Inspection on 09/10/07 for Dixon House

This inspection was carried out on 9th October 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dixon House 06/07/06

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Dixon House 17a Gorse Road Blackburn Lancs BB2 6LY Lead Inspector Mrs Janet Proctor Unannounced Inspection 9th October 2007 09:30 Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dixon House Address 17a Gorse Road Blackburn Lancs BB2 6LY 01254 665522 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) S.M.S CARE LIMITED Mrs Janet Phillips Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th July 2006 Brief Description of the Service: Dixon House is registered to accommodate 6 people who have a learning disability. SMS Care Ltd are the registered persons for Dixon House and the day-to-day management of the home is the responsibility of a registered manager. The house is a split level modern detached property, set in its own well established grounds, with a private garden to the rear. At the front of the house is an elevated outdoor porch area, where people may sit and look over the lawn towards the road. There are two sitting areas and a dining room, and all bedrooms are for single occupancy. Parking is available at the front of the property, at the side of the driveway, or on the road. Dixon House is located close to bus stops with easy access into Blackburn via regular bus services. Blackburn provides most facilities and services, with bus and train routes being available to other towns or cities. The home has a Statement of Purpose and a Service User’s Guide that tells prospective residents about the home. The current fees are £479-00 to £52000. Residents are responsible for paying for their own leisure activities, holidays, hairdressing and clothing requirements. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Dixon House on the 9th October 2007. No additional visits have been made since the previous inspection. On the day of the inspection there were six residents at the home. Prior to the visit the Registered Person had submitted information in a preinspection questionnaire. This gave information that was used in the planning of the inspection. Surveys were sent out and were returned by six residents and five relatives. Not all of the residents were able to fill these in themselves and had had help in filling the surveys in from their parents. On the day of the inspection information was obtained from staff records, care records, and policies and procedures. Information was also got from talking to residents and the Manager. A tour of the building took place. Wherever possible the views of residents were obtained about their life at the home. Due to communication difficulties, some of the residents were unable to make any comments about their experience of living in the home. Wherever possible their comments are included in the report. What the service does well: Residents were able to make decisions about the way the home was run and about their lives. A resident said, “I go to town on Saturday on my own and do some shopping. That’s ‘my time’”. One of the relative surveys returned said, “Dixon House believes in the individuality of each person living there. They are encouraged to do things as a group, but are supported in doing things of their own choice.” Meetings were held so that the residents could talk about what would happen at the home. A resident said, “ We have meetings – all of the residents go to these. You can say what you want.” Contact with families and friends was encouraged and maintained. All of the relative surveys returned said that the resident was helped to keep in touch with them. One comment said, “can use the phone to ring me anytime and spend as long as she wants on it.” Residents were provided with a balanced and nutritious diet that was to their liking. Residents said, “The meals are much better now, more home cooking. It’s much better” and “It’s sausages for tea. The meals are good”. The residents were satisfied with their lives at Dixon House. Residents spoken to said, “ Things are fine here. I’m happy here at Dixon House” and “I like Dixon House.” All of the resident surveys returned said that the staff treated them well. One of the relative surveys said, “The home provides a caring and Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 6 happy environment. My daughter is always ready to return and misses the staff when she is away”. What has improved since the last inspection? What they could do better: The risk assessments must be specific to the condition and behaviour of the individual resident. This is so that staff know exactly what care they must give whilst that activity is being done. There must be an application form completed by each employee that shows their full employment history and the reasons why they ceased to work with vulnerable adults in any previous employment. This is to protect residents from unsuitable staff being employed. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 7 The contract should state the room number so that this is not changed without agreement. The amount of the fees to be paid should also be specified so that the resident knows how much their care costs. All handwritten entries on the medication administration recording chart should be an exact copy of what is on the medicine label so that the full information is given to staff. The procedure for safeguarding adults should be completed and made available to staff so that they know what to do if they see, hear, or suspect something is not right. All new staff should receive a copy of the GSCC code of conduct and practice so that they are aware of their responsibilities in social care. There should be a record of the first day induction so that it can be seen that staff have been given the information they need. Quality assurance systems should be started. This is so that the registered manager has a way of looking at the service being provided and ensuring that this is run in the best interests of the residents. 