Inspection on 04/12/06 for Oak Lodge

This inspection was carried out on 4th December 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oak Lodge 14/04/09

Oak Lodge 15/10/08

Oak Lodge 31/01/06

Oak Lodge 04/10/05

Oak Lodge 17/01/05

Oak Lodge 23/08/04

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

CARE HOME ADULTS 18-65 Oak Lodge 213 Eastbourne Road Polegate East Sussex BN26 5DU Lead Inspector Lucy Green Key Unannounced Inspection 4th December 2006 11:00 Oak Lodge DS0000046902.V321248.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 Oak Lodge DS0000046902.V321248.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. Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak Lodge Address 213 Eastbourne Road Polegate East Sussex BN26 5DU 01323 488616 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) The Regard Partnership Limited Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated will be six (6). Only service users diagnosed with a learning disability to be accommodated. Service users will be aged between eighteen (18) and sixty-five (65) years on admission. 31st January 2006 Date of last inspection Brief Description of the Service: Oak Lodge is a purpose built bungalow, situated just off the main A22 Polegate/Eastbourne Road. The home shares the same site as Hillview, another service owned by this organisation. Local shops and public transport links are a short walk away. The home is registered to accommodate six younger adults with learning disabilities. Resident accommodation provides six single bedrooms and a communal lounge. The bathrooms are fitted with the necessary adaptations. The site provides a large garden and ample parking. The Registered Providers of the service are The Regard Partnership. This organisation owns a large number of homes across England and Wales. Information received from the Manager details that the current fees at Oak Lodge are based on a block contract rate of £1276.56 per week. More detailed information about the services provided at Oak Lodge can be found in the home’s Statement of Purpose and Service User Guide – copies of these documents can be obtained directly from The Regard Partnership. Latest CSCI inspection reports are on available on request from the home. Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Oak Lodge are referred to as ‘residents’. This report reflects a key inspection based on the collation of information received since the last inspection, feedback from a range of representatives and an unannounced site visit which lasted five hours on Monday 04 December 2006 between the hours of 11am and 4pm. The site visit included discussion with all parties, a tour of the premises and an examination of medication, care and staffing records. There were five residents living at Oak Lodge at the time of this inspection visit. During the visit, the Inspector met with all of the five residents. Due to the complex needs of the residents at Oak Lodge, verbal feedback was only able to be obtained from one resident. The Inspector therefore made judgments about the quality of care received by the other residents based on observation and feedback from other stakeholders. The Inspector spoke individually with the Manager and two staff members, including a Senior Carer and a newly appointed staff member. Comment cards were sent to stakeholders as part of this inspection and at the time of this report, feedback had been received from one relative and four General Practitioners. What the service does well: The residents at Oak Lodge benefit from being supported by a team of staff that clearly enjoy their work and who are dedicated to meeting the needs of the people they support. It was pleasing to observe the positive relationship between staff and residents on the day of inspection. The atmosphere at the home is one that is relaxed and friendly. One staff member described coming to work as “a pleasure, it’s like leaving one home and coming to another”. Staff recognise that choice is integral to the provision of good care and one stated that “staff intention is always to give choice”. Residents are supported to access a range of activities that are fulfilling and meaningful to them. The standard of planning and provision of holidays at Oak Lodge is excellent, with four of the five residents going on holidays abroad this year. Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 6 The quality of care planning is good with sufficient information to enable staff to support residents with their healthcare and personal routines in a sensitive and appropriate way. Feedback from one General Practitioner included “patients are well cared for and the staff are excellent”. 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. Oak Lodge DS0000046902.V321248.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 Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents benefit from an admission process that ensures their individual needs and aspirations are assessed prior to moving into the home. EVIDENCE: There have been no new admissions to Oak Lodge and therefore this standard could only be assessed in respect of the admission systems in place. There is currently one vacancy at the home and therefore Standard 2 will be assessed at the next key inspection if someone has moved into the home. The admission policy details two stages of assessment. The Regard Partnership has a central referrals department who undertakes an initial assessment of all prospective residents. A copy of the prospective resident’s social care assessment would be obtained and then a representative from Oak Lodge would meet the individual and conduct their own assessment. The second stage of the assessment covers more specific issues such as the home’s Statement of Purpose and compatibility with the other residents living at the home. Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 9 The Statement of Purpose and Service User Guide both reflect that prospective residents are encouraged to visit the home and undertake trial stays before deciding to move to the home on a permanent basis. Oak Lodge DS0000046902.V321248.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from care plans which provide staff with the necessary information and risk management strategies to support them safely and effectively. Residents are offered choice and the opportunity to make their own decisions wherever possible. EVIDENCE: Staff practices observed throughout the inspection demonstrated a good understanding of the residents and their needs. The interaction between staff and residents was positive and the atmosphere at Oak Lodge was found to be friendly and happy. Care and support was seen to be provided in a sensitive, dignified and respectful way. One of the residents spoken with individually was able to confirm that staff support them with their personal routines in an appropriate way. Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 11 The Inspector viewed a sample of two care plans and it is pleasing to report that these have been updated and that improvements have been made in this area. The Manager reported that care plans were still in the process of being worked on and that a new format was being considered. There is however evidence that residents have a plan of care that provides the necessary information about their health and welfare needs. The home has also introduced person centred plans with residents and these were found in resident’s bedrooms. One resident showed the Inspector his person centred plan and confirmed that the information recorded was an accurate reflection of his strengths, needs and goals. It was evident from the two plans viewed that care plans are now regularly updated. Service users have a multi-disciplinary review at least every six months and the minutes from these were in evidence. As part of the review process, service users and their key worker identify goals which are then monitored for the next six months. Two residents have achieved their goals for this year, with one resident undertaking a holiday abroad and another learning to look after his own fish. Another resident had a goal to improve their writing skills and was observed practising this task during the inspection. It was noted in those care plans viewed that the home has started to consider the longer term aims for each resident when setting these goals. It is important that the home concentrate on this area to ensure residents are supported to work towards achieving maximum independence. The Manager has reviewed and updated the range of risk assessments for each resident and risk management strategies are now in place that link to the care plans and goals. The Inspector spent time talking and observing residents and it was clear that residents have the opportunity to make choices about their lives. Staff were observed giving residents choices about what they eat, drink and whether they wished to participate in activities. Conversations with the Manager and two staff members confirmed their commitment to offering choice and ensuring that residents are empowered to make their own choices and decisions. Oak Lodge DS0000046902.V321248.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to lead healthy and fulfilling lives. Residents benefit from a range of nutritious and well-balanced meals. EVIDENCE: The weekly activity schedules for the two individuals case tracked provided documentary evidence that residents participate in a range of appropriate activities. For one resident this included attendance at a local day service provision and college courses. In-house activities were seen to include: sensory, arts & crafts, cooking, music and snooker. One resident told the Inspector that he enjoys practising his reading and writing and this was noted to be incorporated into his activity plans. On the day of inspection, this resident was observed participating in this scheduled activity. Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 13 Residents continue to access a wide range of community based activities, including swimming, shopping and cinema trips. Staff reported that theatre trips and shows are also popular outings amongst the residents at Oak Lodge. The home has also started a monthly in-house church service, which staff reported had been successful. Conversation with the Manager revealed that all residents have been on holiday this year. Two residents went to Majorca for a week, whilst two residents enjoyed the luxury of one holiday to Euro Disney and another to Tenerife. It was reported that one resident does not enjoy holidays and was therefore supported to spend three nights away in London, where she enjoyed going to shows and relaxing at a spa. One of the residents talked about his holiday and showed the Inspector is holiday photos. On the day of the inspection, it was observed that the routines of the home were reflective of individual needs. It was evident that residents are enabled to choose where to spend their time and make informed choices about their daily lives. One resident spent the afternoon baking with a staff