Inspection on 24/05/07 for Crown Meadow Care Centre

This inspection was carried out on 24th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Crown Meadow Care Centre 08/06/10

Crown Meadow Care Centre 18/03/10

Crown Meadow Care Centre 09/04/09

Crown Meadow Care Centre 25/09/06

Crown Meadow Care Centre 27/02/06

Crown Meadow Care Centre 29/07/05

Crown Meadow Care Centre 16/11/04

Crown Meadow Care Centre 26/05/04

Crown Meadow Care Centre 11/02/04

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

CARE HOMES FOR OLDER PEOPLE Crown Meadow Care Centre Bayleys Bridge Tipton West Midlands DY4 0HB Lead Inspector Mrs Mandy Beck Unannounced Inspection 24th May 2007 09:00 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 Crown Meadow Care Centre DS0000042299.V330654.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. Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crown Meadow Care Centre Address Bayleys Bridge Tipton West Midlands DY4 0HB 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) 0121 520 0700 0121 557 8279 Southern Cross Care Centres Limited Mrs Susan Joan Hall Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user identified in the variation report dated 23.3.05 may be accommodated at the home who is 64 years and over. This will remain until such time that the service users placement is terminated. One service user identified in the variation report dated 22.11.05 may be accommodated at the home who is aged 59 years and over. This will remain until such time that the service users placement is terminated. One service user identified in the variation report dated 21.2.2006 (female) may be accommodated at the home in the category PD. This will remain until such time that the identified service users placement is terminated. One service user identified in the variation report dated 21.2.2006 (male) may be accommodated at the home in the category OP aged 63 years and over. This will remain until such time that the identified service users placement is terminated. 25th September 2006 2. 3. 4. Date of last inspection Brief Description of the Service: Crown Meadow Nursing Home provides nursing care for up to 35 service users who are over 65 years. The home is situated on a main road close to Great Bridge and other local shops and amenities. The property is a purpose built three-storey building with parking at the front and garden at the rear. The home consists of 31 bedrooms, 4 of which are doubles. Other than their own rooms, service users have use of a large lounge/dining room on the ground floor, fronted by a conservatory entrance way and a small quiet lounge on the first floor. The second floor contains just 5 bedrooms, hairdressing salon and staff room. There are two passenger lifts and the home has two assisted bathrooms that are suitable for dependent residents; assisted showers are also available in most bedroom en-suites. Fees for this home are in the range £335 - £439 per week for social service funded residents and £550 per week for privately funded residents. Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the service. It lasted seven hours and during this time a variety of methods were used to gather evidence and make the judgements in this report. Time was spent talking to the staff and the service users. Staff files were also looked at to make sure that the home is continuing to recruit people in a safe manner. Three service user files were looked at in depth as part of the case tracking process. This process enables us to see if the home is continuing to meet the needs of the people who use this service. Information has also been used from the Pre Inspection Questionnaire the manager completed prior to this inspection and the service user questionnaires which were returned to us. Some of the comments from those questionnaires have been included in the body of this report. The inspector would like to thank the manager, service users and the staff for their hospitality throughout this inspection. What the service does well: What has improved since the last inspection? It was pleasing to see that all of the requirements from the last inspection have been addressed and have been removed from this report. Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 6 Staff are no longer re sheathing hypodermic needles and so reducing the risk to their own health and safety. The manager has now enrolled most of the care staff on to the National Vocational Qualification (NVQ) level 2 course meeting the minimum requirement of 50 of the care staff being qualified. The home must also be congratulated on being awarded the Gold Award from the Food Team based at Sandwell Council. The cook needed to meet guidelines for providing a healthy diet to service users and for maintaining a clean working environment. This means that service users are assured a wholesome and nutritious meal at all times. 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. Crown Meadow Care Centre DS0000042299.V330654.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 Crown Meadow Care Centre DS0000042299.V330654.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, 6 Quality in this outcome area is good. Service users can feel confident that the home will complete an assessment of their needs and that the home will meet those needs once they move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the service user plans of three people who use this service. It was pleasing to see that in all cases the manager had visited the service users prior to their admission to complete an assessment of their needs. Once the manager has completed this she then writes to the service user confirming that the home is able to meet their needs. In two of the files seen the information in the pre admission assessment had been used to inform staff of the care needs for service users and been transferred into a more in depth assessment after their admission. This process helps to make care planning more effective and service users know that their needs are being addressed. This did not happen in the last file that Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 9 was looked at, there were lots of blank areas on the assessment sheet this would make planning care difficult because the information about the service users needs had not been recorded. It was positive that the home also obtains a copy of the care management assessment from the Social worker before any service user is admitted. The home does not provide intermediate care services. Crown Meadow Care Centre DS0000042299.V330654.