Inspection on 17/08/05 for Gorsefield Residential Home

This inspection was carried out on 17th August 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Gorsefield Residential Home 24/08/09

Gorsefield Residential Home 09/09/08

Gorsefield Residential Home 10/09/07

Gorsefield Residential Home 29/09/06

Gorsefield Residential Home 22/02/06

Gorsefield Residential Home 30/03/05

Gorsefield Residential Home 03/11/04

Gorsefield Residential Home 25/02/04

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

CARE HOMES FOR OLDER PEOPLE Gorsefield Residential Home 306 High Lane Burslem Stoke-on-Trent Staffordshire ST6 7EA Lead Inspector Peter Dawson Announced 17 August 2005 9:00am 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 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. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Gorsefield Residential Home Address 306 High Lane Burslem Stoke-on-Trent Staffordshire ST6 7EA 01782 577237 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) Mr David John Hood Mrs Shirley Grainger CRH 17 Category(ies) of OP - 17 registration, with number PD(E) - 5 of places Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 30 March 2005 Brief Description of the Service: Gorsefield is situated on the main road in High Lane, close to Burslem and directly on a bus route allowing easy access for visitors. The home is a large detached property which has been extended and provides good spacious accommodation. The building and location are quite impressive, well presented and well maintained. There are attractive gardens to the front and rear with good parking facilities. Accommodation for residents is on 2 floors with shaft lift access to the first floor. On the ground floor there are 2 lounges, spearate dining room, kitchen and 5 single bedrooms, there is an assisted bathing facility also on this floor. On the first floor there are 10 bedrooms, 2 are shared rooms and have en-suite facilities, some with shower. On this floor there are 2 bathrooms, one has assited facility. There are separate toielts, office and storage facilities. There is a small lounge/recessed area with kitchenette, allowing space to receive visitors. The home provides accommodation for up to 17 older people 5 of whom may have a physical disability. There is presently no registration for dementia or mental health care. There has been staff training in this area of work and application is being made to the Commission additional categories. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There were 16 people in residence at the time of this announced inspection and 1 vacancy. All residents were seen and most spoken to both individually and in small groups during the inspection. 8 feedback forms were received from residents and 8 feedback forms from relatives. A feedback form was also received from a GP who visits the home. Feedback forms were sent directly to the Commission. Residents spoken to were all satisfied with the care provided at Gorsefield and commented positively about staff attitudes and care. Two residents indicated in feedback forms received that more activities should be provided, this was restated in discussions with residents on the day. Two residents felt that greater choice of dishes at mealtimes could be provided. Written comments included “I am very pleased with everything” and “I am very satisfied”. Relatives made similar positive comments, none made complaints. Comments included “As a family we feel we couldn’t have chosen a better home for mum” “We have always felt my mother has been well cared for” and “highly satisfied with care received” The GP made positive comments about working with care staff, communicating needs and a general satisfaction with overall care. A pre-inspection questionnaire was sent to the Commission prior to the inspection and forms a basis for information in this report. All staff on duty were spoken to by the inspector and there was a keenness to engage in NVQ study. One person is currently studying NVQ another keen to start in September. There was no NVQ study by staff in this home until 2005. The Manager provided good information both written and verbal during the inspection an as always was open and helpful. A proprietor visited during the inspection and had a positive dialogue with the Inspector. The home does not have category to admit people with dementia, although staff have received training in this area of work. The Proprietor will make application for this additional category, some residents already falling into the category. Two residents have had falls recently and sustained injuries, review of risk assessments has taken place and staff are vigilant about the vulnerability of those residents. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 6 What the service does well: What has improved since the last inspection? There has been required training for staff in Moving & Handling, Medication administration, food hygiene and health and safety. The refurbished smaller lounge has been draught proofed, resident commented upon the improvement. A new dishwasher has been installed reducing staff time spent with the older machine. Easier and safer access to the kitchen area for staff has been provided as required. Referrals to Consultant and Optician required in the last report have been made. There are plans to allow the Manager 1 day per week to carry out Management duties rather than hands-on care, this is very positive. A new computer has been installed to improve information systems in the home. All external doors have been alarmed to ensure safety for residents who wander in the home. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 7 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. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 - 5 There is adequate information available to facilitate choice of home. Assessments and introductory visits are made prior to admission wherever possible. Standards relating to choice of home were found to be met. EVIDENCE: The home has a statement of purpose/service users guide. All residents have been given a copy and there are copies in the home available for visitors. The documents provide adequate information relating to the services provided by the home. Funded residents are provided with contracts by sponsoring local authorities. Self funding residents are reported now to be provided with contracts, this previously was not the case. This will be further checked on the next inspection. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 10 All funded residents are subject to Care Management assessments prior to admission. The home always completes their own assessment prior to admission in all instances. It is the homes policy to arranged visits to the home prior to admission for prospective residents wherever possible. A recently admitted resident was initially provided with respite care prior to formal admission. Relative always visit the home prior to admission. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 - 10 Health care needs were known and acted upon. Action is required in relation to 2 aspects of medication: review of policy and provision of suitable means of transporting medication in the home. There is a safe system of medication in the home. Privacy and dignity were seen to be respected by staff. EVIDENCE: Care plans were sampled and seen to generated from assessed need and were adequate. Information is in 2 forms and together cover the needs of residents. Plans are reviewed monthly in the home as required. There are key workers allocated to all residents. Risk assessments relating to resident activity were in place and also reviewed regularly. Risk assessments are now reviewed following falls and this had been done in relation to recent falls of 2 residents. Health care needs are identified and acted upon. There are no pressure area management problems in the home at this time. District nurses visiting only in relation to blood samples and dressings to head injury following falls of a resident. In relation to falls appropriate responses had been sought from paramedics, hospital, GP. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 12 A residents with extremely low weight had not been weighed for 2-3 months. It is a requirement of this report that all residents are weighed monthly and where there are concerns about weight loss they must be weighed weekly to accurately monitor any changes. There have been previous requirements regarding regular weighing of residents. Referrals for further eye tests recommended in the last report have been appropriately made. The confusion of a resident with deteriorating physical health had resulted in 2 serious falls. Medical attention had been sought and risk assessments reviewed. The decreasing mobility provided cause for concern and staff aware of the need to monitor the movements of the resident very closely. Medication is provided by Boots Chemists in MDS (blister pack form). The system was inspected together with all records. There is a safe system of medication in the home. In relation to a resident given Paracetamol by relative this was discussed and it is recommended that the medication policy be reviewed to include a statement about over the counter medication not being brought into the home without the permission of the manager. Paracetamol should be prescribed in PRN or other form as needed. The home were advised that phenobarbitone does not need to be stored separately and signed by 2 staff (it is not a controlled drug) and that temazepam must only be stored as a controlled drug and is not required to be administered as one. A recommendation of the last report relating to provision of suitable medication trolley or means of transporting medication stored on the first floor to the ground floor has not been acted upon, but the proprietor is in the process of ordering a suitable facility for this purpose. Arrangements for privacy and dignity were observed to be in place and resident in discussion confirmed the principles were practised. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 - 15 Some residents feel that more activities should be provided, but this is limited to some extent by the minimum staffing levels provided. Constant TV watching throughout the day for all could be relieved by listening to music, encouraging greater interactions or more stimulating activities. There is good contact with families, relatives confirmed this in feedback. Areas of food provision could be reviewed with greater participation in menu planning by residents and clear choice of food at all mealtimes. There are indications that choices are available but not known to all. EVIDENCE: There is no formal programme of activities in the home. Sometimes staff engage in activities as time allows but this is only occasional. There are armchair aerobics provided fortnightly and entertainment provided 2 monthly. The main activity appears to be watching TV which some but not all residents like. Residents in the past and during this inspection indicated that more activities would be their preferred option. The home are arranging a visit to Chester Zoo in August. This is an annual outing, probably 10 residents will go. The garden area is very pleasant and there are good seating facilities. Residents said they have been taking advantage of the good summer by sitting in the garden area which they enjoy. Some residents go out with visitors where this is possible. One resident goes Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 14 out 2 days per week to visits friend and has meals out, two others go out each week with relatives for lunch. Some residents access their bedrooms during the day as they wish. Two suffer from dementia and wander constantly in the home. All external doors have been fitted with alarms to ensure safety of those residents. Routines appear to be flexible, residents seen arriving for breakfast up to 10.30 a.m. Visiting hours are open, early morning visitors seen. There is a designated smoking area off the reception area. An extractor fan is needed to improve the area and reduce effects upon others. There is an excellent small lounge area on the first floor with TV and kitchenette facility, used by some visitors, drinks can and are made here by visitors. Food provision