member and was proud of the cakes that he had made, whilst another was observed enjoying a film in the privacy of his bedroom. Oak Lodge has a positive approach to enabling residents to maintain contact and relationships with families and friends. There was evidence in the care plans that the home supports residents to meet with and receive visits from their families. One resident informed the Inspector that staff take him to visit his mum each week. At the time of this report, one relative had returned a comment card which stated that they are kept informed and consulted about their relative’s care. Meals are generally prepared according to a rotating menu. The menus viewed were found to be varied and well-balanced. One resident told the Inspector that he often gets to have his favourite food, which makes him happy. Oak Lodge DS0000046902.V321248.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the provision of flexible and respectful personal and healthcare support and are protected by the systems in place to manage medication. EVIDENCE: It was observed during the inspection that personal care is provided with dignity and respect. The two care plans viewed contained detailed support plans to guide staff in the delivery of care. In addition to the main care plans, each resident now also has a person centred plan that is kept in their bedroom. One resident was able to show the Inspector this plan and confirmed that staff support him in the way recorded. Staff support residents to ensure their health needs are met, with care plans containing a record of any visits or contact with professionals external to the home. There was evidence of current involvement from General Practitioners, Dentists, Chiropodists, Optician and the local Community Learning Disability Team. Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 15 Comment cards were sent to the General Practitioners with whom the residents at Oak Lodge are registered. At the time of this report, all of the four had been returned with all feedback positively stating that healthcare needs are met by the home. One Doctor commented that “the patients are well cared for and staff are excellent”. The storage and administration of medication were found to be generally satisfactory. Records were accurate and current. Staff receive appropriate training in the management of medication. As a matter of good practice however, it is recommended that the home implement consent forms in respect of the medication that is held on behalf of residents. It was also identified that there should be protocols in place for all medication that is prescribed on an ‘as required necessary’ basis. Oak Lodge DS0000046902.V321248.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and visitors to the home benefit from and are protected by, the open culture at Oak Lodge. EVIDENCE: The home has a complaints procedure in place and a pictorial format has been produced for residents. The feedback from one relative who returned the comment card and the resident who is able to articulate his views, confirmed they knew how to make a complaint if necessary. The Manager stated in information submitted both before and during the inspection, that the home has not received any complaints about the service in the last twelve months. The home seeks to operate an open culture where issues are openly discussed and opinions shared. Positive interaction was observed between residents and staff during the inspection. Various systems are in place to protect residents from abuse. The two recruitment files inspected showed that new staff are employed subject to robust checks. In line with a requirement of the last inspection, the adult protection policy and procedure has been reviewed and updated to reflect recent changes in legislation and best practice guidance. The two staff members spoken with confirmed that they had attended training in the protection of vulnerable adults and that they were clear of their responsibilities in this area. Oak Lodge DS0000046902.V321248.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a clean, comfortable and well maintained home. The physical adaptations enable service users to move safely and independently around their home. Residents would however benefit from improved access to the garden. EVIDENCE: One of the residents showed the Inspector around the home and it was evident that this individual was proud of his home. The home was found to be clean and tidy throughout. Oak Lodge is a large purpose built bungalow that is well maintained and provides residents with sufficient private and communal space to meet their needs. Level access is provided inside the home, although it is again Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 18 highlighted that residents are unable to independently access the garden. The requirement to improve access to the garden is again highlighted at this inspection. Resident accommodation is provided in six single bedrooms which have been decorated and furnished to reflect individual tastes and preferences. Communal space comprises of a large lounge and a kitchen / dining area. Bathroom facilities are appropriately adapted. There is a separate laundry and sluice and it was evident that correct infection control procedures are followed. Oak Lodge DS0000046902.V321248.