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. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There was sufficient information about Dixon House and a contract was given to residents. This prevented any misunderstandings. Procedures were in place to ensure that needs were assessed and staff were confident that they could meet them. EVIDENCE: There was a welcome brochure that had all relevant detail about the home and a copy of the contract. This helped people to understand what would be provided at Dixon House so there were no misunderstandings. There was a list of useful addresses. The Manager said that she had given a copy to a prospective resident and their family. There was a copy of a contract on file for all of the residents. Those who were able had signed these. The contract did not state the room number that the resident would live in. This is needed so that the room cannot be changed without agreement. The amount of the fees charged should also be added to the contract so that people know how much it costs to live at Dixon House. The home was full and no new residents had been admitted since the previous inspection. The manager was aware of the correct procedures for ensuring that the needs were assessed before anyone was admitted to the home. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The plans of care told staff how to meet residents’ needs. Residents were allowed to make decisions about their life so that it met their choice and preferences. Risks were assessed and meant that residents were supported to be independent whilst being safeguarded. EVIDENCE: Two care plans were examined. A new system had been started in June so all of the care plans had been rewritten at that time. No reviews had been done yet. The Manager said that she had spoken to all of the parents about the care plans and they had chance to read these. All of the surveys returned said that they were kept up date with important issues affecting the resident. One comment said, “I am always told in advance of any developments and rung afterwards with the results”. The plans of care had an assessment of the resident’s needs and abilities. The plan told staff what they had to do to assist or support the resident. This Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 11 meant that staff knew what they had to do and helped residents keep their independence. Residents meetings were held where decisions about home routines such as decoration, outings, and meals were made. Residents made personal decisions about their rising and retiring times and how they spent their leisure time. For example one resident had gone to the gym after work on the day on the inspection. There was information on advocacy services on display in reception foyer. This meant that staff, residents and visitors knew who to contact to get help for residents in making decisions about their lives. The finance records had improved. There was now an individual record for each resident showing the date, any money deposited, any money withdrawn, the balance and a signature. Two of these were checked and the balance of money was correct with the records. Residents were assessed as to their numeracy skills and money was given to them in amounts that they were able to manage. A resident said, “I get paid on Fridays. I keep my own money and look after it myself”. Risk assessments had been done. There was a good risk assessment for one resident’s psychotic episodes and outings with a friend. The other risk assessments were not personalised, for example bathing and moving and handling. The risk of the activity was assessed but did not say how this applied to the individual resident. This meant that staff did not have full information on how to care for the resident when this activity was being done. There was a missing persons procedure for staff to follow if a resident did not return to the home within a certain time period. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents engaged in a range of activities that met their social and recreational needs and relationships with friends and family were encouraged. The rights of residents were respected through staff encouraging decision-making and individual choice. The meals served were healthy and to the liking of the residents. EVIDENCE: All of the residents had either a part time job or attended College courses. They met other people at work or College and had opportunities to make friends there. They had access to Lifelong learning through the Gateway Club. Two of the resident surveys returned said that they always made decisions about what they did each day, two said they usually did and one said sometimes. Three of the relative surveys said that residents were always supported to live the life they choose and one said they usually were. One survey said that their relative could not make decisions. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 13 Residents’ likes and dislikes were noted in the plan of care. There was a range of activities done both communally and individually. Residents discussed any communal activities as a group and had a choice about what was done and whether they joined in or not. Residents also did individual activities that included gym membership, weight watchers, Blackburn Rovers Football Club supporters club and attending matches, going to the theatre, swimming lessons and computer courses. All of the residents had their own DVD player and TV. A resident said, “I go to bed when I want – I watch TV in my room” All of the residents had regular contact with their families. They had opportunity to make friends with others at work or at College. One resident had a friend who came to visit her at the home and stayed for a meal. A resident said, “I go to the pictures with my boyfriend.” Privacy and dignity was respected by staff and other residents. All of the residents had been asked if they wished to have a lock to their bedroom door and one had wanted this. Two residents had chosen to have a key to the front door. A resident said, “I have a key to the front door. I don’t want one to my bedroom.” The residents took responsibility for cleaning their own room with staff assistance and for other household tasks on a Saturday. Residents decide what would be on the menu. There was an emphasis on home cooked food and healthy options were encouraged. Fresh fruit and vegetables were in stock. Family style meals were taken most days but they could eat on their own if they wished to. One day a week the residents prepared their own meal. Residents were encouraged to help with setting tables, clearing away and loading the dishwasher. There was a rota for this. Records were kept of fridge and freezer temperatures. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents’ personal care and health needs were identified and met. The management of medication was good. All of these ensured that residents’ health and well being was protected. EVIDENCE: The plans of care gave details of any assistance needed with personal care. They told staff what level of support or prompting was needed. Personal care was done in private. Residents could choose their own style of dress. A resident said, “I’m going to a cricket do on Saturday. I bought a new dress – it was my own choice. I’m having my nails done tomorrow”. The week-day routines tended to be structured because of work or College but they could make choices about when they went to bed and also about when they got up at week-ends. A resident said, “I get up at 7.00 am during the week as I have to go to work. At weekends I get up at 9.00 am.” The health needs of the residents were covered in the plan of care. Appointments with the GP were recorded. The Manager said that they all could see the GP or other professional on their own if they wished to. Access to other Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 15 professionals was also recorded. Risk assessments were done for nutrition, falls and moving and handling. None of the residents needed a pressure sore risk assessment. None of the residents managed their own medications and there was a medication assessment to show why. There were policies and procedures for staff to refer to about medication management. There were patient information leaflets for details about specific medicines. There was a homely remedies policy and a letter from each GP authorising administration if needed. A record was kept of any given to residents. All staff had received medication training. The medicines were kept in locked cupboard in the kitchen. There were no Controlled Drugs stored at the home. There were records to show what medications had been ordered, received, administered and disposed of. There were now records of any medications taken home by residents and returned to the home. There was a photograph of the resident for identification purposes. Ear sprays were dated when opened so it could be seen when they needed to be disposed of. There was very good criteria for ‘as required’ medication so that staff knew exactly what circumstances this should be given in. Hand written entries were signed and witnessed but did not contain all the information that was on the printed label. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Any complaints were listened to and acted upon. Staff had received training so that they knew what to do to safeguard residents. EVIDENCE: There was a complaints procedure on display. This said the time frame in which an acknowledgement and response would be made. The procedure had the Commissions contact details. It assured the complainant that there would be no repercussions or victimisation if a complaint was made. There was a ‘resident friendly’ procedure in simple words and some pictures seen in some rooms. No complaints had been received at the home or the Commission. Five of the resident surveys returned said that knew who to speak to if they were not happy. Three said that they knew how to make a complaint. Four of them said that staff always listened and acted on what they said and two said they usually did. All of the relative surveys returned said that they knew how to make a complaint and that the home had responded appropriately to any concerns or complaints raised. All staff had now had safeguarding adults training so that they knew what to do if they saw, heard or suspected something was not right. The Whistle blowing procedure was now specific to Dixon House. It had the Public Concern at Work helpline number. The safeguarding adults procedure not yet completed. There were the Blackburn with Darwen Borough Council leaflets at Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 17 the home for staff or others to read. A resident said, “If I wasn’t happy or was worried about anything I would tell the staff.” Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lived in a safe, clean and homely environment that met their needs. EVIDENCE: The home was clean and tidy and furnished and decorated in a homely manner. There was a choice of two lounges. The first floor lounge had been redecorated and had new leather suits. The residents had been involved in the decision about the decoration and new furniture. There were sufficient bathrooms and toilets for residents to use. There was a garden that residents could use. Each resident had a single bedroom. These were personalised to their own individual taste with personal possessions, posters and other items. A resident said, “I like my room. I clean it myself.” All of the residents surveys returned said that the home was always fresh and clean. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 19 Some building work had been commenced to extend the number of residents the home could accommodated. When this has been completed it is intended to improve the existing facilities by adding en-suites. This had been fully discussed with the residents. The said, “I’m looking forward to them finishing the new building” and “I like my bedroom. It’s going to get better, I’m going to have my own toilet. Just for me. I’m looking forward to that.” There was a separate laundry area that could be reached without going through food storage or preparation areas. There was a domestic style washer and dryer and access to an iron. Residents did their own laundry with assistance from staff. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff had received training to ensure that they had the skills and knowledge to meet residents’ needs. The recruitment procedures were not through and did not fully safeguard residents. Staff received supervision so that they were monitored and supported to do their work. EVIDENCE: There were four carers employed. Of these two had their National Vocational Qualification in care and another was enrolled on the course. Copies of the duty rotas were seen. These showed the name of the staff member and the hours they worked. It also showed who was on sleep-in duty. Extra staff were brought in when needed. There were both male and female staff members. Staff meetings were held and minutes were available to show what had been discussed and decided upon. There had been one new member of staff employed since the previous inspection and the recruitment file for this person was examined. No application form had been completed, therefore there was no employment Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 21 history. There was proof of identity and two references had been taken up, one from the current employer. A Criminal Records Bureau check had been done before the member of staff started work. The staff member had NVQ level 2 but there was no copy of the certificate on file. The manager did not have any copies of the General Social care Council’s code of conduct to give to staff. This meant that they did not have details of their professional responsibilities. There was a copy of a job description and a contract had been issued. The manager said that the new employee had received an induction to the home but there was no evidence of this. All staff had done training in safe working practices and administration of medication. Two staff were booked on a specialist course for autism. All staff were now receiving supervision. There was a form for recording this that included the topic, the discussion, and signatures. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a competent person in charge of the home. Quality assurance systems were needed to ensure that the home was run in the best interests of the residents. Health, safety and welfare of residents and staff was protected as all staff had received training in safe working practices. EVIDENCE: There was a registered manager who had the relevant skills and experience for her role and responsibilities. She had done all of the training updates in safe working practices. She was booked to do a course on autism soon at Lancashire University. She reported to the directors of the company and meetings were held so that any issues could be discussed and action decided upon. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 23 There were few quality assurance systems to allow the manager to identify any shortfalls in care and management. Residents meetings were held as a means of getting their views and opinions. These were acted upon wherever possible. Residents’ surveys had been done in May 2006. A relatives survey had been done in November 2006. The comments made on one the forms had been acted upon. A letter of explanation had been sent and kept on file. Staff meetings were held and there minutes of these on file. The majority of the policies and procedures had been reviewed so that staff could refer to these and know what they had to do in any circumstance. There was a resident friendly fire procedure. The fire alarm was tested weekly and fire drills done at intervals. There were records to show that servicing of appliances and equipment was done as required. The temperatures of baths and showers were tested and recorded. All staff had done training in safe working practices. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X X 3 X Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 25 No 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 YA9 Regulation 13(4)(c) Requirement The risk assessments must be specific to the condition and behaviour of the individual resident so that staff know how to care for them. There must be an application form completed by each employee that shows their full employment history and the reasons why they ceased to work with vulnerable adults in any previous employment. This is to protect residents from unsuitable staff being employed. Timescale for action 31/10/07 2 YA34 19 10/10/07 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 Refer to Standard YA5 Good Practice Recommendations The contract should state the room number so that this is not changed without agreement. The amount of the fees to be paid should also be specified so that the resident knows how much their care costs. All handwritten entries on the medication administration DS0000067394.V348089.R01.S.doc Version 5.2 Page 26 2 YA20 Dixon House 3 YA23 4 5 6 YA34 YA35 YA39 recording chart should be an exact copy of what is on the medicine label so that the full information is given to staff. The procedure for safeguarding adults should be completed and made available to staff so that they know what to do if they see, hear, or suspect something is not right. All new staff should receive a copy of the GSCC code of conduct and practice. A record should be made of the issues covered in the first day induction so that it can be seen that staff have been given the information they need. Quality assurance systems should be introduced so that there is self-monitoring of the service. Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Dixon House DS0000067394.V348089.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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