was discussed with residents, most were satisfied, two felt that there could be greater choice. Menus were forwarded to the Commission prior to inspection and had been revised. There appears to be no direct input from residents in relation to food provision. The menus do not show a choice of main meal or sweet, although in practice there appear to be options and examples were given. It appeared that alternative preferences for dishes and for food in general were known to catering staff (there are 3 different staff), but there is no list of likes/dislikes etc in the kitchen, the details confined to memory. Food choice could perhaps be discussed in more detail with residents who are clearly not all aware of the options available. There were no hot alternatives on the tea-time menu, although some examples were given by staff. Teatime menus comprised mainly of sandwiches and cakes. The home had started to provide sandwiches at lunch time for 2 residents who requested them and had not been eating prepared hot meals. This is clearly a good move for those people who were eating more, or at least something at the mid-day meal. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 - 18 Standards relating to Complaints and Protection were found to be met. EVIDENCE: There is a clear and concise copy of the complaints procedure in the home available to residents and visitors. No complaints have been received by the home over the past 2 years and no complaints received by the Commission. There are clear instructions to staff concerning the reporting of suspected or actual abuse and all have a copy of those procedures, which include an outline of the definitions of abuse. The home has a whistle-blowing policy which is on the notice board. Standards relating to complaints and protection were found to be met. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 - 26 There is a good standard environment which is well maintained. The environment meets the national minimum standards. Facilities throughout the home are excellent. Three requirements of the Environmental Health Officer still require some action and the proprietor is aware of those. EVIDENCE: Gorsefield provides a good standard environment. Furniture, fittings and equipment are to a good standard and the home is well maintained. There has been redecoration and refurbishment of the communal areas providing good and pleasing lounge areas, comfortable, attractive and with good natural light with large windows. The home preserves much of its original character. The dining room is large, well fitted with attractive tables, well equipped and extremely bright providing views to the front garden area. The room is conducive with socialisation. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 17 A visit by the Environmental Health Officer in February this year resulted in 10 requirements being made. All have been addressed with the exception of the emergency button in the lift not working properly – the proprietor will address this. An extractor fan must be provided in the smoking area and the former pond area made safe. A new dishwasher has been purchased to replace the previous one found to be unsatisfactory. Access via the door to the kitchen area has been improved and is now safer. There are 3 bathrooms in the home 2 have assisted facility although only one is used mainly from choice. A new assisted facility on the first floor is rarely used. Four bedrooms have en-suite facilities some with shower and there are adequate numbers of toilet facilities located throughout the home and near to the communal areas. The bathing/toilet facilities are quite adequate for the numbers of residents. There is registration for 5 people with physical disabilities and bedrooms and access to the communal areas on the ground floor are adequate and good for those people. There is passenger lift providing access to the first floor. There is good access to the home and the garden area for people with a disability. The majority of bedrooms were seen. All were bright, well furnished and personalised in accordance with the wishes and interests of residents. All bedrooms have lockable doors although none used at this time. There is a good heating system throughout the home with individual controls in all bedrooms. The home is constantly heated to the required level. Hot water fail safe valves are fitted in all resident areas. There are regular checks (seen) of hot water outlets to ensure safety. Standards of hygiene throughout the home were observed to be high. A domestic assistant is employed 24 hours per week. Infection control practices are good with glove/aprons readily available throughout the home for appropriate use. There are adequate facilities for handling soiled linen and the washing machine has sluicing facility. The route to the laundry avoids food preparation areas. The laundry was not inspected on this visit. There are paper towels and soap dispensers in toilet/bathroom areas. The kitchen was inspected and there were high standards of cleanliness indicated. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 - 30 Staffing levels meet required minimum standards only. The proposal to allow specific Management Hours for the Manager are a positive move. Staff recruitment procedures have improved although some CRB checks for existing staff are outstanding. Contract of employment are required for all staff. EVIDENCE: The staffing level remains the same as at April 2002 which is the minimum staffing level required for this home. – 2 staff are on duty throughout the waking day and one waking night care worker and one person sleeping in and on call are provided at night time. The overall dependency levels of residents in this home is low to medium. Presently 2 residents require input for dementia care needs. The Manager presently works on the rota all her hours being “hands on”, although there are plans to allow her supernumerary hours each week when the Deputy returns from long-term sick leave. The Manager has been provided with a new computer to assist with her management tasks. Additional staffing at peak times would be helpful particularly in