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): 7,8,9,10 Quality in this outcome area is good. Service users can be assured that their needs will be met and they will have access to health care professionals when they need it. Service users can expect to be treated with respect and dignity at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Every service user has their own individual plan of care. This plan details how the nursing staff will meet their needs. In all three of the service user files seen there were risk assessments in place that looked at the risk of malnutrition, falls, moving and handling and pressure sore development. The nursing staff also assess service users for the use of bed rails and their associated risks. In most cases where a risk had been identified a management or care plan had been drawn up showing how the risk was to be managed. However, there must be improvements to the record keeping to ensure that where an area of risk has been identified and a care plan drawn up, the care plan reflects the care that is being given. For instance one service user had Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 11 been identified as being at very high risk of developing pressure sores, the care plan did not mention any of the pressure relieving equipment that would be needed to reduce this service users risk. Additionally there was a care plan in place for skin excoriation (soreness) in thighs and groin but the care plan addressed catheter care and no mention of the treatment for the excoriation. There were entries in the daily notes that this service user had sacral breaks and skin break on buttocks but this had not been included in the care plan. When the care plan had been reviewed there was no mention of the skin break and staff had recorded “pressure relieving practice continued, client kept clean and dry to prevent pressure sores”. It was clear when discussing this service users care with the staff that they were aware of her needs and providing the appropriate equipment needed and were able to say that this service users skin had now heeled but this needs to be reflected in the record keeping practices of the home. All service users have regular contact with their own Doctors and are able to access other specialist community health services such as chiropody, dentists and the opticians. The home keeps records of all hearing and sight tests and ensures that service users have the appropriate aids such as glasses and hearing aids. The home must also be able to demonstrate how they have involved the service user or their representative in the care planning process; none of the care plans viewed had been signed by the service user. Medication practices in the home are generally good and service users can feel confident that their medication will be administered as prescribed by the doctor. Trained nurses administer medication and they have good systems in place for the ordering, storage and returning of medication. There were one or two improvements that must be made to further safeguard service users. Where service users are prescribed medication with a variable dose, such as one or two tablets, it is advisable that the nurse records on the Medication Administration Record (MAR) sheet the actual dose given to the service user. This will help improve records for audit purposes and give staff a clear record of how many tablets each service user has received in a twenty-four hour period. It was also noted that some Controlled Drugs for service users who were no longer at the home were being stored in the medication cabinet. These medicines must be denatured and removed from the home. The home is recording the fridge temperatures on a daily basis to ensure that medicines that require cold storage are kept at recommended temperatures. The home also records the temperature of the treatment room for the purpose of keeping other medicines at their recommended temperatures, it was seen that at times the temperature goes above 25oC and there is little ventilation in the treatment room. Staff do open the window but feel uncomfortable with this because the window opens onto a public pathway. It is recommended that Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 12 the provider consider the installation of bars at the window to increase the security and ensure that the temperature of the room is ambient. Throughout the inspection staff were observed talking to service users politely and clearly had a positive relationship with them. All staff were seen to be knocking doors to toilets before they entered to assist service users. When talking to staff they were able to give examples of how they would make sure that service users privacy and dignity were maintained such as “make sure that the curtains and the doors are closed when helping them to get washed”, “close the toilet door when people are using it”, “its about helping them to be dressed how they want to be and feeling comfortable”. Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 13 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): 12,13,14,15 Quality in this outcome area is good. Service users lead an active life and are encouraged to maintain their relationships and friendships. Meals are of a good quality and meet service users dietary needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the service users who answered the questionnaires we sent out agreed that the home tries to meet their needs when it comes to activites. On the day of the inspection is was a service users 105th birthday, the home had planned the celebrations with the service user. There were decorations, the cook had provided a buffet for guests and service users to enjoy and the manager had arranged entertainment. The service user also received a birthday from HRH The Queen. All of the service users were clearly enjoying themselves and stated that “we always have something to do”, “this lady sings to us and she is wonderful”. In addition to this the manager arranges other activities for service users to take part in and they are kept informed of the home’s activity programme via a notice board in the conservatory and in the day room on the ground floor. The home is also decorated with photographs of various events that have taken place throughout the year. Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 14 Visitors are welcomed into the home at any time but always in accordance with service users wishes and relatives are asked to respect this. Service users have the choice of where to see their visitors, they can see them in the privacy of their own rooms, the lounges or the garden if they choose to do so. The home has just been awarded the Gold Award from Sandwell Council’s Food Team, this means that they have taken steps to make sure the food they give to service users is wholesome and nutritious and would have had to meet guidance on healthy eating set down by the Food Team. On the day of the inspection the inspector tasted the vegetarian option on the menu, which was cauliflower cheese with vegetables and potatoes, the dessert, was raisin sponge and custard. The meal was very tasty and nicely presented. It was noted that service users help to lay the tables and that meal times were a relaxing time. Those service users who required assistance to eat their meals were helped in a discreet and sensitive way by the care staff. All service users are offered choices about the food they want to eat and the home is able to cater for specialised diets if required. The home operates a four weekly menu and this is subject to regular change. Crown Meadow Care Centre DS0000042299.V330654.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): 16,18 Quality in this outcome area is good. The home has good systems in place for responding to complaints and service users can feel assured that their views will be listened to. Service users are protected from abuse by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy that is readily available to all service users. Larger print is available upon request. Most of the service users who completed the questionnaires, said that they had never had cause to complain but they were aware of the process if the need arises. One service user stated “no one at Crown Meadow has ever discussed with us how to complain”. This was bought to the manager’s attention who agreed to review the information given to service users and their families to ensure that all were aware of how to make a complaint in the future should the need arise. Once a complaint has been made the manager logs this information into the complaints log and the information from it is used as part of an audit to improve practice. The home works alongside the Local Authority in any adult protection issues that may arise. Since the last inspection one referral was made to the Adult Protection Team but no action has been taken as a result. The home works in a proactive manner to ensure that no service user is placed at risk. Staff Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 16 receive regular training in adult protection and are aware of their roles in this process. When talking to the staff, it was clear that most of them had a good understanding of what abuse was and what they would do if they suspected abuse had occurred. It was also evident that some of the staff needed to attend refresher training to ensure that they are fully aware of what abuse is and how they would respond to it. This was also discussed with the manager and she will be arranging training in the near future for those staff identified. Crown Meadow Care Centre DS0000042299.V330654.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): 19,26 Quality in this outcome area is good. The home is well maintained and has good systems in place to control the spread of infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A partial tour of the home was undertaken. The home is generally clean and tidy and well maintained. The manager said that they have a rolling programme for decoration and refurbishment to keep the home looking nice. It was noted that in one or two of the bedrooms that we viewed there was an offensive odour, this was bought to the manager’s attention at the time and she has agreed to address this. One relative commented that their mother “likes to have the bedroom door open, but this does happen because of health and safety”. This was discussed Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 18 with the manager, she was not aware of any service user wanting this to happen but she will look into this and see if there are ways to address it. Other areas that will need attention are the shower rooms in each bedroom, some of the flooring was stained and appeared to be water damaged. The manager is aware of this and said that the maintenance worker will be looking at this in due course. The home has a small garden to the rear, it is looked after and has seating and tables for service users to use should they choose to. It was also noted that recently the service users have been out in the garden planting the pots up and they were looking very nice on the day of inspection. It was pleasing to see that the laundry was clean and tidy and that the staff have a cleaning schedule to work with. Gloves and aprons were readily available and staff had a good knowledge of infection control procedures. This means that service users risk of cross infection is greatly reduced. Crown Meadow Care Centre DS0000042299.V330654.