Inspection on 29/07/05 for Dell Residential Home (Sudbury)

This inspection was carried out on 29th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dell Residential Home (Sudbury) 19/05/08

Dell Residential Home (Sudbury) 20/04/07

Dell Residential Home (Sudbury) 06/12/06

Dell Residential Home (Sudbury) 23/05/06

Dell Residential Home (Sudbury) 25/04/05

Dell Residential Home (Sudbury) 25/11/04

Dell Residential Home (Sudbury) 22/09/04

Dell Residential Home (Sudbury) 10/07/03

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

CARE HOME ADULTS 18-65 Dell Residential Home, Sudbury Cats Lane Great Cornard Sudbury, Suffolk CO10 6SF Lead Inspector Joe Staines Deborah Seddon Unannounced 29th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Dell Residential Home, Sudbury Address Cats Lane, Great Cornard, Sudbury, Suffolk, CO10 6SF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01787 311297 01787 313385 Speciality Care (Rest Homes) Ltd Mrs Marianna Banks Care Home 48 Category(ies) of Learning Disability LD (48) registration, with number of places Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25/04/2005 Brief Description of the Service: The ell is a permanent care home for adults with a learning disability. The Dell was first registered in 1987 as a core and cluster home where small groups of service users are accomodated in bungalows, each bungalow forming a self contained unit. Over time, additional bungalows have been built to bring the home to the present capacity of 48. The current registered owners, Speciality Care(Reit) Homes Ltd, purchased the home in 1995 and have agreed that the Dell has now reached its maximum desired capacity. Craegmoor Healthcare Ltd acquired Speciality Care in March 1998. Each bungalow accomodates six service users and provides its own laundry and catering facilities, communal areas and gardens. Bungalows are grouped around a central day care facility. The main kitchen and office/administration building access to the site is by way of a private drive. The home is situated within a quiet residential area with good links to Sudbury town centre. The buildings are modern, purpose-built units and offer a high standard of accomodation. All service users have good sized private bedrooms. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced, starting at 10am and took place over four and a half hours during a weekday. Joe Staines was the lead inspector and was assisted by Deborah Seddon, inspector. During the inspection four of the eight bungalows were inspected, five service users were spoken with separately and a number of records were examined. Time was also spent talking with five staff, one of whom was the registered manager. What the service does well: What has improved since the last inspection? What they could do better: The home has detailed risk assessments in place, which cover a wide range of issues for each service user, however, they need to be revised to make them specific to the individual and not used as a generic model. Information not relevant to the service user needs to be removed. A system must be in place to ensure that all staff are aware of the content and instructions within the risk assessments. Whilst it is recognised that the home employs two domestic staff to clean the eight bungalows on a rota basis, a system for cleaning toilets and commodes must be implemented to minimise the risk of cross infection to service users. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 6 There needs to be a clear policy and procedure and training introduced for all staff, relatives and service users to know what action is taken in the event of unacceptable behaviour of a service user and that a consistent approach is taken at all times. Appropriate induction, training, support and supervision should be in place to ensure that all staff working in the home, including new employees have the competencies and skills to meet the needs of the service users. Staffing levels must be reviewed to ensure that the safety and welfare of the service users are safeguarded at all times. Security arrangements within the home must be addressed; any person visiting the home must be asked for identification and vetted by staff before entering bungalows. The visitor’s books must be signed and kept up to date. Risk assessments need to be carried out to assess the security bungalow and the vulnerability of each service user. Additional restrictors may need to be fitted depending on the outcome of assessment, however existing window restrictors and locks must be and used. The home must take adequate precautions for containing doors must not be wedged or hooked open. of each window the risk repaired fire; fire 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. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not inspected on this occasion. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9,10 Service users can expect to have their personal, health and social care needs identified and monitored. Service users can expect to have risks identified however the risk assessments need to be made more specific to the individual. EVIDENCE: Four care plans were inspected. The plans were comprehensive covering all aspects of personal, health and social care. However, some sections had not been completed. Section 9 of one care plan stated that the key worker was to involve the service user in completing “My book and my way forward”. This was blank in one care plan and missing from another. Discussion with the manager confirmed that the feedback received about this document was that where there was communication difficulties they were based on staff judgements rather than the opinion of the service user. The manager informed the inspectors that they would be raising the issue with Craegmoor to revise the format. