Inspection on 04/12/06 for Homesdale

This inspection was carried out on 4th December 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Homesdale 07/02/06

Homesdale 26/05/05

Homesdale 13/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Homesdale 5-7 New Wanstead Wanstead London E11 2SH Lead Inspector Ms Harina Morzeria Key Unannounced Inspection 7th December 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homesdale Address 5-7 New Wanstead Wanstead London E11 2SH 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) 020 8989 0847 020 8989 0847 Woodford Baptist Homes Limited Ms Brenda Jean Jones Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named individual with learning difficulties aged over 65 years at Homesdale. 7th February 2006 Date of last inspection Brief Description of the Service: Homesdale (Woodford Baptist Ltd) is a Christian organisation that provides a residential care home and sheltered accommodation for older people. It is only the residential care home which is subject to registration and inspection. The complex is situated in a residential area of Wanstead, close to bus and train services and local shopping facilities. The residential home is registered for 18 service users and is based in two inter connecting houses. The home is linked to the sheltered housing accommodation. Bedrooms are located on the ground floor as well as the first and second floors and a new lift has been installed. All rooms are spacious, airy and bright. They all have hand basins, TV points and a call system and some residents have their own telephone. Work has been carried out to provide more rooms with en-suite facilities. There is a separate lounge and dining area downstairs overlooking a well maintained garden to the back of the house. There is disabled access to the front of the building, and there are also car parking facilities at the front of the property. In line with the Baptist ethos, a daily service is held either in the home or in the adjoining sheltered accommodation lounge. The statement of purpose and the last inspection report are available upon request. A service user’s guide is given to each resident upon admission to the home. At the time of inspection the fees were £450.00 per week for the care of frail older people. Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection undertaken on 7th December 2006. The deputy manager was available throughout the time to aid the inspection process. During the inspection the inspector was able to talk with and observe residents, staff members and some ancillary staff. Three residents’ files were case tracked, together with the viewing of staff rotas, training schedules, activity programmes, medication administration, accidents records, menus, complaints and staff recruitment processes and files and a pre-inspection questionnaire which was returned by the manager. A tour of the premises, was undertaken and all of the rooms were clean with no offensive odours present anywhere within the home. The rear garden is secure and was well maintained with disabled access and seating areas for residents. All staff were observed to treat residents with kindness and respect. Residents appeared well dressed and groomed. Where possible the inspector chatted to some residents, it was evident from these discussions that residents liked the food and the care workers. Staff were aware of the need to ensure that an individual resident’s religious, ethnic and social care needs are respected. However, at this inspection all current residents were white British and, their cultural/religious needs were being met by a staff group who were primarily of the same culture. What the service does well: What has improved since the last inspection? The system of care plans is good and all care plans are reviewed monthly, or more frequently if necessary. The quality assurance procedures continue to be developed. Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives have the information required to enable them to make an informed choice about where to live. Each resident has a contract/statement of terms and conditions with the home which is reviewed annually so that they are clearly aware of the services that the home states they will provide. Prospective residents’ needs must be assessed before they move into the home so that they can be assured that their needs will be met by the home. Both residents and their relatives have an opportunity to visit the home and assess the quality, facilities and suitability of the home before making a decision to move in, so that they know that the home they move into will be able to meet their needs. EVIDENCE: Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 9 The Statement of Purpose and Service Users Guide includes detailed information about the service provided and this is available to all prospective residents and relatives. Evidence was seen on the files of the residents tracked that they each have a contract in place which outlines the services that the home can provide as well as the home’s expectations of the residents. Upon examination of files for three of the most recently admitted residents to the home, the inspector noted that a comprehensive assessment of their needs was not undertaken prior to them being offered a place. This is not acceptable practice. The registered manager must ensure that any resident admitted to the home must have a comprehensive needs assessment carried out prior to being offered a place at the home. This is to assess whether the home will be able to meet the resident’s needs and whether it is the most appropriate placement for that individual. Wherever, possible the prospective resident is invited to visit Homesdale. Evidence was seen that the residents were invited to spend a day at the home and have dinner. Each individual is offered a placement for a trial period before making a decision to stay at the home permanently. On admission a key worker is allocated to the new resident, and that worker is responsible for ensuring that the care plan is followed and any changes are recorded