Inspection on 22/08/05 for Lakeside House

This inspection was carried out on 22nd August 2005.

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

The inspector found 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

Lakeside House 18/07/07

Lakeside House 22/09/06

Lakeside House 07/12/05

Lakeside House 23/03/05

Lakeside House 09/06/04

Similar services:

32 Beaumont Way

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

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

CARE HOME ADULTS 18-65 Somerset Court Harp Road, Brent Knoll Highbridge Somerset TA9 4HQ Lead Inspector David Kidner Unannounced 22 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Somerset Court Address Harp Road Brent Knoll Highbridge Somerset TA9 4HQ 01278 760555 01278 760747 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) National Autistic Society Mrs Doreen Diana Paisley Care Home 46 Category(ies) of 1. People with learning disabilities. registration, with number of places 2. People with physical disabilities. Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 46 adults in categories LD and PD. 2. Rooms 4 and 5 of Cadbury Cottage (phase 2) is not to be used without prior consultation with the Commission for Social Care Inspection. Date of last inspection 23 March 2005 Brief Description of the Service: Somerset Court is registered to provide care for up to 46 people who have a learning difficulty. The home specialises in providing a service to people who have autistic spectrum disorder. Accommodation is arranged in 7 separate bungalows with each service user having their own bedroom. Somerset Court is located in a rural location outside the village of Mark, near Burnham-on-Sea. There are no amenities within walking distance but the home provides transport to enable service users to access local facilities. The home is owned by the National Autistic Society. There is a vacancy for a Registered Manager. The Commission for Social Care Inspection (CSCI) has had discussions with Dianne Rawlings, Area Manager, as to the management action that has been taken in support of the home. Dianne Rawlings is taking overall management of the service until the vacancy is filled. The CSCI are in support of these plans and is in regular contact with the service. Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Inspectors conducted the Unannounced Inspection over one day. The Inspectors would like to thank the service users, Senior Managers and the staff team for making the Inspectors welcome at the home and for their contribution to the inspection process. The CSCI is aware of a major consultation event at Somerset Court. The consultation is in three stages. Service users, relatives and all staff have been consulted and are involved in discussions in relation to the future development of Somerset Court. The Inspectors have been advised that Stage 1 is now complete and parts of Stage 2 have already commenced. At the time of the Inspection 44 service users were living at the home. The Inspectors visited five of the seven bungalows. The two remaining bungalows were unoccupied at the time of the inspection as service users and staff were involved in other activities. The Inspectors viewed records in relation to care and support plans, staff recruitment, health and safety and medicines records. Seven care staff were spoken to in private and in small group settings. The Inspector observed the staff team interacting with service users in a very professional, caring and supportive manner. As a result of this inspection the home has one requirement and four recommendations. What the service does well: Somerset Court provides good quality accommodation and all service users have a single bedroom. There are detailed care and support plans supported by risk assessments and behaviour strategies where needed. All staff have had annual appraisals. This has clarified lines of accountability and responsibility. The review of staff meetings has been very positive in ensuring good pathways of communication. Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 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. Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 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 standard(s) None of these standards were assessed, as there have not been any admissions to the home since the last inspection. EVIDENCE: Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 8 9 10 Care plans contain detailed information as to the needs of service users. Somerset Court takes every step to ensure that service users are consulted as much as possible in relation to aspects of daily living and decision-making. The home promotes matters relating to confidentiality. EVIDENCE: Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 Page 10 The Inspectors viewed the care plans of three service users. The care plans were very detailed and contained an autistic profile, information on domestic and personal care needs, likes and dislikes and behavioural support plans where needed. Those viewed had been signed, dated and reviewed. There was evidence that staff were aware of changes in care plans and behaviour protocols. This was a requirement at the last inspection. One service user had recently had an annual review on the 12 August 2005. A number of care staff; senior managers and a representative of the placing authority attended this. The care plan and behaviour support plan is in the process of being adjusted following this review. Each person has a link book where all staff; including day care, staff note daily records of significant events and behaviour. The link books are now located in a more confidential and secure area as recommended