Inspection on 15/08/06 for Hopton Court

This inspection was carried out on 15th August 2006.

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

Hopton Court 08/05/07

Hopton Court 27/10/05

Hopton Court 01/06/05

Hopton Court 07/12/04

Hopton Court 27/04/04

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

CARE HOMES FOR OLDER PEOPLE Hopton Court Hopton Mews Armley Leeds West Yorkshire LS12 3HT Lead Inspector Chris Levi Key Unannounced Inspection 08:45 15th August 2006 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 Hopton Court DS0000001467.V297855.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. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hopton Court Address Hopton Mews Armley Leeds West Yorkshire LS12 3HT 0113 263 2488 0113 2632509 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) Southern Cross Care Management Limited Mrs Elaine Parker Care Home 40 Category(ies) of Dementia - over 65 years of age (40) registration, with number of places Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th October 2005 Brief Description of the Service: Hopton Court is a 40 bedded home which provides care for older people with dementia. The home was purpose built as a residential home for older people, though not architect designed specifically for people with dementia. The building was constructed with new environmental standards in mind so all rooms exceed the minimum standard on size and all have en suite toilet and hand washing facilities. Built on two floors, there is access to the first floor by passenger lift. Each floor operates as a separate unit with food and laundry being provided from a central area on the ground floor. A garden area to the rear of the building has been developed to provide a secure outdoor sitting area for service users, and which allows them the freedom to wander outside in safety. The home is situated in the Armley area of Leeds within walking distance of the main shopping area, a small park, two pubs, a hairdresser and a post office. Because of the vulnerability of the residents, restrictions, in the form of digital locks (linked in to the fire alarm system) prevent residents walking freely around all areas of the home. The front door can only be opened by staff for the same reason. The current weekly fees charged by the providers is £405- £447. Additional charges are made for hairdressing, private chiropody and newspapers. This information was provided to the Commission for Social Care Inspection in April 2006. The contents of Inspection reports are discussed at staff, relative and residents meetings. A copy of the report was displayed in the entrance hall. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group for example Choice of Home. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers outcomes to the people using the service. The judgements categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded within the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk This unannounced inspection by one inspector took place over one day, starting at 8.45am and finishing at 5pm. The person in charge of the home was the manager, Mrs E Parker. Feedback on the findings of the inspection was given at the end of the visit by the inspector. The inspector would like to thank everyone who took the time to talk to me and express their views. This report reflects the preference of people living at Hopton Court to be collectively referred to as residents, rather than service users. Before the visit, accumulated information about the home was reviewed. This included looking at the number of reported accidents, complaints and compliments from service users and relatives. This information was used to plan the inspection visit. During the visit to Hopton Court the inspector case tracked a number of residents. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. Where appropriate, issues relating to the cultural and diverse needs of residents and staff were considered. Using this method the inspectors assessed all twenty-two key standards from the Care Homes for Older People National Minimum Standards, plus other standards relevant to the visit. The inspectors spoke with identified residents and relevant members of the staff team who provide support to the residents. Documentation relating to these residents was looked at. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 6 Where possible contact was made with relatives and other external professionals to obtain their opinions about the quality of services provided at the home. Four residents completed a CSCI survey and gave their individual views about living at Hopton Court. Surveys and comment cards for residents and relatives were left at the home. These cards provide people with an opportunity to share their views of the service with the CSCI. Comments received in this way are shared with the provider without revealing the identity of those completing them. A number of direct quotes from residents, staff and visitors were also included in the report. What the service does well: The home has a warm, friendly atmosphere, where visitors are welcomed. Staff appear to work hard maintaining the dignity and well being of the people who live at Hopton Court. A visitor said;” this is like home from home for my mother.” Medication for residents is managed in safe way, to minimise the risk of errors. The home has a robust recruitment procedure to ensure staff are suitable to work with vulnerable adults. Next of kin are kept up to date with any changes to their relative. E.g. an accident, or unscheduled visit to the hospital. Relatives said they valued this service. A visitor said the laundry services were excellent. The home has a robust system to manage residents personal allowance monies. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The residents would benefit from a person centred approach to care by staff. This would promote a more individual approach to care rather than the task focussed approach currently used. The manager stated that, the organisation has arranged for training and support to enable staff to understand the principles of person centred care. The recording of social activities for residents should be improved and be included in the residents plan of care. Where a risk is identified for a resident, there must be evidence of a relevant risk assessment that is regularly reviewed and up dated. The manager would benefit from undertaking a formal qualification in dementia care. This would enable her to enhance her knowledge of the needs of people with dementia. Residents must have access to their emergency call bells when they are in their own rooms, to enable them to call for assistance. Residents should have access to jugs of liquid when in their own rooms. This would enable them to maintain their independence, and promote regular intake of fluids that is important for their health wellbeing. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 8 A written system of handover from the senior care staff, to the manager should be introduced. This would enable the manager to be up to date with events that have happened during the shift. The catering team should use sugar substitutes for cooking, thus allowing residents who are diabetics to have the same choices as other residents. The hot trolley must have a hot surface warning sign to minimise the risk of burns to staff and residents. Generally staff were observed treating residents with respect and dignity. Visitors confirmed this. However, two incidents were noted, one where a member entered a residents room without knocking, and another where a carer was assisting a resident to eat her lunch, rather than sitting next to her, she stood over the resident, this is poor practice. Confidential documents must be held securely to comply with data protection. The kitchen requires repair and redecoration. A water leak under the sink has left the wall damp. The stairwells must not be used as a storage space, as it may present a fire hazard. Furniture for another home was seen to be stored in one stairwell. Some areas of the first floor would benefit from redecoration. The number of care staff with NVQ level two needs to increase to achieve the target of 50 of care staff holding an NVQ level 2 qualifications. All staff require training in Infection Control to ensure they understand how to minimise the risk of cross contamination, that may put residents and staff at risk from infection. The homes service user guide could be more “user friendly.” It would benefit from information about dementia, and how the home meets the needs of residents with dementia. 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. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 9 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 Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 1, 2 and 3. Quality in this outcome group outcome is good. This judgement has been made because evidence demonstrated that the manager provides good quality information to prospective residents and their families about the services provided at Hopton Court. There was evidence that all residents are assessed before admission to the home, to ensure the home can meet their needs. Residents or their representatives are issues with contracts of occupancy. This document provides written information about the responsibilities of the provider and user of the service. EVIDENCE: The Statement of Purpose provided by Southern Cross, the organisation that owns Hopton Court has been updated. The Service User Guide produced by the Manager of the home is adequate in providing potential residents with information about the services available. At a later date it could be revised to become a more personal document, to include how the home provides care for Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 11 people with dementia, quotes from people living at the home, photos and more detail about daily life as a resident of Hopton Court. All residents or their representatives are given written contracts of occupancy. This document outlines the fees charged and the responsibilities of both the provider and the resident. The contracts for self-funding residents are updated annually, when the weekly fees are increased. Those funded by a local authority do not receive an amended contract. The home has a detailed pre admission assessment procedure. Whilst this is comprehensive to identify the physical needs of prospective residents, it would benefit from further development, focusing on the dementia needs of an individual. The manager stated that there were imminent plans to introduce this to the pre-admission assessment process. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 7, 8, 9 and 10. Quality in this outcome group outcome is adequate. This judgement has been made because evidence was seen that: Information in residents care plans has improved, but there were still gaps in information in reviewing risk assessments and introducing social needs plans. External health professionals provide services to meet the health needs of residents effectively, and the management of resident’s medication is satisfactory. Staff were generally observed treating residents with respect and dignity. Visitors confirmed this observation. EVIDENCE: Care planning documentation introduced by Southern Cross the owners of Hopton Court is very comprehensive. However, it has an emphasis toward the physical needs of residents. As Hopton Court is home to people with dementia, Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 13 the paperwork would benefit from a focus on the dementia needs of residents. The manager stated this was to be introduced to the home. 3 care plans were looked at. Each contained comprehensive information about the physical needs of the individual residents and how staff in the home met them. In those looked at, there was no evidence of a social care assessment or a social care plan. It is acknowledged that the home has recently started to include this as part of care planning for residents. The manager was able to show a plan, which included information about the resident’s life. This would enable staff to engage in the relevant social activities with the resident. The introduction of a person centre approach to care planning would benefit all residents, as staff would have a better understanding of the residents lifestyle, likes and dislikes before they had moved to Hopton Court. Risk assessments were in place. When a risk to a resident had been identified these assessments should be reviewed, and recorded as part of the monthly review meetings to ensure the care given is still appropriate to meet any changing needs of the residents. There was evidence of visits by external professionals, to provide residents with specialist care or assessments. A