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 10 Section 12 of another care plan referred to the monitoring of one service users behaviour and the need for staff to make a record on the appropriate chart. However, the chart only had two entries whereas their behaviour book had more sporadic recordings, with general comments on mood. The manager confirmed that the service user had only two significant incidents of challenging behaviour, which was due to anxiety. A service user’s specific behaviour plan called an antisocial behaviour and consequence chart (ABC chart) had an entry “put in room”. A member of staff was asked how this had been dealt with. They confirmed that the service user had been escorted to their room to chill out, this was as agreed by the service user in their care plan. The manager, staff and service users spoken to confirmed that there is no policy in place for locking service users in their rooms, however they did say that service users are escorted to their rooms sometimes for time out if they display behaviour that is challenging to other service users. This is for their own and others safety. One service user confirmed this by telling the inspector “that another service user in their bungalow had been upset and was taken to their room for a long time, which made them feel sick.” Risk assessment number 7 referred to section 3 in care plans for guidance for care staff to use a consistent approach when dealing with aggressive outbursts of service users, however in 2 of the care plans looked at there was no consistent approach recorded. A clear policy and procedure needs to be introduced for all staff, relatives and service users to know what approach is taken in the event of unacceptable behaviour of a service user occurring within the home. Care plans contained very detailed risk assessments for each service user, however these were blanket risk assessments that contained a lot of detailed information some of which was not relevant to the individual. All risk assessments referred to autistic spectrum disorder and the need for staff training, even though the service user was not diagnosed with this condition. The care plans were kept in the staff office in each bungalow; the doors were kept shut but not locked. Service users can access their care plan with assistance from staff to protect confidentiality of the other service users. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15,16 Service users can expect to be supported to take part in appropriate activities within the home and in the community and have the opportunity to mix with other adults. Service users can expect staff to support them to maintain appropriate relationships within a risk assessment framework. EVIDENCE: During the inspection it was evident that service users chose how they spend their time, in bungalow 3 one service user was drawing and another was completing a puzzle. One service user had chosen to have a lie in and was assisted to get up on request for lunch. A member of staff confirmed that other residents were attending a local day centre. In bungalow 5 one resident spoken to told the inspector “that they liked to spend their time knitting, and that they had lived here for a long time, and that all staff are alright and speak to me nicely.” The atmosphere in the bungalows seen was calm and the relationships between service users and staff were observed to be relaxed friendly and inclusive. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 12 It was clear from discussions with staff and entries made in care plans that service users maintain appropriate relationships. Relatives visit the home on a regular basis. One member of staff spoken to informed the inspectors that one of the service user’s had recently had a birthday and that their relatives had brought a cake to share with the other service users in their bungalow. Although it was recognised that visitors were welcome to the home, a recent situation had been highlighted and acted on promptly by the manager regarding an ex employee who had shown an inappropriate attachment to a vulnerable service user. A risk assessment had been undertaken and staff had been informed that if this person was seen on the premises they should be asked to leave and the police and manager were to be notified immediately. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20, Residents can expect to receive personal support in the way they prefer and to have their physical and emotional health needs identified and monitored. They can expect to have their prescribed medication administered correctly. EVIDENCE: Through discussions with service users and staff, and observation it was evident that service users receive the appropriate level of personal support as recorded in their care plans in an appropriate time and manner. One service user informed the inspector that they like to have a bath or a shower when they get up in the morning and that they would choose on the day. Evidence was seen in the staff office that a service user’s health needs are being monitored. This is part of a behavioural assessment requested by the service user’s doctor in relation to their food, fluid intake and behaviour. A service user spoken to described being ”happy at the home, that they were treated well and spoken to nicely by the staff.” Another service user spoken with said, “They had lived here for a long time and liked living here.” The team leader was observed administering medication for service users in bungalow 8, the medication was being administered in accordance with the policy and procedure of the home. Medication administration record sheets (MAR) looked had no gaps in signatures. There was no evidence on the training records that staff have received recent medication training. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Until stricter security measures are implemented, service users cannot expect to be protected from abuse. EVIDENCE: A tour of the premises was made by the inspectors who were able to enter the service and were on site for over an hour unchallenged by a member of staff. The inspectors entered two of the bungalows without being asked for identification. During the visit the manager distributed a memorandum to all staff reminding them of their responsibility to check the identity of all persons on the premises. A detailed risk assessment has been undertaken informing staff of the procedure to take if a named person arrives at the service. This is due to the inappropriateness of their relationship with a potentially vulnerable service user. However, concerns were raised with the manager with regards to the staff’s knowledge of this risk assessment. One staff member spoken to was unaware that the risk assessment was in existence. The inspectors discussed with staff on how they would deal with the behaviour of service users if they were aggressive towards them and what steps they would take, if they observed an abusive reaction from a member of staff towards a service user. Staff confirmed that although they had received no training in management of challenging behaviour, they would report the incident immediately to the manager. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,30. This judgement remains the same from the previous inspection of 25th April 2005 that minor repairs needed to the window restrictors in the bungalows and overall security arrangements must improve in order that service users can live in a safe and well-maintained environment. Systems of cleaning need to improve to ensure that service users live in a clean and hygienic environment. EVIDENCE: Walking around the outside of the service it was noticed that some windows were fitted with restrictors, others were not. Of those fitted with the restrictors some were broken. Concerns were raised with the manager about security, particularly about the vulnerability of service users and access to the bungalows. A risk assessment needs to be undertaken to determine which of the service users are most vulnerable and which windows need restrictors and arrangements for the existing ones to be repaired. Each of the service users bedrooms are fitted with door locks, these are operated with an override master key from the out side, there is a handle on the inside for service users to open the door, this was demonstrated by one service user who showed the inspector their room. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 16 The call bell in one service user’s bedroom was tied up above head height, which they were unable to reach to call for assistance if required. In general the home was found to be bright and cheerful, service users rooms were nicely presented and personalised, decorated in the style of their choosing and reflected their individuality. One service user showed the inspector their collection of ornaments. Concerns around hygiene were discussed with the manager about the cleanliness of the toilets in the bathroom and shower room in bungalow 3, and the strong smell of urine in one of the service users bedrooms in bungalow 5 where a spillage from a commode had not been cleaned. There are two domestic staff that clean the bungalows on a rota basis. The laundry room in bungalow 3 had a new washing machine; and had recently been electrically inspected; this was a requirement form a previous inspection. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,36 Progress has been made in the home’s recruitment procedures, however, staffing competence and levels need to be reviewed to ensure that there are sufficient trained staff on duty to meet the needs of the service users and to ensure their safety at all times of the day and night. EVIDENCE: From the previous inspection, requirements were made about the recruitment procedures of the home in order to protect service users. Craegmoor does the paperwork for the recruitment of staff centrally; whereas previously this was undertaken within the home. Concerns were raised at the last inspection about the transfer of two foreign staff members from another care home owned by Craegmoor. The manager had thought that the necessary checks had already been undertaken. One of these criminal records bureau checks (CRB) have been returned the other is still outstanding, although a prevention of vulnerable adults check (POVA first) has been obtained. The home has recruited three new care staff; the manager had not yet received the paper work for two of the new starters but could provide evidence for the third. Records showed that procedures had been followed and a POVA first had been obtained prior to the person commencing employment. A current CRB has been applied for. Two satisfactory references had been obtained, and a completed application form and a work permit were evident. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 18 One staff member spoken to informed the Inspectors that they had transferred from another home within the Craegmoor group. They had a limited understanding of the English language and struggled to recognise issues of an individual service users care plan and identified risk assessment. The member of staff was working alone in one of the bungalows with a group of quite vulnerable service users. They were also unable to identify what support, training and induction they had received since working at the home. The manager confirmed that the learning disability awareness framework (LDAF) was being used at present however; work is in progress by Craegmoor to produce their own induction and foundation training based on the care of people and principles of learning disability. The manager was advised that the training pack needs to be linked to the national training standards. The staffing rota was seen. The staffing ratio is one staff to each bungalow with two staff in number 8 due to the special needs of the service users. Each bungalow houses 6 service users. This was observed on the day of the inspection; however, a staff member was seen leaving bungalow 3 unattended for a short time whilst they went to assist another member of staff. The rota showed an average 8-10 staff on duty, however there were occasions when the numbers fell below this. The manager informed the inspectors that the team leader is additional to the nine staff required to staff the bungalows and would be the first person to fill in for staff sickness, appointments and breaks. The manager also confirmed that they would be available to offer support and that additional care hours have been negotiated for some service users for one – one support when accessing the local adult training centre. However, numbers reflected on the rota at times fell below nine and there needs to be consideration as to how cover and additional support is provided when this occurs, particularly at weekends. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 41,42, To safeguard the health, safety and welfare of the service users the home’s induction programme for new staff needs to be reviewed to ensure induction training relates to the needs of the service user group. EVIDENCE: Throughout the inspection the manager’s approach and response was one of openness and honesty, and they were able to demonstrate a commitment to the service. The manager provided a staff-training matrix, which indicated that the member of staff had received induction and foundation training, however, this training had occurred at the previous care home for the elderly and not at the Dell for the service user group living at the home. Fire doors in bungalow 3 were found to be wedged open and one was held open by a hook. The fire exit door in bungalow 8 did not fit properly. The manager informed the inspectors that a fire safety officer has been arranged to visit the home to undertake a full risk assessment on Friday 5th August 2005. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 20 The fire alarms were tested in all bungalows during the inspection. All staff and service users were told by the maintenance person that the test was due to take place. Doorbells to bungalows 3 and 5 were found not to be working, however, these were rectified during the inspection. The manager informed the inspectors that the maintenance person tested these on a weekly basis. Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 3 x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 2 2 2 3 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Dell Residential Home, Sudbury Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x 2 2 x I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 22 YES 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 YA 9 Regulation 13(4) Requirement The Registered Manager must ensure that individual risk assessments carried out for each service user of any activities and identified unnecesary risk are specific to the individual and discussed with the service user to form part of their individual plan. The Registered Manager must ensure that the home is kept clean, hygenic and free from offensive odours and systems are in place to prevent the spread of infection. The Registered Manager must ensure that staffing levels are regularly reviewed to reflect service users changing needs and ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropraite for the health and welfare of the service users. Visitors must be appropraitely vetted by staff before entering bungalows and visitor books in bungalows kept up to date. This is a repeat requirement. Timescale for action By 31st October 2005 2. YA 30 YA 42.2(v) 13(3) By 30th september 2005 3. YA33.1 18 By 30th September 2005 4. YA 24 13(6) 23 By 30th September 2005 Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 23 5. YA 42.2(ii) 23(4)(c)i The Registered Manager must ensure the health, safety and welfare of service users and staff relation to making adequate arrangements for containing fire. Fire doors must not be wedged or hooked open. By September 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA 35(3) YA 42.9 YA 32.3 Good Practice Recommendations All staff should receive appropriate induction and foundation training within firdt six weeks of employment to the Sector Skills Council specification including the principles of care, safe working practices, the organisiation and the role of the worker, experiences and particular needs of the service user group, influences and particular requirements of the service setting. Staff must have the skills and experience necersary for the tasks they are expected to do. The Registered Manager should make arrangements for the exisiting window restrictors to be repaired and new ones to be fitted to windows without restrictors based on assessment of vulnerability and risk to service users. There should be a clear policy and procedure and training introduced for all staff, relatives and service users to know that a consistent approach is taken in the event of unacceptable behaviour of a service user. 2. YA 42.3(v) 3. YA 40 YA 35 Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 5th Floor, St Vincent House Cutler Street Ipswich IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dell Residential Home, Sudbury I54-I04 S24372 Dell, Sudbury V245006 050729 Stage 4.doc Version 1.40 Page 25 - 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!