Inspection on 28/08/07 for House 2 Slade House

This inspection was carried out on 28th August 2007.

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

The inspector 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

House 2 Slade House 03/08/06

House 2 Slade House 23/02/06

House 2 Slade House 30/11/05

House 2 Slade House 16/02/05

House 2 Slade House 11/11/04

House 2 Slade House 09/03/04

House 2 Slade House 09/12/03

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

CARE HOME ADULTS 18-65 House 2 Slade House OLD NHS Trust Horspath Driftway Headington Oxford OX3 7JH Lead Inspector Annette Miller Unannounced Inspection 28th August 2007 15:00 House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service House 2 Slade House Address OLD NHS Trust Horspath Driftway Headington Oxford OX3 7JH 01865 228135 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) anna.munday@oldt.nhs.uk Oxfordshire Learning Disability NHS Trust Mrs Anna Kathryn Munday Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd August 2006 Brief Description of the Service: The Step Down Service (House 2, Slade House) is a three bedroomed house situated on The Slade site in Oxford. It provides a transitional placement for individuals who have a learning disability and have moved from secure in-patient environments. The service falls within the remit of the specialist health services at the Oxfordshire Learning Disability NHS Trust (OLDT). The house provides short-term accommodation and outreach support for up to three people who are assessed to subsequently move into the community within a timescale of two years. Clinicians and the management team, before acceptance into the service, formally assess individual’s needs. Service users identify their own needs through a ‘life planning’ process/tool and are supported by staff to gain the skills required to achieve goals and eventually achieve independence in the community. The current range of fees for this service is unavailable due to funding being received through the National Health Service. House 2 Slade House DS0000013162.V342351.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 inspection carried out by one inspector from 3pm to 6.30pm. The time spent at the home allowed for a thorough look at how well the service is doing. The inspector toured the premises and looked at care plans and other documents relevant to the inspection. The inspector took into account detailed information sent to the Commission for Social Care Inspection (CSCI) by the manager before the inspection. This was on the Annual Quality Assurance Assessment (AQAA) that services registered with CSCI are required to provide. The inspector spoke to each of the three residents and also two members of staff during the inspection. This was to obtain their views of the home. The registered manager was off duty and the inspector telephoned her two days after the inspection to check some details and to give feedback of the findings. CSCI sent questionnaires to three residents, one person visiting the home before admission, three relatives and five health and social care professionals. Responses were received from three residents, the person waiting for admission, one health professional and one social care professional. Everyone made good comments about the service, which are referred to within the report. The inspector looked at how well the service was meeting the national minimum standards (younger adults) set by the government and has, in this report, made judgements about the standard of service provided at the home. What the service does well: The home is well managed and is run in the best interests of residents. Residents receive good support to assist them in their integration into the wider community, with the eventual aim of leading independent lives in a supported living environment. They also have good support from an advocate who visits the home weekly to listen to any concerns they have. The NHS patient advice and liaison service is also available if they need it. Staff are provided with a good range of training opportunities. This ensures that they continue to develop their skills and knowledge enabling them to give good care. Good comments were made on CSCI questionnaires. A health professional said, “The home provides a highly valued service for individuals with complex needs”. A prospective resident said, “It is good. I am currently visiting 2-weekly and will hopefully move in soon”. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home completes a clear and detailed assessment of need before people are admitted. This ensures that a person’s individual and diverse care needs are met. EVIDENCE: All prospective residents are formally assessed to identify their care needs before decisions are made about admission to the home. Health and social care professionals are involved in this process, together with the home’s manager. The inspector looked at the care file of one resident and found that a detailed assessment had been conducted prior to admission. A social worker said on a CSCI questionnaire: “Thorough assessments (nursing reports) are requested to accompany funding panel applications. All are excellent supportive documents”. A prospective resident said: “It is good. I am currently visiting 2-weekly and will hopefully move in soon”. