Inspection on 26/09/06 for Old Vicarage The

This inspection was carried out on 26th September 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 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

Old Vicarage The 04/01/06

Old Vicarage The 07/09/05

Old Vicarage The 25/11/04

Old Vicarage The 12/08/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Old Vicarage The 75 High Street Airmyn Goole East Yorkshire DN14 8LD Lead Inspector David White Key Unannounced Inspection 26th September 2006 09:00 X10015.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 Old Vicarage The DS0000019751.V313459.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. 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. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Vicarage The Address 75 High Street Airmyn Goole East Yorkshire DN14 8LD 01405 763699 F/P01405 760399 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) Jumacare Limited Mrs Amanda Pepper Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (22) of places Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2006 Brief Description of the Service: The Old Vicarage is situated in a village setting close to Goole, East Yorkshire. It is registered to provide care for 22 elderly persons, both male and female. The home has two lounges, a separate dining room and an additional lounge/dining area. A small patio area is available adjacent to the lounge along with a larger paved courtyard and gardens. Accommodation is provided in a range of double and single rooms many of which have en-suite toilet facilities. Three bathrooms are provided for service users, two of which are adapted for service users with mobility problems. The current weekly fees for the home at the time of the site visit on 26th September 2006 ranged from £291 to £375.30 and do not include costs for hairdressing, chiropody and toiletries. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an unannounced site visit undertaken on the 26th September 2006. This visit was carried out by one Regulation Inspector and took 6.5 hours with 6 hours preparation time. The home was able to return the requested information before this site visit. Surveys were sent out to service users’, relatives and health and social care professionals and four surveys had been returned. Information was used from the Regulation Inspector’s inspection record, which detailed the history of the home and relevant information about what had been happening in the home since the previous inspection visit. The site visit comprised of an inspection of the premises. The care records of three service users’ were looked at which included service users assessments, care plans and medication records. Staff rotas and health and safety documentation were inspected. Time was spent talking to three service users’, a relative, two members of care staff, a cook, the manager, and the owner of the home. The activity in the home and the interaction between service users’ and staff was observed. The focus of the inspection was on a number of key standards and inspecting the case records of a number of service users to establish whether they corresponded with their experiences of life in the home. The manager and the owner of the home were available throughout the inspection and the findings were discussed at the end of the inspection. What the service does well: Service users’ and relatives felt that the standards of care at the home were good and service users’ said that the staff were “helpful and friendly”. Good care planning information meant that staff knew what the needs of the service users’ were and how these were to be met. Service users’ were encouraged to make their own decisions about their daily routines and this helped them to maintain their independence. Visitors to the home said they were always “made to feel welcome” and this helped them to maintain their relationships with the service users’. All concerns were taken seriously and acted upon to safeguard service users’ interests. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 6 The home was very clean and well maintained and one relative said that they “couldn’t have wished for their father to live in a better place”. Service users’, staff and relatives had confidence in the management of the home and felt that the home was run in the best interests of the service users’. 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. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 and 6 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Proper pre-admission procedures were in place and being followed to ensure that people moving into the home could have their needs met. EVIDENCE: The home provided detailed information together with a thorough preadmission assessment procedure for prospective service users’. The admission procedures ensured that new service users’ were properly assessed and that staff were fully aware of their needs. Information was obtained from a number of sources prior to admission such as social services, health professionals and relatives so that the needs of the service user were clearly understood. The care records of three service users’ were looked at and this included a recently admitted service user. The records showed that either the manager or a senior member of staff carried out pre-admission assessments. A recently admitted service user said that she had been given the opportunity to visit the home before moving there and that a relative had been able to look around the home prior to the service user’s admission. The home did not provide intermediate care. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. 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 feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Good care planning systems were in place to make sure that service users’ personal and healthcare needs were understood and met by a respectful staff team. EVIDENCE: The Commission had received information since the last inspection visit stating concerns about service users’ losing weight and the lack of hoisting equipment in the home. The management of the home were asked to investigate these matters and had found that the concerns were not substantiated and evidence from the site visit was able to confirm this. Service users’ looked well cared for and made positive comments about the care they received. All the service users’ spoken to said that the care was “very good” and one said that “the staff can not do enough to help you”. The staff could be seen to be interacting well with the service users’ and there was a good atmosphere in the home. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 10 The care records of three service users’ were looked at and these provided good information about the needs of individual service users’ and how these were to be met. Risk assessments were in place which covered a number of aspects of daily living and included measures to reduce risks from falling and pressure sores. The risk assessments in reducing the risk from falls were specific and clearly stated how service users’ should be assisted with their mobility when required. All the service users’ were able to weight bare and the manager said that the home did not have hoisting equipment as it was not necessary for the service user group and members of the staff team felt they were able to support service users’ with their mobility without the need for specialist equipment. The home had two assisted baths one of which was a “walk in” bath so that people with mobility problems could easily get in and out of the bath. One service user felt that her mobility was deteriorating and her care records indicated that staff were having more difficulty in supporting the service user with her mobility. This had been discussed within the service user’s care plan review and close monitoring was taking place to address any changing needs. Care records included information about dietary needs and the likes and dislikes of each service user. Service users’ were weighed on a regular basis and in one particular instance a service user who had lost weight was being weighed on a weekly basis. The care records for this service user showed that measures put in place to address the service user’s weight loss had been successful and the service user had put on some weight as a result of this. Referrals to outside agencies such as GP’s and other healthcare specialists were recorded. A relative spoke positively about the care provided at the home and said that she had been impressed at the way the staff team had responded quickly in addressing a health problem with her relative. Care plans and risk assessments were reviewed on a regular basis with the involvement of the service user and relatives where possible. At the previous inspection visit it was recommended that care records for people receiving respite care services should be more detailed. At the time of the site visit there were no service users’ receiving respite care, however the manager did say that the care planning systems for people receiving respite care had been improved. Proper medication procedures were in place for the administration, recording, storage and return of medication. The medication records were accurate and up to date and a random check of an individual service user’s medication tallied with the records. One service user administered her own medication and had a locked drawer within her bedroom to be able to store the medication safely. A risk assessment had been carried out on this service user with regard to her administering her own medication in order to promote her independence and safety. Service users’ felt that they were always treated with respect by the staff who could be seen knocking before entering service users’ bedrooms and service users’ were addressed by their preferred names. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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 maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Service users’ were encouraged to make their own choices about their lives and maintained contact with relatives and friends, however some service users’ needed to have more opportunity to be able to spend time out of the home and have access to local community facilities. EVIDENCE: The Commission had received information since the last inspection visit stating concerns about service users’ getting up too early in a morning, one service user missing meals and a lack of choice of food at mealtimes. The management of the home were asked to investigate these matters and had found that the concerns were not substantiated and evidence from the site visit was able to confirm this. The home had previously employed an activities co-ordinator who no longer worked at the home. Staff carried out in-house activities with the service users’ and some service users’ enjoyed watching television, listening to the radio and reading and it was observed that large print books were available for those people with visual impairment. The local library visited the home on a monthly basis to provide a book service and communion was held in the home every month for service users’ to take part in if they wished to do so. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 12 Some of the service users’ were independent and would enjoy walks out and visits to the local pubs and community facilities whilst one service user attended a local day hospital to help to maintain his social skills. However for those service users’ who were less able and who had mobility problems it was more difficult for them to be able to spend time out of the home if they wished to do so and this meant that they had limited access to the local community and its facilities. One service user did not know the area and said that she would benefit from being able to access the local library to find out more about the local facilities. Another service user said that she rarely left the home but would welcome more opportunity to be able to do so and one service user said she was generally dependent on her family to take her out. Visiting times were flexible and at the time of the site visit a number of relatives were observed to be visiting the home. A relative commented how visitors were “always made to feel welcome and offered refreshments”. The relative also said that she was kept well informed about her father’s progress and other relative surveys received prior to the site visit supported this. People living at the home had access to a telephone if they wished to contact relatives or friends. Service users’ said that they could choose their own daily routines and made their own decisions about when they would get up in a morning