district nurse visiting a resident at the home said, she believed standards at the home had improved in the past year. Systems relating to residents medication were looked at. The home has a thorough procedure for the management of resident’s medication. The deputy manager was observed following the procedure when dispensing medication at lunchtime. The management of controlled drugs was checked and found to be accurate. All staff that administer medication has been trained to do so. Some are undertaking a distance-learning course on safe medication practices. Staff appeared to know the residents well and have a good friendly rapport with them. Generally they were observed treating residents with respect and dignity. Visitors confirmed this. However, two incidents were noted, one where a member entered a residents room without knocking, and another where a carer was assisting a resident to eat her lunch, rather than sitting next to her, she stood over the resident, this is poor practice. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome group outcome is good. This judgement has been made based on evidence that: Residents are given opportunities to choose how they spend their day. There is a range of social activities offered to residents. Visitors are welcomed and families are encouraged to remain involved with their relatives living in the home. Food served at the home appeared nutritious and was well presented. EVIDENCE: The home has a part time activities co-ordinator who spends time with small groups or individual residents. A duo of residents were involved in a painting activity under her supervision. She had also spent one to one time with number of residents. Recording of these events should be in a social care plan as part of the general care planning for individual residents. The manager agreed this was a priority to implement. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 15 The atmosphere at the home was lively, and friendly. Staff then not undertaking tasks spent time talking and singing with some residents. The home produces a regular magazine that informs residents and relatives about what is going on in the home. Some residents had been to a local shopping mall. Other group activities take place. When staff understand and introduce a person centred focus there should be more opportunities to offer activities relative to the likes and dislikes of the individual residents. The home had a large number of visitors. All those who spoke to me gave positive feedback about the staff and care offered at the home. They said they are contacted if there are any events that may affect the well being of their relative. Staff were welcoming to all visitors, offers of cups of tea appear to be the norm for any visitor. One said, “The standard of laundry care was excellent.” Another said, “ The staff cannot do enough for my aunt.” All relatives spoken to say, they felt confident to raise any concerns they had about standards of care with the manager. Residents said they enjoyed the food served at the home. It was positive to note that regular snacks and drinks were offered to residents in between meals. This is an important factor when providing care to people with dementia, to help them maintain their physical wellbeing. The dining room and tables were set to look attractive. With one exception, staff were observed offering discreet support to those residents who needed assistance. It was suggested that when offering residents a choice they are shown what the choices are. It is possible they may not understand the verbal choice because of their dementia, and, as a result, their choice is compromised. Jugs of liquid should be made available in resident’s rooms. This would offer independence and promote fluid intake, necessary for their physical well being. The cook said she would implement the suggestion to use a sugar substitute when baking. This would enable diabetic residents to enjoy the same cakes and deserts as other residents. The kitchen appeared clean and tidy. All the equipment was working. A leak under the kitchen sink had damaged the wall and required repair and repainting. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 16 and 18. Quality in this outcome group outcome is good. This judgement has been made as evidence confirmed systems are in place to protect residents from abuse, and encourage them or their relatives to make complaints. EVIDENCE: The complaints procedure is displayed in the entrance hall. One complaint had been recorded since the last inspection. Evidence was available that it had been investigated and improvements made. Relatives confirmed they felt confident to make complaint and were sure it would be dealt with appropriately. Staff confirmed they had attended training on adult abuse and all were clear about their responsibility to report any concerns to the senior in charge. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. Quality in this outcome group outcome is adequate. This judgement has been made based on evidence seen when touring the building. The upstairs communal environment is showing some signs of wear and tear and requires redecoration. Fire safety maybe compromised by the inappropriate storage of furniture in the stairwell. Residents maybe at risk by not having emergency call bells accessible. EVIDENCE: The home is furnished to domestic standards. The staff have introduced colourcoded doors on corridors, as visual aids to assist residents with dementia find Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 18 their own room. There was also evidence of pictures and signage on toilet doors. The corridor walls had a number of tactile collages as visual prompts. The communal areas downstairs have been redecorated. The upstairs requires redecoration, as it is showing signs of wear and tear. Residents rooms were personalised with photos and mementos from home. Furniture must not be stored in stairwells, as it may present a fire, and health and safety hazard. The manager indicated that this furniture belonged to another home and she had raised concerns about its storage. Emergency call bells must be available to residents when they are in their own rooms. One lady in her own room, capable of calling for assistance with the call bell, did not have it accessible. The home was free from offensive odours. The domestics were clear about their roles and responsibilities within the home. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome group outcome is good. This judgement has been made as evidence confirmed: The numbers and skill mix of staff meets residents’ needs. Residents are protected by the homes recruitment procedures. The staff and residents from ongoing relevant training. EVIDENCE: The rotas were reviewed and appeared satisfactory to meet the current needs of residents at Hopton Court. Senior care staff manage the shift, and direct care staff as to their roles and responsibilities for that shift. Most of the staff work 12 hour shifts, but the manager said there was an option for 6 hour shifts if requested. It was recommended that there is a written handover to the manager from senior carers on any relevant events that have happened during the shift to maintain effective communication and services for residents. The number of care staff with NVQ level two needs to increase to achieve the target of 50 of care staff holding an NVQ level 2 qualifications. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 20 The recruitment and training file of one staff member was looked at. There was evidence of a robust recruitment process, to ensure staff are suitable to work with vulnerable adults. An audit of the training given to staff had been undertaken by the organisations training manager. A report was available that identified future training planned. Most staff have attended training on understanding and caring for people with dementia. The training programme is ongoing. Staff said they had learnt a lot about dementia from the training and it was helping them in their job as a carer. Moving and handling training is scheduled for August. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. Quality in this outcome group outcome is good. This judgement has been made as evidence confirmed: The managers approach encourages residents, relatives and staff participation in the running of the home. The Manager receives regular support from senior managers of Southern Cross. The organisation has robust systems to measure the quality of services delivered at the home. Residents’ financial interests are safeguarded. Staff receive one to one supervision. The manager must ensure confidentiality is not compromised. There was evidence of safe working practices, but there is a requirement to provide infection control training for all staff. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 22 EVIDENCE: The Manager, Mrs Parker, has many years experience of working with older people with dementia. She has recently achieved a management qualification. It is recommended that she undertake a formal qualification in managing dementia care services, as this will enhance her existing knowledge experience. Staff and visitors said that Mrs Parker is approachable, and encourages visitors to have their say about the services provided at Hopton Court. Senior managers audit various aspects of the service during their monthly visits. There was evidence of staff meetings, resident/relatives meetings. One relative aid she valued the meeting as it helped her to hear the views of other relatives. Staff confirmed they receive one to one supervision to discuss any concerns or training and development needs they may have. Evidence of supervision notes was seen with the permission of the staff member. The home has a robust procedure for managing residents personal monies held at the home. It was noted that confidential documents were not securely held at all times. This was discussed with the manager, who agreed to introduce measures to ensure that they were stored appropriately, when not in use. Systems are in place to ensure the health and safety of residents and staff. A risk assessment was in place for a pregnant member of staff. Some amendments were to be made regarding shift patterns. All staff require training in Infection Control to ensure they minimise the risks of cross contamination whilst at work. Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 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 3 17 x 18 3 2 x x 2 x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 2 2 Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? yes 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 OP7 Regulation 13 Requirement The manager must ensure that where risks to residents are identified a risk assessment is in place and reviewed and amended on a regular basis. The manager must ensure the dignity and respect for residents by staff is maintained at all times. The providers must ensure the social needs of residents are met and appropriately recorded. The providers must ensure that stairwells are not used for storage as this may become a fire hazard. The kitchen requires repair and redecoration following a water leak. Areas of the communal space in the home require redecoration. Emergency call bells must be accessible to residents when they are in their own room. 50 of care staff must have level 2 in NVQ care. Care documentation must be stored in line with data DS0000001467.V297855.R01.S.doc Timescale for action 30/10/06 2 OP10 12 30/09/06 3. 4. OP12 OP19 16 23 30/10/06 30/10/06 5. 6. 7. OP22 OP28 OP37 12 8 17 30/09/06 30/10/06 30/10/06 Hopton Court Version 5.2 Page 25 8. OP38 13 protection when not in use. All staff must undertake infection 30/11/06 control training. The hot trolleys must have hazard noticed to indicate a health and safety risk. 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 OP1 OP7 & OP12 OP15 Good Practice Recommendations The service user guide should include more detail as to how the homes provides effective care for people with dementia The residents would benefit from staff understanding and implementing a person centred approach in the way they provide care for residents. The cook should consider using a sugar substitute in baking to ensure all residents have choice of deserts. All residents should have jugs of water in their rooms. There should be a system for senior care staff to keep the manager informed of any changes or events during that shift and discuss any action required. The manager should undertake a formal qualification relating to dementia care. 4. 5. OP31 OP31 Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Hopton Court DS0000001467.V297855.R01.S.doc Version 5.2 Page 27 - 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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