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is a clear and consistent care planning system in place that ensures staff have the information they need to satisfactorily meet residents’ needs. EVIDENCE: The inspector looked at one resident’s care file and saw that it contained detailed and comprehensive information about all aspects of his care. There was particular emphasis on providing the support he needed to help him reach his goals of care. The person’s likes and dislikes were clearly recorded, such as how he liked spending his day, his hobbies and his hopes for the future. Each resident has a named nurse who monitors the person’s goals of care to check that progress is being made towards achieving them. This is done through reviewing care plans, as well as meeting individually with the person and other members of staff involved in the person’s care. The person whose care is discussed is at the centre of these meetings to ensure their views are listened to and taken account of. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 10 The home has good policies and procedure in place regarding the management and security of money held for residents. Key staff members help residents to create their own weekly budget plans and to set a daily allowance to spend as they wish. Money accounts are checked weekly by a member of staff from the accounts department within the Oxfordshire Learning Disability Trust (OLDT) to ensure money is properly managed. People living in the home are encouraged to make their own decisions within the limitations of their care plans and risk assessments. Risk management strategies are agreed with the individual. In the care file looked at there were clear risk assessments tailored to the individual’s support needs. Two residents said on CSCI questionnaires that they could “always” do what they wanted to each day; one person said “sometimes”. A person who was spending short periods at the home before moving in permanently said: “I agree with Stepdown and the activities I will be doing”. The inspector observed good practice during the inspection regarding the management of specific behavioural problems concerning one resident. This involved one-to-one support for an individual and extra support from senior members of staff within OLDT for the staff on duty. It was clear that the organisation takes seriously its responsibility to provide the necessary assistance to ensure people’s safety. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are supported to make lifestyle choices that recognise their individuality and provide the support they need to develop life skills. EVIDENCE: The people currently living at the home are able to go out alone during the day and spend their time as they wish. These arrangements are part of their planned programme of integration into the community. The time for returning is agreed with each individual. Residents have unrestricted access to the home during daytime hours, but overnight the home is locked. Essential lifestyle plans are used for each person to describe routines and preferences in order of importance. On a CSCI questionnaire a resident listed activities he was involved in - line dancing, playing football, watching football matches and visiting places. This person indicated satisfaction with the activities available. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 12 The inspector saw information displayed in the home about a multi-sports club for adults with disabilities starting 23rd August 2007. The fact that information is provided about such activities indicates there is good awareness among staff of the importance of identifying social and recreational opportunities that people might be interested in. A computer with internet access is provided for residents. One resident has a part-time job, which a staff member said had opened up opportunities for new relationships outside of the home. Another person is involved in part-time voluntary work. One resident likes gardening and took the inspector into the garden pointing out where he had planted flower seeds. The garden provides good outdoor space for people to pursue gardening as a hobby, or just to be out in the fresh air. A barbeque was held in the garden recently to celebrate a resident’s birthday, showing that staff are keen to arrange enjoyable activities for residents. Two residents told the inspector about a trip to Dorset that was arranged to take place the following day, which they were clearly looking forward to. The home has its own 7-seater vehicle that is being used as transport. One resident has been supported to go on a week’s holiday, the first for many years. The home’s house rules promote independence and individual choice. The inspector saw one person appearing content pottering round the house and garden, and watching TV. It was his turn to undertake cleaning tasks, which he was doing when the inspector arrived, having spent the morning in Oxford. Mealtimes are flexible to take account of people’s preferences. Staff prepare meals, with help from residents when they are available and willing to help. No concerns were raised with the inspector about the standard of food provided. Training records showed that essential food safety training updates are provided to ensure staff have a good understanding of safe and hygienic procedures in the area of food preparation and storage. Various policies are provided by Oxfordshire Learning Disability Trust reflecting equality and diversity. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal and healthcare needs of residents are appropriately supported. EVIDENCE: The residents currently living in the home are able to meet their personal care needs without any assistance from staff. Locks are provided on bathroom and bedroom doors allowing people privacy when they need it. Residents have access to a GP and appointments are made by the person concerned, or by staff. If psychiatric care is needed for identified individuals it is arranged by senior staff. A community pharmacist regularly inspects medication at the home, last done on 17th August 2007. A copy of the report was provided for inspection and showed that medication procedures were good. The manager said the pharmacy inspector made one recommendation regarding medication records, which the manager confirmed had been dealt with. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear complaints policy in use within the home. Residents are protected from abuse, neglect and harm through the home’s policies and procedures and also staff training. EVIDENCE: The complaints procedure is clear and is made easy for people to be able to make a complaint. The manager has received one complaint and was dealing with it at the time of inspection. It involved problems between two people living at the home. The manager confirmed that all complaints are logged showing a summary of the complaint, the action taken and the outcome. The Commission for Social Care Inspection (CSCI) has received no information concerning complaints, concerns or allegations since the last inspection. CSCI questionnaires show that people using the service know who to speak to if they are not happy. One said, “I have named key people that can help me”. Everyone responding said they know how to complain. The people living in the home are well supported by people available to listen to any concerns they have. This includes the independent advocacy service used by the home and also NHS PALS (patient advice and liaison service). House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 15 The home has satisfactory adult protection policies and procedures and staff receive training to ensure that they know what action to take in the event of residents being involved in suspected abuse. Protection of vulnerable adult training was last held in February 2007 when six members of staff attended. This does not include all of the staff employed, but the AQAA shows that the home is aiming to provide this training for all staff by December 2007. No safeguarding referrals have been made to the Oxfordshire County Council adult protection service since the last inspection. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recent redecoration has significantly improved the appearance of the home, creating a comfortable and safe environment for people living there. EVIDENCE: There is a marked improvement in the appearance of the communal areas since the last inspection. Two requirements were made at the last inspection regarding general redecoration and refitting the kitchen. This work has been completed. During this latest inspection the home looked comfortable and homely. Each resident escorted the inspector to his bedroom and they all said they were very happy with their personal accommodation. Bedrooms contained a range of residents’ belongings reflecting individual personalities. Bedroom doors have locks and one person said he was pleased he could lock his door when he wanted to. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 17 New carpet has been fitted in the lounge giving a pleasant appearance. However, staff reported that the flooring in the dining room and bathrooms had not been renewed for many years and was difficult to keep clean, involving staff scrubbing the flooring periodically to remove ingrained dirt. The manager was advised to discuss replacing the flooring with the housing association, or asking the Oxfordshire Learning Disability Trust to purchase/hire a commercial floor cleaner when needed, as it is not appropriate for staff to be scrubbing floors. Cleanliness in most areas was good. Residents have a responsibility to undertake light housework and general cleaning duties, which helps them prepare for independent living. A rota is drawn up with the involvement of residents to ensure that everyone has a fair allocation of work. Bathroom cleanliness was adequate. However, it should not be the sole responsibility of residents to clean these facilities. There needs to be more staff involvement in monitoring cleanliness and arranging for extra cleaning when needed. The AQAA identifies that the bathrooms need to be more homely and that the manager is considering how to achieve this. Residents are responsible for washing their own clothes in the facilities provided. A rota is drawn up with the involvement of residents so that they know when it is their turn to use the laundry. As a result of a requirement made at the last CSCI inspection an environmental health inspection was carried out in October 2006. Three requirements and one recommendation were made, which the manager confirmed had been dealt with. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff to meet the needs of people living in the home and to safeguard their welfare. EVIDENCE: The atmosphere in the home was calm throughout the inspection and the staff worked effectively with residents, showing them respect and sensitivity at all times. The staff team consists of the registered manager, two team leaders and seven support workers. Two more support workers have been employed recently and are starting soon. A health professional said on a CSCI questionnaire: “Staff are highly trained and expert in dealing with challenging behaviours. They impose robust boundaries on service users which service users find extremely helpful.” House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 19 Staffing levels are determined on a day-to-day basis by the needs of residents. An example of this was the one-to-one support provided at short notice for a resident, arranged prior to the inspector arriving. A senior member of staff from The Oxfordshire Learning Disability Trust (OLDT) called in to check on the situation and an experienced worker from another OLDT service