data protection compliance. DS0000000843.V320434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is suitable for its stated purpose, and both cleanliness and maintenance are good, so service users enjoy a safe, homely environment. EVIDENCE: Some communal areas and four private bedrooms were viewed whilst interviewing or chatting to service users and relatives, and all areas are clean and satisfactorily decorated. Service users are satisfied with the cleanliness and tidiness of the home and those interviewed are satisfied with the room they are occupying. DS0000000843.V320434.R01.S.doc Version 5.2 Page 18 Generally the house is well maintained and the handyman deals with health and safety maintenance issues quickly. There are three domestic staff employed to clean the home and generally the house is satisfactorily clean and comfortable. Observation of the property reveals that the house is well maintained, and is suitable for its stated purpose. There is a rolling programme of maintenance, and carpets in bedrooms 1 and 9, recommended for replacement at the last inspection have now been replaced, but the lounge carpet, also recommended for replacement, is still to be done as part of the rolling programme. A recommendation was also made to repair the front door handle and this has been done. DS0000000843.V320434.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The staffing complement of the home is not sufficient to meet service users’ needs and there are not enough staff with the recommended qualifications, therefore only service users’ basic needs are being met. Recruitment and selection practices and training opportunities are good and so service users are well protected. EVIDENCE: Discussion with the Manager and staff and inspection of the revised contract hours list and the duty rosters revealed there are 689.52 contracted care hours per week. This includes the two Deputy Managers’ care hours, but not the Manager’s. According to rosters there are 625.5 and 639 hours being provided over a two week period. Because the Residential Staffing Forum hours require there to be 667.2 hours per week for 14 high, 16 medium and 4 low dependency service users, the home appears to be operating with 41.7 and 28.2 hours less than it should be for the two week period, and yet the contracted hours would suggest there is sufficient cover to meet the recommendations of the forum. DS0000000843.V320434.R01.S.doc Version 5.2 Page 20 Staff in discussion expressed concern that the afternoon shift operates less efficiently and effectively with only four staff on duty, which is the planned roster for five and four days of the two weeks shown and scrutinised. Service users say staff are always busy and always saying “I shall be there in a minute.” Service users recognise staff have many tasks, one said, “Staff are always in a hurry and sometimes speak a little bluntly.” No one made any adverse comment about the staffing levels though except the staff. The Manager explained that since the commission had surveyed stakeholders as part of the inspection, the staff roster had changed and some staff had experienced a change in working hours, which seemed to be working in respect of making staff more available at the busier times of the day. The shortage, according to staff, is experienced on shifts where only four carers are on duty. A recommendation will be made for the home to try to meet the calculated residential staffing forum hours required for the week. Of the 28 care workers employed, 9 have achieved or are soon to achieve the required qualification, thus showing 32.5 of care staff are qualified. Efforts need to continue to ensure the target of 50 is achieved and a recommendation will be made to meet this. There is a robust recruitment and selection policy and procedure in place and practice is good. Staff interviewed gave permission for their recruitment files to be viewed and documentation held shows the home maintains all of those required under schedule 2 of regulation 19. Staff interviewed related the recruitment process they followed and all confirmed having completed a criminal records bureau check. Staff also recalled the training opportunities they undertake and training files showed evidence of the training they have done. The only requirement recorded on the last inspection report was for the home to ensure all staff received protection of vulnerable adults training. This is booked for the 20th November and the 4th December 2006, by which time another 16 staff will have been instructed. DS0000000843.V320434.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The management of the home is effective and the health, safety and welfare of service users and staff is satisfactorily maintained, so that service users know the home is safely run in their best interests. EVIDENCE: Interview with the Manager reveals that she has almost completed her NVQ Level 4 Manager’s Award. She has many years experience of managing a care home. DS0000000843.V320434.R01.S.doc Version 5.2 Page 22 The quality assurance system is well maintained although staff do not have any input into it. The systems were not assessed at the site visit, but brief discussion with the Manager and staff and observation of the many service audit checking records held in the office, show there is a continuing quality assuring system. The Manager was advised to make sure a regulation 24 report is completed and sent to the Commission if and when the quality assuring systems are reviewed. Service users spoken to were satisfied with the arrangements in place for handling their finances. None made any adverse comments about this since they mostly have family that deal with their finances. One spoken to made no mention of finances, but two were quite satisfied. The last fire officer’s visit to the home was on 31/05/05, there are weekly equipment and fire safety system checks completed and recorded and there are regular fire drills carried out two to three monthly, to instruct staff in evacuation procedures. Staff explained that senior carers carry out impromptu fire drills that are a complete surprise to them, thus making the drills realistic. The Manager must make sure all staff receive two drills per year minimum, and that this is recorded. The home does not have a passenger lift, but does use three lifting hoists and Arjo Mecanaids last serviced them on 07/08/06, according to the home’s records and the maintenance certificates. Staff say they use the hoists as much as possible to ensure service users’ and their own safety. The home has documents containing details of safety instructions for cleaning materials etc. under the Control Of Substances Hazardous to Health regulations, and these are maintained for staff consultation. Staff are aware of their responsibilities in respect of safety regulations and practices were observed to be safe. The handyman maintains monthly water temperature checks on the hot water outlets and records these, and there was a full legionella water check carried out in 19/05/06, for which a certificate is available. Health, safety and welfare of service users and staff is satisfactorily maintained in respect of the four areas sampled. DS0000000843.V320434.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 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 X 3 X X X N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000000843.V320434.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. 1. Standard OP27 Regulation 18 Requirement The Registered provider must ensure there are persons working at the care home in such numbers as are appropriate for the health and welfare of the service users, as recommended by the Residential Staffing Forum figures. Timescale for action 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP28 OP31 Good Practice Recommendations The Registered Provider should ensure 50 of care staff have NVQ Level 2 or 3. The Registered Manager should complete the NVQ level 4 Manager’s Award as soon as possible. DS0000000843.V320434.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 DS0000000843.V320434.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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