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): 27,28,29,30 Quality in this outcome area is good. Service users can feel confident that the home has a knowledgeable and skilled staff team to meet their needs. Staff are recruited safely in order to protect service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home currently has vacancies so the number of service users has reduced, when talking to staff they felt that the number of staff on duty at present was sufficient to meet the needs of the service users. However they felt that they struggle when the home is full with their existing staff numbers. “it’s a mad rush sometimes”, “we’re fine at the moment but when the beds get filled up it can get a bit stressful”, “if we had more service users I think we need another member of staff, the nurses have so much paperwork to do you feel guilty asking them to help, it’s not easy for any of us then”. The staff team have been working hard to improve the number of care staff with an NVQ level 2 in care, and the home is now meeting its target of 50 care staff with this qualification. This progress needs to be maintained so that all care staff achieve this qualification in future. The home has a consistent staff team, as a result only one new member of staff has been recruited since the last inspection. Their file was examined to Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 20 ensure that the home continues to recruit new workers in a safe manner that protects service users. It was pleasing to see that all of the required checks such as Protection of Vulnerable Adults (PoVA) and Criminal Record Bureau (CRB) were in place and there were no shortfalls in the process. Some of the qualified nurses files were also seen to make sure that their Nursing and Midwifery Council (NMC) status was still effective and up to date, again no shortfalls were found. There are systems in place to support new workers with an induction programme and support from supervision with the manager or identified key worker. Crown Meadow Care Centre DS0000042299.V330654.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): 31,33,35,38 Quality in this outcome area is good. The home is managed well and is run in the best interests of the service users. Service users can be assured that their health and safety will be protected whilst living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been no change in the management of the home since the last inspection. The manager runs the home in the best interests of the service users and has obtained the necessary qualifications to do so. In order to maintain standards at Crown Meadow the manager completes monthly audits, these include medication, complaints, falls and the environment. Where any issues are highlighted the manager will then form an Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 22 action plan to address this. Service users are included in this process and are asked to complete a questionnaire on yearly basis, this questionnaire gives each service user a chance to tell the home what it is they are doing well and what it is that they could do better. The manager did say that at times some of the service users find it difficult to complete the questionnaires, it was suggested that the use of an independent advocate or reviewing the format of the questionnaires should be considered. This will mean that all of the service users will then have the opportunity to take part if they choose to do so. We also looked at the systems in place for dealing with service users monies. The company has a computerised system that keeps the individual expenditure of each service user up to date. The home obtains receipts for all purchases and records transactions appropriately. Some of the service users monies were spot checked and were found to be in order. The health and safety management in the home is good and again there are systems in place that address the knowledge and skills training for each staff member. There is a computerised system that alerts the manager when each staff member is due for refresher training. Staff can expect to receive training in health and safety, moving and handling, fire safety, food hygiene and first aid. This will ensure that they are practicing safe working at all times and not placing service users at risk. Some of the home maintenance checks for the hoist, wheelchairs and the lift were seen to make sure they are up to date. It was noted that the lift system in the home is less than reliable and the manager stated that since October last year there have been at least ten occasions when the lift technician has needed to come to the home to sort it out. This is the larger of the two lifts but it is the one that service users need if they require transfer to hospital by stretcher. When we asked the staff if there was anything they would change for the better, all of them replied “the lifts, they keep breaking down, its annoying at times”. Crown Meadow Care Centre DS0000042299.V330654.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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 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 X 3 X 3 X X 3 Crown Meadow Care Centre DS0000042299.V330654.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 2 3 4 5 Refer to Standard OP3 OP7 OP8 OP9 OP38 Good Practice Recommendations All service users must have a completed assessment of their needs so that they can sure their needs have been identified and that the home can meet them. The manager should ensure that the monthly care plan reviews are more informative. All service users must have care plans that detail the care they will receive, these plans must reflect the care that is being given All controlled drugs no longer being used by service users must be removed from the home. The frequency of the lift breakdowns must be addressed so that service users have access to all parts of the building at all times and their daily lives at not being disrupted by this Crown Meadow Care Centre DS0000042299.V330654.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Halesowen Record Management Unit West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA 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 Crown Meadow Care Centre DS0000042299.V330654.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!