at the last inspection. Key-workers write a monthly summary, which is kept in care plans and gives details of any changes through the previous month. At the time of the inspection the Inspectors were able to see some service users being involved in daily living skills such as making their bed and hoovering. One service user commented that they had also been dusting their bedroom. Each bungalow holds regular service user meetings with minutes kept. Staff have worked hard to enable people to air their views. Many areas of some bungalows have been redecorated in recent months. This includes complete redecoration of lounge, dining rooms, hallways, bathrooms and kitchens. Service users have been able to make choices about colour schemes and furnishings. However, one staff team commented that service users did not get a choice in the decoration of their bungalow. This was brought to the attention of the Area Manager at feedback. The Area Manager stated that this would be looked into. All service users choose the décor for their own personal rooms. Somerset Court has developed a comprehensive risk management process. Individual risk assessments and environmental risk assessments have been conducted where needed and reviewed appropriately. Some care staff advised the Inspectors that service users and staff are now more involved in the creation of menus. This was a recommendation following the last inspection. Somerset Court has various policies and procedures in relation to Confidentiality and Data Protection Act 1998. Staff that the Inspectors spoke to were aware of issues of confidentiality. Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 14 15 16 17 Service users are encouraged to participate in a variety of activities and leisure opportunities. The home encourages contact with families, friends and other interested stakeholders. Service users are offered a healthy diet and are involved in menu planning. EVIDENCE: Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 Page 12 All service users have a home day where they are able to spend time with a member of staff, usually their key worker, developing household skills. On home days people assist with cooking, cleaning, shopping and laundry dependant on their abilities. This is also a time where service users enjoy one to one time with staff. The Inspectors visited most bungalows and noted that some service users were on home days and were partaking in activities such as cleaning their room and going out shopping. Some of the service users attend church on a regular basis and transport is provided if required. Visitors are welcome at the home at all reasonable times. Somerset Court produce a newsletter that informs relatives and other interested stakeholders on significant events that affect the home. This includes various events, holidays, staff appointments and appropriate information in relation to individual service users. All service user bedrooms are lockable and service users are able to choose whether or not they lock their rooms. There are extensive grounds at the home and service users are able to access all outdoor spaces in line with their assessed abilities and wishes. Some service users walk around the gardens to have periods of time to themselves other service users will go to their room. Somerset Court has a main kitchen and a dining area in the main building where most people eat lunch. Each bungalow has a fully equipped kitchen and dining area. The care staff and service users prepare and cook evening and weekend meals. The Inspectors viewed the kitchen facilities in the individual bungalows. All kitchen and dining areas were clean and tidy. Some of the store cupboards showed that there was good quality food including fresh fruit and vegetables. Some care staff advised the Inspectors that service users and staff are more involved in the creation of menus. This was a recommendation following the last inspection. The Inspectors did not view the main kitchen on this occasion. Specialist diets are catered for based on individual need. Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 19 20 The home makes every effort to ensure that the physical and emotional needs of the service users are met. The home has policies and procedures for the storage and administration of medicines. Following this inspection the home should ensure that good practice is maintained. EVIDENCE: Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 Page 14 The care plans that the Inspectors viewed gave detailed information of the level of support required with personal care. Specialist equipment is provided on an individual needs basis. One of the bathroom areas has an assisted bath to support the needs of one individual. Service users are encouraged to maintain and develop independence. Routines in the houses are flexible, there are no set times to get up and go to bed. If there were any restrictions imposed these would be detailed in the individual plan of care. All service users have allocated key-workers. Service users are able to choose their own style of clothing. Service users are registered with local GPs and other healthcare professionals appropriate to their needs. All medical appointments are recorded and these show that service users are accessing a wide range of healthcare professionals including dentists, chiropodists, opticians and physiotherapy. Documentation was viewed in relation to support from a Consultant Psychiatrist and Psychology Services. Somerset Court uses the Boots Monitored Dosage System. Medication is stored in individual houses. The Inspectors sampled the medication administration records in three bungalows. In one bungalow the MAR Sheets did not contain the signatures of two staff for hand transcribed medicines. It is recommended that this be addressed. In another bungalow it was noted that the fridge temperature for the storage of Insulin at times exceeded the recommended storage temperature of 8 degrees centigrade. The staff took action to address the storage issue at the time of the inspection. It is recommended that the temperature of the fridge be monitored on a regular basis to ensure that the Insulin is stored at the correct temperature. The Inspectors were advised that the medicine keys are kept in each bungalow and do not leave the site. This was a requirement from the last inspection. Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 Page 15 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 standard(s) 22 23 The home operates a comprehensive Complaints Procedure and ensures that service users are safeguarded from abuse, neglect and self-harm. EVIDENCE: The home has a comprehensive Complaints Policy. The Inspectors viewed the Complaints Log and noted that there has been four complaints seen the last inspection. The Inspectors sampled the action taken in relation to two complaints. It appeared that the home has responded in the correct manner with detailed records kept. All complaints had been resolved. The CSCI had been kept informed of complaints where needed. Somerset Court has policies and procedures in respect of recognising and reporting abuse and whistle blowing. All staff receive training in the protection of vulnerable adults. SCIP (Strategies for Crisis Intervention and Prevention) is used at the home. SCIP is designed to help and support staff deal safely with aggression and self-injurious behaviours that may occur during a crisis period. Staff must only use the SCIP techniques that are recorded in care plans and only once they have been trained in its use. All staff receive this training during their induction period. The Inspector saw evidence that all staff are checked against the Protection Of Vulnerable Adults list before commencing work at the home. Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 29 30 Not all standards were assessed in each of the bungalows. However, the areas viewed appeared to be homely as possible. All areas were clean and hygienic. EVIDENCE: The Inspectors viewed some living areas at Somerset Court including lounge and dining areas, bathrooms, toilets and kitchens. Those areas viewed were homely and comfortable. Some bungalows have received redecoration and refurbishment since the last inspection. Some kitchens have received major refurbishment and have vastly improved the environment. Some lounge and dining areas have been redecorated and new furniture and soft furnishing have been replaced. The Inspectors were advised of the plans to provide an extension to one bungalow area. This will increase communal space. The Inspectors noted that some bungalows that were visited did not appear to have adequate ventilation as the majority of the ground floor windows were closed. Staff advised that this was because one service user at Somerset Court will gain access to other bungalows and will invade other service user’s private space. Following discussions with the Area Manager and Area Estates Manager it is recommended that consideration is given to ensure that all bungalows are able to open windows for ventilation and that restrictors are fitted if needed. Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 Page 17 Environmental aids and adaptations are put in place on an individual needs basis. One bungalow has an assisted bathing facility for one service user who is not able to use a domestic type bath. All areas viewed were clean and hygienic. Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 33 34 The home has recently reviewed the roles and responsibilities of the staff team. This has clarified individual roles. The home strives to ensure that service users are supported by an effective team with sufficient number of staff at all times. However, following this inspection there is a recommendation in relation to one team being supported with additional staff. The home has a robust recruitment process. EVIDENCE: Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 Page 19 The Inspectors were advised that since the last inspection all staff roles have been revised to ensure that staff are fully aware of their roles and responsibilities. This was a requirement from the last inspection. Additionally, all staff at Somerset Court have received an annual appraisal. There are three Residential Managers that oversee the houses and report directly to the Residential Manager, currently Dianne Rawlings, Area Manager. Each house has a Team Leader and an Assistant Team Leader who are supported by Support Workers. In addition a member of the Senior Management Team is on call over the 24-hour period. Some staff spoken with confirmed that they have received an annual appraisal and that their roles and responsibilities have been discussed/clarified. The Inspectors had discussions with the Area Manager about staffing levels at Somerset Court. They were advised that the home has a vacancy factor of 2.0 wte. Staff that the Inspector spoke to commented that they felt that they have adequate staff on duty. Staffing rotas are kept on each bungalow to include day service staff that support each bungalow first thing in the morning and include information of activities planned. This was a recommendation from the last inspection. The Inspectors viewed a number of files of recently appointed staff. All files contained the required documentation as listed in Schedule 2 of the Care Homes Regulations 2001. The Inspectors spoke to a member of staff in one bungalow. It appears that a service user is experiencing a very difficult time and this is having a negative impact on the other service users’ lifestyles and the staff team. The team is also experiencing some staffing difficulties due to annual leave and sickness. The Inspectors spoke to a member of the Senior Management team to discuss this matter in more detail. Following this discussion it is recommended that the staffing levels at this bungalow be reviewed on a daily/weekly basis if needed. This will ensure that the bungalow is more than adequately supported throughout this period of time and more than minimum staffing levels are maintained. The Senior Manager agreed that this was appropriate and would address this without further delay. . Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 39 40 41 42 It appears that the management approach of the home is open, positive and inclusive. The home has reviewed the process in which communication methods between the Senior Management Team and bungalow staff is disseminated. This appears to be more positive. The home has effective quality assurance systems. Due to the consultation event the home has been very pro-active in seeking the views and opinions of the service users, staff and other interested stakeholders in the development of the home. The home has comprehensive policies and procedures. Service user’s records are stored safely. The home must ensure that fire safety issues are addressed as detailed in the main body of this report. Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 Page 21 EVIDENCE: The Inspectors were advised that there are three distinct systems for meeting at Somerset Court that promote the dissemination of information and the feedback of information at all levels. Records are kept of all minutes at Somerset Court including minutes to Senior Management Meetings, Senior Residential Team Meetings and Senior Day Service Team Meetings. Some staff that the Inspectors spoke to confirmed that communication has improved at the home. This was a recommendation at the last inspection. Some staff commented that they are looking forward to the appointment of a new Registered Manager. Dianne Rawlings discussed the current position in relation to the major consultation event. It was evident that all interested stakeholders are being fully involved in this process. Somerset Court has a comprehensive handbook of policies and procedures. These are available at the home and can also be accessed by staff via the National Autistic Society intranet. The home has an Area Estates Manager who is responsible for ensuring health and safety across the site. The Inspectors sampled health and safety records in some of the bungalows. It was noted that weekly checks of some fire alarm systems, emergency lighting and torches had not been conducted on a regular basis. This must be addressed. It was also noted that some bedroom doors were not closing correctly thus not promoting fire safety. A Fire Alarm Certificate for the fire system, emergency lighting and smoke detectors was issued for the site on the 20 May 2005. Records are kept of hot water, fridge and freezer temperatures. The home had an Environmental Health Officers (food hygiene) visit on the 25 May 2005. Staff receive training in health and safety issues including first aid and food hygiene when they begin work at the home and on an ongoing basis. The Inspectors viewed documentation in relation to Gas Certificates for all bungalows. Certificates were issued on the 3 June 2005 and 5 June 2005. All incidents are recorded and entered onto a computer package, which is able to analyse these and provide valuable information in respect of patterns and frequencies. All accidents are recorded at the home and are audited. Risk assessments are in place in respect of environmental hazards and individuals. There is evidence that the home has taken steps to minimise risks to service users whilst allowing people to retain their independence. Portable appliance testing is overdue in some areas. The Area Estates Manager identified dates with the Inspectors when this will be addressed. Somerset Court D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x 3 3 Standard No 11 12 13 14 15 16 17 x x 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Somerset Court Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x 3 3 3 3 2 x D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA42 Regulation 23 (4) Requirement The home must ensure that arrangements are made for ensuring the promotion of fire safety including the testing of equipment and the containing of fires. Timescale for action 12.09.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations The home should ensure that all hand transcribed medicines are supported by two staff signatures and that the temperature of the Insulin fridge is monitored on a regular basis. The home should give consideration in ensuring that all the windows in the bungalows are able to open to allow adequate ventilation. It is recommended that the staffing levels in one identified bungalow are reviewed on a daily/weekly basis. This will ensure that the bungalow is more than adequately supported throughout a difficult period of time and that more than minimum staffing levels are maintained. The home should ensure that Portable Appliance Testing is completed as discussed at the time of the inspection. D53_D02 S15975 Somerset Court V234866 050805 Stage4.doc Version 1.30 Page 24 2. 3. YA24 YA33 4. YA42 Somerset Court Commission for Social Care Inspection Riverside Chambers Castle Street Tangier, Taunton TA1 4AL 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. 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