Inspection on 05/07/07 for Landona House

This inspection was carried out on 5th July 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

Landona House 12/01/07

Landona House 19/10/05

Landona House 10/05/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Maple Lodge

Polesworth Group 32 Station Road

Heathlands

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Landona House Love Lane Wem Shrewsbury Shropshire SY4 5QP Lead Inspector Joy Hoelzel Unannounced Inspection 5th July 2007 09:30 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and 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. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Landona House Address Love Lane Wem Shrewsbury Shropshire SY4 5QP 01939 232620 01939 232620 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) Mrs Radhika Lakhubhai Ramlal Sisodia Mr Kamal Sisodia Mrs Dawn Helen Burrows Care Home 30 Category(ies) of Dementia - over 65 years of age (15), Learning registration, with number disability (2), Old age, not falling within any of places other category (13) Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may provide accommodation and personal support to a maximum of 30 service users over the age of 65 years to include 15 service users with dementia and two service users with a learning disability (under the age of 65 years). The risk assessment relating to both people with dementia must be regularly monitored, reviewed, and updated. All care staff must received training in dementia awareness and learning disability. The residents with a learning disability should be formally reviewed every six months. There must be a minimum of three care staff on duty from 7am - 10pm. There must be two waking members of staff on duty throughout the night. 12/01/07 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Landona House is registered to accommodate and provide personal care to thirty people. It is situated on the outskirts of the small town of Wem, and is within easy walking distance of various local facilities. Accommodation is provided in both single and shared bedrooms, some of which have en-suite facilities. Bedrooms are located on the ground and first floor with access to the upper floor via passenger lift. Communal areas comprise a large lounge, separate dining room, and a conservatory area. Weekly fees range from £327.20- £450.00 Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are readily available. Commission for Social Care Inspection Reports for this service are available from the provider or can be obtained from www.csci.org.uk Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection took place over five and three quarter hours on Thursday 5th July 2007. It was conducted by one regulation inspector. Twenty one of the thirty eight National Minimum Standards for older people together with twenty one National Minimum Standards for younger adults were inspected on this occasion. Twenty seven people are currently living at the home, and were observed to be accessing all areas of the home. Three case files were selected for case tracking, relevant documents and procedures were inspected, together with a selection of staff personnel files. A full tour of the premises was conducted. Discussions were held with people living, working and visiting the home. What the service does well: The home provides a homely, comfortable environment in which to live and work. The manager and staff have a good understanding of the individual needs of the people living at the home. The manager and staff are aware of equality and diversity and its implications even if very few individuals with recognised diversity issues are in receipt of a service. All individuals have a comprehensive plan of their care needs and are involved with the process should they wish to be so. The home has an active social and recreational programme. The manager has a good understanding of safeguarding adults and is open and transparent when discussing incidents with external bodies. People living at the home stated ‘I like it here’, ‘ the food is good, ‘ staff are good’, ‘ a home from home’. Visitors stated ‘very pleased that my relative has been able to come here to live’, ‘ staff are very supportive, extra special care has been offered’. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 6 Staff commented ‘good place to work we work as a team’, ‘ the manager and owner are very supportive and will discuss issues with us’, ‘training needs are up to date’. 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. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1, 3,6. YA 1,2 Quality in this outcome area is good. The home provides a Statement of Purpose that is specific to the individual home, and the resident group they care for. Admissions are not usually made to the home until a full needs assessment has been undertaken and involves the individual, and their family or representative, where appropriate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 9 The statement of purpose and service user guides were supplied on request both documents appear to contain the required information and were reviewed in January 2007. The case file of a person who most recently moved into the home indicated that the person was admitted on an emergency basis. Information had been obtained prior to the person arriving at the home and a full assessment of care need was completed at the point of the admission. Other case files contained pre admission assessments undertaken by the home and obtained from various authorities. The statement of purpose includes a section on admissions to the home and states that whenever possible prospective residents and their representatives are invited to visit to have a look round. The home does not offer an intermediate care service. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10. YA 6,9,16,18,20 Quality in this outcome area is good People living at the home have an individual plan of care that clearly records their personal and healthcare needs and details how they will be delivered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 11 Three care plans were selected for inspection and included people with varying lengths of stay at the home. Each plan assesses the activities of daily living; specific care plans are then developed following identification of any concerns or problem areas. The care plans are based on needs, the care instruction and the review. All are reviewed at least monthly with evidence of the person’s involvement. Where a risk has been identified, following assessment, a specific plan of care has been formulated offering full details for the action to be taken by staff to reduce the risk. One plan included specific instructions of the action to be taken by staff in the event of a medical emergency. Another plan detailed the coping strategies and management of the occasional challenging behaviour and the potential triggers that may give rise to it. Medication is administered using the monitored dose system with the additional use of bottles and boxes. Senior care staff administer the medication with the registered manager supervising and auditing the procedures. An occasional gap was observed on the Medication Administration Record, the member of staff stated that it was an error in the recording. Other Medication Administration Records appeared to be completed correctly. The manager stated that the medication file, storage cupboards and the medication trolley are currently being reorganised, tidied up and rearranged. The care staff were observed to be assisting service users with personal care discreetly and in a manner which promotes a persons dignity. The people looked well cared for, well groomed and nourished. There was lots of chatter and discussions happening, it appeared that good relationships had been developed between the staff, visitors and residents. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12,13,14,15. YA 12, 13,15,17 Quality in this outcome area is good. People who use services are involved in meaningful daytime activities of their own choice and according to their individual interests and capability; they are involved in the planning of their lifestyle and quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 13 An active Landona friendship group is operational, consisting of staff and relatives (whenever possible), who meet to arrange and facilitate activities in house and in the community. There is a wide and varied programme including church coffee mornings, riding for the disabled, gardening, special day celebrations and religious services with Holy Communion arranged each month. Staff stated that mainly the activities happen during the afternoon and went on to discuss the imminent trip to Chester Zoo. One person commented that they were looking forward to going to the Zoo, as they ‘hadn’t been there for years’. Two people stated that they didn’t very often join in with arranged activities but preferred their own company, watching TV and reading the newspapers. There were lots of visitors during the day of the inspection all appeared to be very well at ease. All spoke very highly of the staff and that they were satisfied with the care provided. During the tour of the premises many of the private rooms were highly personalised, two people stated that they were very comfortable and having ‘bits around makes it feel like home’. The dining room has recently been refurbished to a high standard and is prepared in advance of the meals. People have the choice of where to dine with most people appearing to be in the dining room for the midday meal. Staff were available to offer assistance to people where needed. People commented that the food is always good and that staff ask them what they prefer prior to the meal but sometimes they forget what they have ordered and then it is ‘a pleasant surprise’. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16,18. YA 22,23 Quality in this outcome area is excellent. Individuals and others associated with the home say that they are extremely satisfied with the service, feel safe and well supported. The home is clear when an incident needs to be referred to the Local Authority as part of the local Safeguarding procedures in place. It is open and transparent when discussing incidents with external bodies. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is included in the statement of purpose and service user guide; a copy is also displayed at the entrance of the home. The manager discussed the recent complaints that had been received and the referrals to the multi disciplinary adult protection teams. The manager demonstrated a good knowledge of the procedures and the outcomes of the recent investigations. People living at the home said they would speak with the manager or their relative in the first instance if they had any concerns. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 15 Visitors stated ‘very pleased that my relative has been able to come here to live and have no complaints, very satisfied’. People and/or their representative are invoiced on a monthly basis for any sundry expenses (hairdressing, newspapers etc.). Records and receipts are kept of each transaction. No cash is held on behalf of service users. The statement of purpose states that safe boxes are available for the storage of money and valuables should a person wish to do so. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19,26. YA 24,30 Quality in this outcome area is good. The home provides a physical environment that is appropriate to the specific needs of the people who live there and encouraged to personalise their bedrooms. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. This judgement has been made using available evidence including a visit to this service. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 17 EVIDENCE: A full tour of the premises was conducted with the owner and manager. The communal and private areas are well furnished and appear to be well maintained. The owner stated that a cover would be fitted to the one radiator that is not guarded, and that locks will be fitted to all bedroom doors. The fire officer visited the premises on 17/04/07; the fire risk assessment has been completed and will be reviewed at regular intervals. Where recommended at the last inspection, additional lighting has been provided and emergency call bells have been installed in the ensuite facilities. Handrails have been placed and fitted around the baths, all rooms now have a TV ariel point and self-closing devices have been fitted on doors. The replacement of the fabric continues with rooms being redecorated and refurbished as they become empty. All areas of the home were clean and hygienic. Comments received by people living at the home included ‘ a very good place to live’, ‘ very happy to be here’, ‘ very satisfied with my room’. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29,30. YA 32,34,35 Quality in this outcome area is good. There are enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The service puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A rota is maintained of the staffing levels for each week. Usual levels are maintained of three care staff at all times during the day with an extra person at peak times and two waking night staff. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 19 Catering, domestic and maintenance staff additional. No agency staff are used the manager states there are no problems with recruiting staff due to the locality of the home. There are no vacancies at the moment. Staff commented that they thought the staffing levels were sufficient at the present time. Two staff personnel files were selected for inspection and included proof of identity, criminal record bureau disclosures, and two references. Accreditations and certificates for training are included in the file. The manager stated that mandatory and specialist training is arranged for all staff throughout the year. A member of care staff confirmed that her training is up to date and that she is currently on the distance learning course for dementia care. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 21 OP 31,33,35,38. YA 37,39,42 Quality in this outcome area is good. The manager is person centred in her approach, and leads and supports a strong staff team who have been recruited and trained to a high standard. The home has a consistent record of meeting relevant health and safety requirements and legislation, and closely monitoring its own practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Dawn Burrows has been the registered manager since November 2004; she demonstrated a good knowledge of the day-to-day management responsibilities, the skill mix and competencies of the staff and the care needs of the service users group. People living, working and visiting the home made positive comments regarding the style of management. The owner was at the premises at the time of the inspection and stated that he visits at least weekly. The manager stated that he was very supportive and a good working relationship had developed. The manager has supernumery time, ensuring that all records relating to the service are well organised, in date, complete and easy to understand. Quality assurance and monitoring continue on a regular basis with questionnaires distributed to relatives and people at the home. Staff meetings are arranged regularly and service users formal meeting arranged every three months. The manager explained that there is ample opportunity for discussion and informal chats. The manager carries out monthly audit checks care planning, medication and infection control. People and/or their representative are invoiced on a monthly basis for any sundry expenses (hairdressing, newspapers etc.). Records and receipts are kept of each transaction. No cash is held on behalf of service users. The statement of purpose states that safe boxes are available for the storage of money and valuables should a person wish to do so. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 22 Health and safety checks are carried out weekly, monthly and annually with full records kept. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 3 4 X 5 X 6 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 3 Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 24 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. Refer to Standard Good Practice Recommendations Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Shrewsbury Local Office Commission for Social Care Inspection 1st Floor Chapter House South Abbey Lawn Shrewsbury SY2 5DE 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. Landona House DS0000062558.V340479.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!