arrived to give further support. OLDT requires new workers to achieve the LDAF (learning disability awards framework) within six-months of employment. Following this, staff are encouraged to enrol on NVQ 3 with the aim of achieving the LDAF and NVQ within 18 months. The home has not yet reached 50 of care staff with NVQ and therefore Standard 32 is assessed as ‘partly-met’. However, two staff members have started this training at Level 3. Also, one support worker has a diploma in occupational therapy, which is equivalent to NVQ. A team leader is on the NVQ assessor training and when this is achieved she will be able to help staff through NVQ. The manager and team leaders are registered nurses. Three recruitment files were inspected at the OLDT personnel office situated a short walk from the home. Most of the necessary information and checks had been obtained before staff had started at the home. However, a full employment history was not seen in one of the files and both references on file had been obtained from a previous employer dating back some years. A full employment history is needed for gaps in employment to be checked and at least one reference should be recent. Staff photographs were not seen in any of the files, but following the inspection the manager confirmed that staff photographs were kept at the home. The omissions were discussed with the manager following the inspection so that these matters could be clarified with the members of senior staff involved with recruitment. The home has a comprehensive induction programme for new staff. A member of staff said she thought her induction was well planned and that it provided her with the knowledge and confidence she needed for her role. She also said she had received ‘lots of training’. Training records confirmed this. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed with leadership, guidance and direction given to staff to ensure people admitted receive consistent quality care. This results in practices that promote and safeguard the health, safety and welfare of people living in the home. EVIDENCE: The Commission for Social Care Inspection approved the manager’s application to be the home’s registered manager in December 2006. This involved a thorough check of the manager’s suitability for her role and involved a face-to-face interview. She is a registered nurse and has wide experience in supporting adults with learning disabilities, challenging support needs and mental health issues. House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 21 The manager has not yet started the Registered Manager’s Award, although has recently received confirmation from the Oxfordshire Learning Disability Trust (OLDT) that funding is available. It was clear that the home is well managed, but until this award is achieved, the highest possible rating for Standard 31 is ‘partly-met’. The CSCI questionnaires asked people to comment on what they thought the home did well. A professional said: “Provides a highly valued service for individuals with complex needs”; another professional said, “Liaison with others, supportive information for professionals, working with individuals, fair treatment of clients who may challenge the service.” Residents’ views are sought in a variety of ways to ensure that the home is meeting their needs. For example, residents’ meetings are held every other month, and at other times on request, to provide opportunities for people to make suggestions and to deal with any issues they want to raise. The AQAA shows there are plans to formalise residents’ meetings to run in line with team meetings, so that issues can be addressed quickly and promptly. OLDT takes seriously its responsibility to ensure the safety of people living at the home, as well as staff and visitors. This is achieved through good policies and procedures that underpin staff practice. External contractors are employed to carry out maintenance work as it arises and also to undertake specialist checks. A staff member conducts an in-house monthly health and safety inspection to ensure that maintenance matters are noted and reported promptly. The manager confirmed that hot water to baths, showers and washbasins was controlled by temperature control valves to protect residents from scalds. Also, confirming that regular checks were made on the temperature of hot water to ensure that valves were operating effectively, with records kept. The inspector noted that window opening restrictors fitted to first floor windows were either broken or had been disabled. When operating effectively, the window restrictors limit the amount a window can be opened for residents’ safety. This was discussed with the manager after the inspection so that she could take prompt action to deal with this situation. House 2 Slade House DS0000013162.V342351.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA24 Good Practice Recommendations That consideration is given to replacing the flooring in the dining area and bathrooms to provide a surface that is easier to clean. That consideration is given to providing a more homely appearance in the bathrooms. That staff are responsible for monitoring the cleanliness of the bathrooms on a daily basis, arranging for extra cleaning when it is needed. Repairs to the first floor window opening restrictors should be undertaken for residents’ safety. 2 3 YA27 YA30 4 YA42 House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House, 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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 House 2 Slade House DS0000013162.V342351.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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