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a dedicated and competent team of staff and are protected by the robust recruitment procedures. Staff have both the skills and support to enable them to perform their roles effectively. EVIDENCE: The Manager reported that staff hours are applied flexibly, but with a minimum of three staff during the waking day. It was reported that ideal levels would allow for four staff in the morning and three staff in the afternoon. An alternative to this would be three staff on both the morning and afternoon shifts with an additional staff member working a middle shift of 9am – 4:30pm. The Manager was honest and highlighted that recent sick leave had not always allowed for ideal staffing levels to be carried out, although stressed that staff overtime and the use of bank staff generally enabled a minimum of three staff to be maintained. The rota was found to be reflective of this. It should also be noted that there are currently only five residents at Oak Lodge. Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 20 At night, the home is covered by one waking and one sleep-in person. The latter is shared with Hillview. The atmosphere in the home was observed to be calm and relaxed on the day of the inspection and there were sufficient staff on duty to meet the needs of the residents. The comment card received from one relative stated that they believed that there were sufficient staff on duty when visiting the home. The recruitment files for two new staff members were viewed and found to contain the required information, thus demonstrating a robust system of recruitment. There was documentary evidence that new members work towards completion of approved induction and foundation programmes. The Inspector spoke with one newly employed staff member and she confirmed that she had undergone a thorough induction and received lots of training. The training audit was viewed and it was evident that there has been a recent increase in the provision of training at Oak Lodge. On the day of inspection, two staff were attending training in the protection of vulnerable adults. The Manager reported that staff were also working towards more specialist courses including supporting people through bereavement and dementia. In information submitted to the Commission as part of the inspection process, the Manager stated that currently four staff members have completed National Vocational Qualifications. Oak Lodge DS0000046902.V321248.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a safe and well run home that has effective systems in place to self-audit and improve. EVIDENCE: The Manager now in post transferred from another service within The Regard Partnership earlier this year. It is pleasing to report that this individual has worked hard over recent months and made significant improvements to the quality of care at Oak Lodge in the short time she has been in post. Whilst, the Manager is not yet registered, the CSCI has received an application which is currently being processed. Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 22 All staff spoken with were extremely complimentary about the management of the home. One staff member told the Inspector “things have greatly improved since [name of Manager] came to Oak Lodge”. Another staff member commented: “the home is well managed, she is people friendly and approachable”. The Regard Partnership has implemented robust systems for monitoring quality assurance and there a number of checks by the organisation to ensure that the home is performing. Monthly monitoring visits are carried out on behalf of the Registered Provider and copies of these reports were viewed during the inspection. In addition to these, The Regard Partnership now undertakes ‘mock CSCI inspections’ which generate a list of improvements for the home to action. The home has a number of systems in place to gain feedback from residents and these were evidenced by way of monthly 1-1 meetings between residents and their key worker. In line with the organisation’s policy, monthly residents’ meetings are also conducted at oak Lodge, although it is recognised that this is a less successful way of obtaining feedback from the current client group. At the current time, the home does not have a mechanism in place for gaining formal feedback from other stakeholders, including, relatives and Care Managers. It is therefore required that the home introduce a method of seeking this feedback. Various systems are in place to ensure the Health and Safety of the home are maintained. The information submitted by the Manager provides evidence that safety audits are being conducted on a regular basis. Oak Lodge DS0000046902.V321248.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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 24 YES 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. 1. Standard YA24 Regulation 23(1)(a) Requirement That action must be taken to provide level access to the garden. (Previous timescales of 01/04/06 and 01/04/06 not met) Timescale for action 01/02/07 2. YA39 24 That the Registered Person must 01/02/07 introduce a system of obtaining formal feedback from all relevant stakeholders. 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 YA20 YA20 Good Practice Recommendations That the Registered Person should implement a recorded system of obtaining consent from those service users whose medication they hold. That the Registered Person should implement written protocols for all medication that is ‘prescribed as required necessary’. Oak Lodge DS0000046902.V321248.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Oak Lodge DS0000046902.V321248.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. 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