and put into practice. Intermediate care is not provided at Homesdale Residential Home. The Care Homes Regulations 2001 have been amended with effect from the 1st September 2006 for new residents, and for existing residents with effect from the 1st October, 2006 so that more comprehensive information is to be included in the service users’ guide. Details of information to be included are contained with the amended regulations which can be obtained from the Commission’s website www.csci.org.uk Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of each service user are set out in an individual care plan. Residents can be assured that their health care needs are fully met, that they are protected by the home’s policies and procedures for the administration of medication, and that they will be treated with respect and their right to privacy upheld. EVIDENCE: The files of three residents were inspected. Care plans are available for each resident, which identify aspects of health, personal and social care needs of the individual. Daily entries into case records are made, which indicate the actual care given. Discussion with the deputy manager and staff suggested that they constantly observe and talk to the residents, so that they can take swift action if anyone becomes unwell. However, it was difficult for the inspector to Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 11 ascertain how the care plans were initially developed, as the residents did not have a comprehensive assessment of their needs prior to admission, from which to produce an individual and comprehensive care plan. However information was available from their previous placements in sheltered accommodation to enable the carers to draw up a basic care plan. A requirement has been made elsewhere in this report stating that a comprehensive needs assessment of each individual must be undertaken which should form the basis of an initial care plan. Evidence was seen that the care plans are reviewed on a monthly basis, or more frequently if necessary, and updated to reflect changing needs and current objectives for health and personal care. The manager is aware that where a resident has a “challenging” behaviour then the care plan shows the required strategies necessary for staff to implement to minimise such behaviours. Discussions were held with the deputy manager to involve residents as far as is possible, in the drawing up and reviewing of their care plan. Residents are encouraged to remain as independent as is possible and are therefore assisted in undertaking personal and oral hygiene on a daily basis. All residents are registered with a GP, and also have the services of an optician, dentist and chiropodist. All senior staff have completed training in the administration of medication and during the inspection all records in this area were found to be in good order. Staff monitor the condition of residents on medication and if there are any concerns, they would call in the GP. Currently there are no residents who are able to self-medicate. Staff were observed to knock on a bedroom door before entering, and obviously had a good knowledge and understanding of the needs of residents with regards to what they preferred to be called. Staff were seen to treat residents with respect, understanding and kindness. Nutritional screening is undertaken on admission but on a more frequent basis if the health needs of the resident indicate this. Appropriate action is taken if necessary with the involvement of the GP, nutritionist or dietician. All residents are weighed monthly and any increase/decrease in weight is monitored, together with the actual daily diet of each resident. Residents are never sent to hospital or to attend appointments outside of the home without being accompanied. Wherever possible family and friends are encouraged to support these appointments, but where this is not possible then a member of staff will accompany the resident. Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that the lifestyle experienced in the home generally matches their expectations and preferences with regard to social, cultural, religious and recreational interests and needs. The home is particularly good at being able to meet the cultural and religious needs of the residents, all of whom have a strong Baptist belief. All residents are helped to exercise choice and control over their lives and to maintain contact with family and friends and the local community as they wish. They can be assured that they will receive a wholesome appealing balanced diet in congenial surroundings, and at times convenient to them. EVIDENCE: There is a general programme of activities available for all residents. Day trips are also organised during fine weather. An activities co-ordinator comes to the home three times a week and undertakes organised activities with the residents. Staff members also take responsibility for arranging activities and Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 13 outings at other times. These include: armchair exercises, listening to music, reminiscence, watercolour painting, playing games and knitting. On the day of the inspection most of the residents were seen to be relaxing after their lunch, either in the lounge or their bedrooms. One resident said that although he participates in some of the activities he would like to do individual and more stimulating activities. The deputy manager was informed of this and stated that his key worker will have a word with him to plan an individual programme of activities. Residents are also responsible for taking the daily religious service and those wishing to join them are encouraged to do so, otherwise they are given the opportunity to go to the service held at the adjoining sheltered accommodation lounge. Although there are set mealtimes, residents can exercise choice in relation to meals as these are made flexible and varied to suit an individual’s preferences and capacities. Visiting times are very flexible and visitors commented that they are always made to feel welcome by staff. Residents are able to receive visitors in one of the lounges, or in their own rooms, as they wish. They can also request a meal by phoning in advance. Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints’ procedure and residents and their relatives feel that their views are listened to and acted upon. Staff have received training in Adult Protection/abuse awareness. However the Adult Protection procedure must accurately reflect the actions to be taken in the event of an allegation being made. EVIDENCE: The home has a clear complaints’ procedure, which is followed when a complaint is received. As part of the inspection process the complaints log was viewed. One complaint was recorded together with the action taken to resolve it. There have been very few formal complaints. The complaints policy and procedures are available within the home to residents and relatives and included in the service user guide. However, a complaint received by the CSCI was not logged in the complaints book, although a full investigation of the complaint was carried out by the Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 15 CSCI regulation manager as the complainant was not satisfied with the initial investigation carried out by the home. The registered person must ensure that all complaints are investigated fairly within an open culture so that the residents, relatives and staff know that their complaints will be dealt with appropriately and without fear of victimisation. All complaints must be recorded in the complaints log, noting the outcome of the investigation although the detail may be kept confidential. In discussion with some of the residents they said that they felt able to tell staff if they were not happy. Following discussion with the deputy manager and staff, it was clear that they have received training relating to Adult Protection. However, although the home has the London Borough of Redbridge Adult Protection policy document, and a standard policy from a training organisation, they have not developed their own policy and procedure. The policies and procedures regarding protection of residents do not cover all areas required. Links with external agencies i.e. CSCI, police adult protection teams and social services adult protection teams must be clearly defined and developed. The registered person to ensure that all staff can demonstrate an awareness of the content of the home’s adult protection policy once developed and know what immediate action to take and when and who to refer any incident on to by following the home’s policy and procedures. The residents and others associated with the home state that they are satisfied with the service provision and feel safe. The registered manager must develop an Adult Protection/abuse awareness policy and procedure to ensure a proper response for reporting any suspected or witnessed abuse. This requirement has been outstanding from the previous inspections. It is a requirement that is considered to be a priority and must be complied with by the new timescale. Failure to comply with regulatory requirements impacts on the welfare and safety of the residents. If this requirement is not met by the stated timescale enforcement action will be considered by the CSCI. Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, generally well-maintained environment with sufficient and suitable lavatories and washing facilities. Any specialist equipment required by a resident is provided, and their bedrooms reflect their own choices with personal possessions around them. The home is clean, pleasant and hygienic. EVIDENCE: A tour of the premises was undertaken and the home was found to be well-lit, clean, pleasant and hygienic with no offensive odours anywhere in the home. The inspector noted that specialist equipment such as handrails were evident, but there was only one hoist available in the downstairs bathroom. From Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 17 observation and in discussions with the staff it was evident that this is not sufficient to meet the needs of residents and staff who require this level of support. The registered manager is required to ensure that all appropriate specialist equipment such as hoists and the correct sized slings are available for staff to use to maintain the health and safety of the residents and staff. Any other specialist equipment must also be provided to enable a resident to maintain independence. There is a mixture of suitable baths and showers which gives a resident choice. Bedrooms have been personalised by the individual, and fixtures and fittings are of a good standard. Residents are encouraged to bring in some of their own furniture. The lounges and dining room have been refurnished and new carpets have been laid making the rooms look bright and cheerful. The rear garden area is laid to paving and lawn and has sitting areas for residents, and has disabled access from the lounge. There is an ongoing programme of redecoration and refurbishment. Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally service users’ needs are being met by the numbers and skill mix of staff. Service users are protected by the home’s recruitment policy and practices and the training provided to all new and current staff. EVIDENCE: The files of four staff were inspected and these contained the necessary references and Criminal Records Bureau disclosures. The deputy manager is aware that new CRB disclosures should only be retained until the next inspection. Then having been inspected by the Commission’s inspector they should be destroyed in accordance with the Data Protection Act and the Criminal Records Bureau’s code of conduct. Also all new staff must undertake induction training in accordance with the requirements of the regulations and the Skills for Care. Generally staff are receiving training in various areas such as dementia awareness, medication administration, moving & handling, fire safety, health Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 19 and safety, adult protection and infection control. It is essential that the manager ensures