Inspection on 27/10/06 for Kingscourt

This inspection was carried out on 27th October 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingscourt 25/04/07

Kingscourt 16/11/05

Kingscourt 12/07/05

Kingscourt 02/03/05

Kingscourt 12/10/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Kingscourt 100/102 Kings Drive Bishopston Bristol BS7 8JH Lead Inspector Vanessa Carter Key Unannounced Inspection 27th October 2006 09:15 Kingscourt DS0000040011.V302034.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 Kingscourt DS0000040011.V302034.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. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingscourt Address 100/102 Kings Drive Bishopston Bristol BS7 8JH 077680 94473 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) Supported Independence Ms Nicola Jane Stanworth Ms Catherine Twine Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 11 persons with Learning Disabilities aged 19 to 64 years. The shared management arrangements will be reviewed no later than one year from the issue of the certificate. 16th November 2005 Date of last inspection Brief Description of the Service: Kings Court is registered with the Commission for Social Care Inspection as a care home for up to eleven residents with a diagnosis of a learning disability. The home is able to accommodate people aged 18 to 64. The home is based in two adjoining semi detached houses in a residential area in North Bristol. It is approximately a quarter of a mile to local shops and a variety of community facilities. Public transport links (buses) are available in Kings Drive close to the home. All residents have to be physically able as the home is based over three floors with stairs being the sole means of access to each floor. There are three ground floor bedrooms. Supported Independence is the registered organisation. The home has four services under the umbrella of Supported Independence including Kings Court. The other services are for residents who wish to live within more independent housing. Kingscourt is presently the only service registered with the Commission for Social Care Inspection as personal care is given to one or more residents. The philosophy of care for Supported Independence is that a continuum of care is available to provide residents with an opportunity to progress towards greater levels of independence from within a consistent and planned environment. The cost of placement at the home is £700-1000 per week, and additional charges are made for hairdressing, toiletries, some activities and holiday money. Information can be obtained from the home manager or from Supported Independence. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over 5½ hours on one day. Evidence has also been obtained from a number of other sources, namely: Pre-Inspection Information supplied by Supported Independence Information supplied by residents in survey forms Information that has been received by CSCI since the last inspection Touring the home Talking to the home manager and the operational manager Talking to some of the residents Talking to staff Observations of residents and their interaction with other residents and the staff team Looking at staff and care records Looking at other documentation and policies of the home The overall analysis is that the home is a good place in which to live and to work. Improvements in one area would ensure that resident’s safety is further protected. What the service does well: What has improved since the last inspection? The home has met all the requirements made following the last inspection. Improvements have been made with the cleanliness of the property, particularly the kitchen areas. Medication procedures have been tightened and this means that staff will have better knowledge about the medicines they are administrating to the residents. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 6 The care planning processes will ensure that each resident receives the support they need to enable them to reach their full potential. Any behavioural management strategies that have been put in place will have been agreed between the resident, the home and any other interested parties. 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. Kingscourt DS0000040011.V302034.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 Kingscourt DS0000040011.V302034.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s information and assessment processes ensure that those residents who move to Kingscourt, will be appropriately placed, and will have been involved in the decision making, throughout the arrangements. EVIDENCE: The home has a statement of purpose that contains all the necessary information to enable prospective residents and their representatives to make an informed choice about living at the home. It sets out the aims, objectives and philosophy of the home. The representatives of any new resident who moves into Kingscourt, will know what the home has to offer. The care planning file of a newly admitted resident was examined, to look at the processes involved in determining whether their care needs could be met at the home. The home manager had completed a pre-admission assessment and had obtained a copy of the local authority health and social care assessment. Information was obtained on file concerning any other services involved in the care of the individual Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 9 Any new resident is only admitted after a number of introductory visits have been made, and compatibility with the existing residents has been checked out. The manager talked about the arrangements currently in place to introduce a new person into a vacant room. Graduated visits are made to the home – this may initially be a meal visit and end with a weekend stay. The existing residents would meet the new resident and would be asked how they felt about the person coming to live with them. The homes provides placement for residents who have a learning disability. It provides an initial preparation period in a “care home” environment, with the focus on helping the resident to achieve the daily living and social skills necessary to move on to supported living arrangements. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s care planning and risk assessment processes ensure that residents have the opportunity to have a say in how they want to be cared for, and what lifestyle they want to lead. EVIDENCE: Three care plans were looked at as a means of determining the processes the home go through to look at a residents assessed needs and then say how they are going to meet them. Each person had a detailed care plan that had obviously been written in consultation with him or her. The plans state how much help they need with specific tasks, like help with personal care tasks, daily living tasks, and management of their own personal safety. The resident and their key-worker regularly update the plans. Two of the plans need to be rewritten, as the handwritten additions of new information made the documents messy and confusing. The manager has already identified this as a problem and addressed this - each key-worker is allocated time each week to keep their paperwork up-to-date, neat and tidy. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 11 Each resident has key worker support time every week and this is referred to as a “supervision meeting”. One resident confirmed that they had a regular meeting with their key worker and they discussed how they were doing and any concerns they had. A record of the meeting is kept and both parties will sign their agreement of the notes made. Residents are involved in all aspects of the planning and decision-making processes concerning their lives. Discussions with residents and staff members, and information in the resident’s files evidenced this. House meetings are held on a weekly basis, and meal planning, redecoration of the lounge room and holidays are some of the recent topics discussed. The manager ensures that all residents have an equal say in the running of the home, enabling those quieter members to have their say as well as the more vocal members. The residents have compiled a list of house rules, and have “signed up” as agreeing to them. Residents are supported to move to more independent settings within the organisation. Staff stated that this is done based on the wishes of the individual and within a risk assessment framework. Risk assessments seen were based on enabling and did not appear to hinder residents from any activity. Risk assessments were seen around managing any health and safety risks whilst in the home, and for another, whilst outside of the home. For two residents there was an agreed “contract of support” saying “I agree I need support to go ‘off-site’ ”. Any behavioural management strategies that have been put in place will have been agreed between the resident, the home and any other interested parties. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a good quality of life and are assisted by staff who will enable them to take up new opportunities, develop further skills, with the aim of being able to live a more independent life. EVIDENCE: The inspection took place during the ‘half-term’ break therefore a number of the residents were away. Six residents were in the home at differing times during the inspection period. Two left to go and spend time with their family, one went along to a pre-arranged review meeting, one was entertaining a visitor and one went along to the shops. Despite there being only half of the residents around, the home was busy and lively. One relative responded in a CSCI survey form “I am always made to feel welcome in the home. The home is an extension of our family” Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 13 Each resident has a weekly plan of activities that includes college placements, attendance at other Supporting Independence projects and visits to day centres. For one person there was a record in their review notes that “keen to explore work options” and the manager explained how this was being looked into. One resident received her mail that day and proudly showed me the certificate she had received from the college. One staff member said they were working with one resident around relationship issues. Specialist guidance is being provided to both the resident and the support worker, with the aim of helping the resident make appropriate decisions. This is commendable, and evidences that the home enable the residents to have good personal, family and sexual relationships. Residents will each have a period of time each week when they do “Independence Training”. One resident explained that this involved tidying and cleaning their bedrooms, organising their laundry and changing bedding, and going to the shops. Each resident will help with meal preparations as much as they able. Risk assessments are completed prior to any resident undertaking a task to ensure that the likelihood of harm is minimised. Residents can have a key to their bedroom doors if they want one and can move around the home independently. The interaction between residents and staff was appropriate, friendly and supportive. At least two of the residents have made agreements with the staff team on the need for support when going out of the home. There are procedures in place for the staff to follow should they leave the home without staff support. One relative responded in a CSCI survey that family member had flourished whilst living in the home, had been given the opportunity to develop new skills and helped to find new ways of dealing with their weak points. This statement evidences that the home looks at each resident as an individual; their care is planned accordingly. The residents normally have their main meal in the evening upon return from their college or day care placements. At the weekends arrangements are more flexible depending upon the movements of the residents. One resident said that “everybody decides what we are going to have for tea and I help get it ready sometimes”. The home provided a sample two-week menu with the preinspection information. There was a wide range of meals offered. One resident said they had to watch what they eat but the staff knew what was OK and what wasn’t. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive the help they require with their personal and healthcare needs, and medication systems are safe. EVIDENCE: The operational manager, home manager and staff team demonstrated a good knowledge of the resident’s specific healthcare and personal needs. Each resident needs different levels of support to meet their daily personal care needs, and the aim is to enable each person to do as much for themselves as possible. One resident said they had to be “prompted or reminded” to have a bath or shower, whilst observations of the support provided to another resident showed they needed full support. Personal assistance is done in private and residents are able to choose who helps them. Residents spoken with during the inspection said that they are able to get up and retire to bed, at their preferred time, but when they go to their day centres they need to be up in time for the transport. On the day of the inspection the usual routines were relaxed, therefore residents were getting up later than normal. The residents were each well dressed and looked clean and well cared for. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 15 All residents are registered with the same doctors practice and the same dental practice. The residents will be assisted to consult the doctor whenever there is a need. Where there is a need for other health care professionals, the home staff will enable the residents to access the support they need. One GP practice responded via a CSCI survey form that “the home has greatly improved” and that “staff demonstrated a clear understanding of resident’s needs”. The homes medication procedures are safe, with the homes policy being that all medications are administered to residents are double-checked. Prior to being able to administer medications all staff will undergo ‘Safe Handling Medications’ training. The whole staff team have just completed this and are awaiting their certificates. The pharmacist supplies the majority of medications in sealed medication trays. Examination of the medication administration sheets evidenced that the records are well maintained. Some of the residents are on medications that they take as and when required. There are clear instructions for the staff to follow so that they know how much and how often they can administer the medicines. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. 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. The home’s procedures for dealing with concerns or complaints are good, ensuring residents that they will be listened to and have their concerns acted upon. Residents will be safeguarded from harm. EVIDENCE: The home’s complaints procedure is displayed on the inside of each of the resident’s bedroom doors. The home has devised a simple method using pictures of happy, sad, angry and confused faces. The residents can indicate on one of these forms how they are feeling and give the form to one of the staff. The manager would then arrange a supervision meeting with the resident so that the issue is explored. Two residents spoken to during the course of the visit said that they knew how to make a complaint and who to speak to. One resident added that the staff did listen to them and their concerns would be acted upon. The home keeps a record of all complaints. Both the home and operational manager demonstrated their awareness of safeguarding adult issues and their responsibility in ensuring that the residents are protected from abuse, harm or neglect. Staff spoken with confirmed that they have had training in adult protection, and also demonstrated good awareness of issues, and their responsibilities in protecting the residents from harm. The manager has completed training that will enable her to teach others on adult protection issues. Residents said that they were well cared for and the staff team were all kind. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s live in a homely environment but improvements with the internal decorations would mean that the residents would live in a much nicer and brighter home. EVIDENCE: Kingscourt is two semi-detached houses that have been converted into one property. It accommodates up to 11 people, and the bedrooms are split between the three floors. The home does not have a lift and is therefore only able to accommodate anyone with mobility impairment on the ground floor. The home is comfortably furnished throughout. The home is located near to local amenities, bus routes and relevant support services such as day resource centres and leisure centres. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 18 The main lounge has recently been redecorated and residents said that they had been involved in choosing the colour of the paint. The rest of the home is in poor decorative order. The hallways were dark and drab and since they do not have any natural light, the use of ‘low energy bulbs’ should be reconsidered. The home was generally clean and tidy, and fresh smelling throughout – this is a marked improvement from the previous inspection. The environmental health officer has visited following the last inspection the home. The home were advised to make a number of improvements in the kitchen area – these matters have been addressed and strict cleaning schedules put in place to ensure that the standards are maintained. A tour of the home was made but only some of the resident’s bedrooms were seen. All but one bedroom has en suite facilities of a bath, wash hand basin and toilet. Those rooms seen were personalised by the resident. One bedroom is currently vacant and this is being prepared for a new resident. Each bedroom is furnished to meet that persons needs. Bedroom doors are lockable – not all residents use the facility, it is down to personal choice. One resident said they liked their bedroom but needed to be reminded to keep it tidy. There are five additional toilets and one shower room in the home. The home has a large comfortably furnished lounge on the ground floor, with dining areas situated next to the main kitchen. There is also two other ‘training rooms’, one on the ground floor and the other on the first floor. The home was generally clean and tidy throughout, however as previously mentioned, the home would benefit from being freshened up, with the corridors particularly being made lighter and brighter. Residents assist in keeping their own rooms clean and tidy, along with support from care staff. The laundry facilities are located in an outhouse and are adequate to meet the resident’s needs and any disinfection standards. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents will be well looked after by a caring staff team who are well supported by the manager, and are skilled and competent to undertake their role. However, improvements must be made with recruitment practices to remove the potential that unsafe workers could be employed to work at the home. EVIDENCE: There is a core of well-established staff with varying abilities who are skilled and experienced to meet the needs of the service users in the home. There have been only two new recruits to the staff team since the last inspection. Observation of staff practice and interactions with the residents demonstrated that they were approachable, and respectful of those who they were looking after. The residents were at ease with the staff and there was a great deal of friendly and supportive interaction. The manager has already completed the NVQ level 4 in management and the registered managers award. One staff member has already completed an NVQ level 3 in care and a number of other support workers will be working towards the award. The home should continue working towards achieving a 50 ratio of trained support workers. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 20 All new staff will complete a comprehensive induction programme that meets the new “Skills for Care” criteria, upon starting their employment at the home. One staff member confirmed that they had had an induction programme to complete when they started and said that the staff team were supportive. This ensures that their suitability for the work is measured, and the residents receive a satisfactory service, that meets their expectations. All staff will also complete a programme of mandatory training that includes fire safety, first aid, food hygiene, manual handling, and abuse awareness. A training file is kept for member of staff. The home has recently increased the numbers of staff in order to meet the resident’s increasing individual needs. The home does not use agency staff. This means that the residents will be cared for by staff who are familiar with their needs. Full staff meetings are held on a regular basis. From discussions with staff, it is evident that the team are supportive of each other, have good working relationships, and that the main purpose is to ensure the resident’s needs are met and they are content. The home must follow safe vetting and recruitment procedures to ensure that the right people are employed at the home. The practice of employing staff before POVAfirst clearance has been received is not only against the law, but could also potentially place the residents at risk from being cared for by staff who have been barred from care work. The home must ensure that the necessary checks are completed prior to a new recruits employment and the appropriate records to evidence the checks must be retained at the home for inspection. All staff receive formal supervision at regular intervals, and this was confirmed in discussion with staff members. The homes records were not checked on this occasion. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. 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. Residents live in a home that is well run, and has their best interests at the heart of all decision-making processes. EVIDENCE: Ms Nicola Stanworth has been the registered manager at Kingscourt for nearly two years, a position she ‘shares’ with Ms Catherine Twine. Since the last inspection Supported Independence have recruited an operational manager. Both Nicola and the operational manager were present during the visit, and both demonstrated full knowledge of each resident and their experiences in care of people with a learning disability. One relative responded in a CSCI survey form that Ms Stanworth has the residents best interests at heart, has shown herself to be ‘super caring’ and is very approachable. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 22 The operational manager visits the home on a regular basis and on a monthly basis will complete a report of arrangements at the home. Supported Independence reported on their annual analysis of their services in August 2006 and a copy of the report was provided. The analysis covered residents views of their social life, ability to meet new people, key worker support, staff and other house members, complaints procedure and ability to make choices, to name a few. During the tour of the home, no health and safety issues were noted. The previous inspector had been concerned about the raised thresholds in some doorways that could cause trips and falls. This applies to only two doorways, the rear entrance to the home and the doorway from the conservatory area into the staff office. Warning signage about the raised step has been displayed – the home is unable to make changes, as the doorframes are part of a complete uPVC unit. None of the residents have experienced any problems with the raised step. The fire log was looked at. All the necessary weekly/monthly/quarterly checks of fire fighting equipment and the fire alarm system were in order. The staff team receive training every three months. Since the last inspection the home have provided CSCI with a copy of their Fire Risk Assessment. Kingscourt DS0000040011.V302034.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 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 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 24 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 YA34 Regulation 19 Schedule2 Requirement The recruitment of new workers must follow safe vetting procedures. • POVAfirst clearance must be obtained before employment commences • If employment starts before CRB disclosure has been received, induction and supervisory arrangements must be in place. • Evidence of both POVAfirst clearance and CRB must be retained in the home. An immediate requirement notice was issued to the home. Timescale for action 27/11/06 Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 25 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. Refer to Standard YA6 YA24 Good Practice Recommendations That care plans are kept neat, tidy and legible, so that support workers can easily determine what is current information. The hallways could be made lighter and brighter if redecorated and the use of low energy bulbs is reconsidered. Kingscourt DS0000040011.V302034.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Kingscourt DS0000040011.V302034.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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