relation to residents with higher dependency needs, also staff would have more time to spend in activities with residents. There has been one new member of staff appointed since the last inspection and relevant CRB checks, etc. were seen to have been obtained as required. There are still outstanding CRB checks required for 3 members of staff. It was a requirement of the last report that these were obtained, so a further Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 19 requirement made in this report. This was discussed with the proprietor who will pursue the matter. Some staff have not had contracts of employment this was a recommendation of the last report. The proprietor states he is in the process of providing new contracts for all staff and these are necessary. NVQ training in this home only commenced in January this year. One member of staff is presently undergoing training, another member of staff hope to commence NVQ training later this year. The home will not meet the required 50 of trained NVQ staff by the end of 2005. There has been staff training in Moving & Handling and also in Medication Administration following requirements of the last report. Additionally there has been training in Food Hygiene and Health & Safety since the last report. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 - 33 and 36 38 The Manager is competent to manage the home but will not have the required qualification by 2005. There are positive relationships between residents and staff and good staff commitment to resident care. There is regular supervision of all staff. Annual fire training is required for all staff and there must be immediate action to provide a means of communication between waking and non-waking staff at night time. Staff training in relation to safe working practices has been carried out as required since the last report. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 21 EVIDENCE: The Registered Manager has the required experience in care to run the home but will not have the NVQ4 in Care & Management qualification by 2005. The Manager has clear responsibility for all aspects of care in the home. She does not have control over financial matters that rests with the proprietors. There is a positive dialogue between Manager and staff. The Manager works “hand-on” in the home but retains the required status to manage the home effectively. There is a relaxed atmosphere in the home and indications of good dialogue between residents and staff. Residents are reported not to have been particularly successful in the past and the Manager and staff now have a face-to-face discussion with all residents to assess their views on care provision. The comments and views are recorded. This is a positive way of seeking resident input into quality assurance. Residents finances were not inspected on this visit. There is a process of regular supervision in the home for all staff. Records are kept and seen previously. Regularity of supervision varies but generally complies with standard 36. Records required by regulation were sampled. Standards relating to care plans were adequate. Policies and procedures were sampled and those seen were satisfactory. Amendments need to be made to the Medication policy/procedure. CRB checks have not been obtained for all staff and this must be done. In relation to Standard 38: Moving & Handling training has been provided for all staff in accordance with requirement of the last report. Fire records were satisfactory, with appropriate checks and servicing of equipment. Fire drills are carried out but there is no Staff training in Fire Prevention from an outside body as required on an annual basis. Food hygiene training has been provided since the last report and infection control standards are good. COSHH is safely stored (records not seen on this inspection). Servicing of equipments were seen. Heating Engineer visited 15.7.05. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 22 Fire equipment serviced 12.4.05. Lift serviced 20.6.05. – The emergency call on the lift does not operate effectively and this should have been picked up on the service, the proprietor will pursue this matter . The hoist was serviced on the day of the inspection. Hot water temperatures throughout the home were seen to have been regularly sampled/checked. There are window restrictors on all windows in the home. A confused resident recently wished to leave via the window but prevented by restrictor. Risk assessments are in place and regularly reviewed. All accidents, injuries and incidents checked had been notified to the Commission as required. At night time there is no means of the waking night care worker contacting the person sleeping-in and on call in the sleep-in room without having to visit the sleep in room on the first floor. There was previously an intercom type system that no longer operates. It is a requirement of this report that a suitable means of instant communication is provided at night time in the interests of safety. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x x 3 2 2 Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 24 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 29 Regulation 19 Requirement CRB checks must be completed for all staff. - (This was a requirement of the last report timescale not met) All residents must be weighed monthly. Where there are concerns about weight loss this must be weekly. Provide immediate means of communication between waking and non-waking night staff. Provide annual fire training for all staff. Timescale for action Immediate 2. 8 12(1) Ongoing 3. 4. 38 38 12(1) 23(4) Immediate 30.9.05 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. Refer to Standard 29 9 9 Good Practice Recommendations Provide written contracts of employment for all staff Provide appropriate facility to distribute medication Review medication policy and practice relating to over the counter medication. Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Gorsefield Residential Home E51-E09 S8233 Gorsefield V240315 170805 Stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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