that staff put into practice skills learned during the training. More than 50 of the current staff have achieved NVQ level 2 and above at the date of this inspection. This is good practice. Whilst the current level of staffing appears to be adequate, residents’ needs do change with age and it is essential that staffing levels are kept under review and adjusted when required in order to meet the needs of an ageing group of residents. With sufficient staff on duty, in all areas such as care and ancillary work, residents will receive a service suited to their needs and staff will be under less pressure and stress. The inspector noted that staff work long days often up to 14 hours a day. The registered manager is required to closely monitor this and to ensure that the home comply with the working time directive. Staff must also take regular breaks in order to ensure that they are sufficiently energised to be able to meet the demands of working in a residential setting. Upon discussion with the staff group and the deputy manager the inspector was informed that staff prefer to work in this way. However as stated above this must not be to the detriment of the residents. Upon examination of staff files, the inspector noted that the recruitment procedure is followed and staff files contain all required information including a photograph of each staff member. However, it was difficult to easily access information from the staff files due to the files not being sectioned/organised. The inspector recommends that staff files are appropriately sectioned with information stored in a way which can be easily accessed. Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their families can be assured that the home is managed by a person competent to do so, and that the home is operated in their best interests. Generally staff are appropriately supervised but there is some room for improvement in this area. The health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: The registered manager is experienced and qualified and has been employed at Homesdale for many years. Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 21 From observation on the day of the inspection and during discussions with staff and residents it was apparent that the home is run in the best interests of residents. Staff stated that they are receiving adequate and appropriate supervision. However upon examination of the supervision records the inspector noted that there was no evidence that all staff receive regular supervision. The manager is aware that formal supervision is important as it allows the staff time and space to reflect on their practice with their manager/senior. Recording the supervision is important, as it provides a retrospective picture of an individual’s development and change. The home must be able to demonstrate that all staff are receiving regular supervision which is accurately recorded. All staff delivering supervision are required to attend a supervisory training course in order to deliver effective supervision to the staff. Residents are encouraged to manage their own finances with assistance from their families or representatives. Maintenance records such as those for gas, electric, water, lift maintenance, fire alarms and insurance were inspected and found to be in good order. The inspector recommends that key members of staff have specific areas of responsibility, and carry out weekly audits on health and safety in their areas. In line with the new fire regulations which came into effect on the 1st October 2006, a fire risk assessment should be undertaken at Homesdale. Notifications under Regulation 37 and reports under Regulation 26 of the Care Homes Regulations continue to be received. These are necessary to ensure good internal monitoring of the quality of the service being provided to the residents. Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 2 3 3 Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The registered manager must ensure that a prospective resident does not move into the home without a comprehensive needs assessment carried out prior to being offered a place at the home. This is to assess whether the home will be able to meet the resident’s needs and whether it is the most appropriate placement for that individual. The registered manager must ensure that all complaints are recorded in the complaints log, noting the outcome of the investigation although the detail may be kept confidential. The registered provider must ensure that there is an Adult Protection policy and procedure in place to ensure a proper response for reporting any suspected or witnessed abuse by staff. The registered manager is required to ensure that all DS0000025904.V322338.R01.S.doc Timescale for action 31/03/07 2. OP16 22 31/03/07 3. OP18 13 & 18 31/03/07 4. OP22 12 &13 31/03/07 Homesdale Version 5.2 Page 24 appropriate specialist equipment such as hoists and the correct sized slings are available for staff to use to maintain the health and safety of the residents and staff. Any other specialist equipment must also be provided to enable a resident to maintain independence. 5. OP36 18 The manager must ensure that all staff receive regular, planned supervision which is evidenced. All staff delivering supervision are required to attend a supervisory training course in order to deliver effective supervision to the staff. 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP37 Good Practice Recommendations The inspector recommends that staff files are appropriately sectioned with information stored in a way which can be easily accessed. The inspector recommends that key members of staff have specific areas of responsibility, and carry out weekly audits on health and safety in their areas. In line with the new fire regulations which came into effect on the 1st October 2006, a fire risk assessment should be undertaken at Homesdale. 2 OP38 Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Homesdale DS0000025904.V322338.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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