and go to bed. In general people said that they arose between 7.30-8.30am in accordance with their wishes. One service user liked a glass of wine with his meal and the staff team made sure that the service user’s preferences were met. Comments were favourable about the quality of the meals on offer and service users’ said that they particularly enjoyed the amount of choice available. Menus were displayed on the dining room tables and these showed that there were meal options at all mealtimes. Service users’ confirmed that alternatives were readily available if they did not like the food choices and observation of one mealtime showed this to be the case. Special diets were catered for and the cook had written information about specialist diets to support her with the menu planning. Food supplements were not generally needed for the service user group but were available if needed. None of the service users’ spoken to said that they had ever missed a meal and all service users’ were seen to be enjoying their meal at the time of the site visit. Staff said that if a service user was not available for a meal for any reason then a meal would either be saved or prepared for them to have when they were ready to eat. Service users’ could choose to eat in their bedroom if they wished to do so to maintain their privacy. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 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’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Service users’ views and concerns were listened to and acted upon and staff’s awareness of adult protection issues safeguarded service users’ from harm. EVIDENCE: Since the previous inspection visit the Commission had received three complaints about the home that had been referred to the management of the home to deal with. The issues of concern have been mentioned in other parts of this report under the headings of health and personal care, daily life and social activities, staffing and management and administration. The management of the home provided information to the Commission about the outcomes from their investigations into the complaints. The information showed that there was no substance to the issues raised and the care to the service users’ was not compromised and this was supported by the findings from the site visit. There was a complaints procedure on display in the home that was clear and easy to understand. Service users’ and relatives knew what they would need to do if they wished to raise concerns and were confident that any issues would be dealt with properly. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 14 Adult protection policies and procedures were in place and staff demonstrated a good understanding of what would constitute abuse and the actions that needed to be taken if abuse had occurred or was suspected. The manager said that not all staff had received abuse awareness training but that it was covered within the induction programme for new staff and further training was planned for the near future. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Service users’ lived in a safe, clean, comfortable and pleasant environment. EVIDENCE: The premises appeared to be in good structure and was decorated and well maintained to a high standard. A refurbishment programme was in place and service users’ said they were well satisfied with their accommodation. Most of the bedrooms had en-suite facilities and although there were some double bedrooms only one of these was being shared by two service users’ and it was observed that there was some screening in this bedroom to offer privacy to both the service users’. The home had a passenger lift, a stair lift and ramped access to and from the building to assist those people with mobility problems to have access to all parts of the home. There was sufficient communal space for service users’ to sit in and there were handrails and three bathrooms two of which had assisted bathing facilities to help service users’ with mobility problems with their bathing needs. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 16 Bedrooms were clean and personalised with service users’ personal belongings such as photographs, a television and furniture and one service user had a computer in her bedroom. Two of the service users’ smoked and there was a designated smoking area in the home that had access to a courtyard area outside. An Environmental Health Officer had made a recent inspection of the premises and no recommendations had been made from this. A random check of the hot water temperatures was found to be within safe limits. Appropriate arrangements were in place for the laundering of bedding, linen and personal clothing and gloves and aprons were in place to promote good hygiene practices. Overall the environment was of a very good standard and both service users’ and relatives commented on the high standards of cleanliness in the home. One relative commented “my father is well cared for and I could not wish for a lovelier more comfortable home for him”. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. The staffing team were well equipped to meet the service users’ needs, however improvements were needed in recruitment practices in order to ensure that service users’ were safeguarded from harm. EVIDENCE: The Commission had received information since the last inspection visit stating concerns that staff had not received any moving and handling training. The management of the home were asked to investigate these matters and had found that the concerns were not substantiated although evidence from the site visit indicated that staff were in need of some more updated training. The duty rotas showed that the numbers and skill mix of the staff team ensured that service users’ needs could be met. Although four staff had recently left the home new members of staff had been appointed to address any staffing level deficits. In addition to the care staff two cooks were employed at the home to meet the dietary needs of the service users’. The home had a good atmosphere and staff said that morale was good. Service users’ were complimentary about the staff team saying that all the staff were “kind, helpful and friendly”. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 18 Three staff records were looked at including two of the most recently appointed staff members. The staff records showed that in two cases although Criminal Record Bureau (CRB) checks had been carried out the members of staff had started work at the home before the required CRB checks had been completed. This was discussed with the manager and owner of the home who said that in exceptional circumstances as an interim measure POVA (Protection of Vulnerable Adults) first checks were carried out by the home before new staff started working there and evidence was seen that these checks had been carried out on other members of staff, however there was no evidence within the two staff files of concern to show that these checks had been carried out in their particular cases and so service users’ could have been placed at risk of harm. In one staff record written references sent on behalf of the prospective employee had not been received prior to the member of staff commencing working at the home. These practices were not acceptable and put service users’ at risk of potential harm. The staff team had received a range of training which recently had included some dementia care training. All the staff had attended some fire safety and medication training and the home was committed to providing NVQ training for the care staff. Whilst the staff had received some moving and handling training in the home it was recommended that all the staff received more up to date and formal training to ensure safe working practices and the manager said that a number of staff were due to attend some further training and updated training was also needed in first aid. Staff spoken to had a good understanding of the service users’ needs and felt that the staffing levels and staff training equipped them to be able to meet service users’ needs. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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 the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. The home was well run in the best interests of the service users’ and with one exception proper attention was given to health and safety matters to protect the service users’ from harm. EVIDENCE: Since the last inspection visit the Commission had received some issues of concern about the running of the home. The management of the home were asked to investigate these matters and had found that the concerns were not substantiated and evidence from the site visit was able to confirm this. The registered manager had a lot of experience in managing the home and had attained the Registered Manager’s Award to enhance her management skills. Senior care staff supported the manager in the clinical leadership of the home and the owner of the home dealt with any business management issues. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 20 Service users’, relatives and staff spoke in complimentary terms about the manager’s skills and abilities. All said she was “approachable, supportive and accessible” with a “hands on” approach to care and a survey received from a relative described the management of the home as “efficient”. Staff felt that the home was well managed with one member of staff saying the home was “a wonderful place to work”. Both the manager and the owner were available in the home on a daily basis to deal with any issues that may arise. The management of the home carried out questionnaires to seek service users’ and relatives views about the home. This information was then summarised and a plan was put into place to address any areas that were in need of improvement. Care plan reviews took place on a regular basis and encouraged the involvement of the service user and their family and policies and procedures were regularly reviewed to reflect changing practices. Staff meetings took place on a regular basis and staff said that they were encouraged to voice their views and opinions. The financial arrangements for looking after service users’ monies were looked at and were generally satisfactory although it was recommended that receipts were kept of monies spent by service users’ on hairdressing and chiropody costs so that the interests of the service users’ were safeguarded. The home had formal supervision arrangements in place to support staff in meeting the needs of the service users’. Overall proper arrangements were in place for the promotion and maintenance of a safe and secure environment for service users’, visitors and staff although improvements were needed to the recruitment practices to safeguard service users’ from any potential harm. A number of satisfactory safety reports and certificates were seen relating to the premises and these confirmed that proper arrangements were in place to maintain the safety of the environment for the service users’. Health and safety training was included within the staff induction and this was ongoing although as previously mentioned earlier in the report under the heading of staffing, updated staff training was needed in moving and handling and first aid training to promote safe working practices. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 21 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 3 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 22 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 OP12 Regulation 16 Requirement The registered person must make arrangements to enable all service users’ to have the opportunity to be able to spend time out of the home and have access to the local community facilities. The registered person must ensure as a minimum requirement that POVA checks are carried out on all staff prior to them taking up their post and have all the other required records including written references in place prior to the employment of new staff to safeguard service users’ from harm. Timescale for action 26/11/06 2 OP29 19 26/09/06 Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 23 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. 3. Refer to Standard OP18 OP30 OP35 Good Practice Recommendations All members of staff should have some abuse awareness training. Staff should have updated training in moving and handling and first aid. Receipts should be kept of all costs to service users’ from hairdressing and chiropody services which have been provided to them. Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Old Vicarage The DS0000019751.V313459.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!