Inspection on 13/04/07 for Ormerod Home Trust

This inspection was carried out on 13th April 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ormerod Home Trust 06/09/05

Ormerod Home Trust 24/09/04

Ormerod Home Trust 05/05/04

Ormerod Home Trust 11/01/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Ormerod Home Trust 6 Warwick Road St Annes On Sea Lancashire FY8 1TX Lead Inspector Lesley Plant Unannounced Inspection 12th and 13th April 2007 3:45 Ormerod Home Trust DS0000010004.V331613.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 Ormerod Home Trust DS0000010004.V331613.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. Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ormerod Home Trust Address 6 Warwick Road St Annes On Sea Lancashire FY8 1TX 01253 723513 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) Ormerod Home Trust Limited vacant post Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may accommodate up to 3 adults in the category of learning disability (LD) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 6th September 2005 Date of last inspection Brief Description of the Service: Warwick Road is a semi-detached property registered to provide accommodation and support for up to three adults with a learning disability. It is situated in a residential area of St Annes, close to local shops and amenities. The home is domestic in layout and character. The home is owned by Ormerod, a trust, which operates a number of residential and community based services in Lytham St Annes and the surrounding area. The home is guided by the policies and procedures of Ormerod and has its own dedicated staff team. Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, took place during two visits to the home and looked at all the key national minimum standards, plus supervision arrangements for staff. At the time of the inspection there were three service users living at the home. The inspector spoke to a support worker and the three service users living at the home. One person living at the home has specific communication needs and therefore discussion with this individual was limited. Records were viewed and a tour of the building took place. Two service users completed feedback comment cards for the inspection. Information was also gained from a pre inspection questionnaire completed by the manager. A visit to the organisation’s main office also took place, where recruitment and training records were examined and further information was gained from manager. What the service does well: A number of staff have worked at Warwick Road for some years meaning that a consistent service has been provided. Staff have good communication skills and have built up good relationships with those living at the home. It is clear that staff follow the procedures and guidance set down by Omerod and good records are maintained, making information easy to find. The healthcare support is very good, with staff keeping good records, monitoring changes and liaising with other professionals to ensure that service users get the best possible health care provision. The home is well maintained and provides lovely accommodation. All areas are decorated and furnished to a high standard. A comment card completed by a service user included the response; “ I love my home.” Ormerod provides an excellent staff-training programme. All the staff at Warwick Road are qualified at NVQ level 2 or above. Training is organised by a dedicated training team based at the main office. A training matrix for the organisation shows what training has been completed and when refresher courses are due. A member of staff confirmed that training is of a high standard. The supervision and appraisal system is excellent and regular staff meetings also take place. Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ormerod Home Trust DS0000010004.V331613.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 Ormerod Home Trust DS0000010004.V331613.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. The well-established assessment and introductory processes ensure that new service users would only be admitted to the home if their needs could be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no recent admissions to the home. The provider organisation has well established policies and procedures regarding the assessment and introduction of new service users and has demonstrated good practice in this area of service provision. The written policy regarding admission to the service includes the giving of information, the terms and conditions of residency and a set assessment format. Information about the home is produced in a pictorial format and complimented by written material. Social work assessments are gained and Ormerod carries out their own thorough assessment. Relatives are involved as appropriate to the individual. Compatibility is given a strong focus and introductory visits take place at a pace suitable to the individual concerned. Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. The regular reviewing of service user care plans means that changing needs are being identified and responded to, however the outdated person centred plans may not be a true reflection of individuals’ future aspirations. Potential risks are not always being adequately addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user care plans for the three people living at Warwick Road were viewed. Each care plan contains detailed information regarding the support required for all aspects of day-to-day living. Care plans are regularly reviewed, at least every six months, and for one individual who has required increasing support, the care plan is being reviewed more frequently. Each person also has a person centred plan, identifying dreams and aspirations for the future, with the key worker completing a monthly progress report. Ormerod aims for each service user to have an annual person centred plan, with the individual being Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 10 fully involved in this process. For one person at the home, person centred planning has been put on hold due to a deteriorating health condition and whilst awaiting the outcome of various health related assessments. However person centred planning is also overdue for the other two people at the home. Key workers are completing the monthly update records relating to the last person centred plan, but these may now be not as relevant to the individual. The process of annual person centred planning for each person should be addressed. Files contain a communication passport for each individual at the home. This guides staff in their work, identifying how each person is able to express themself. This focus on communication helps to promote self-determination and supports individuals with decision-making. One person is encouraged to use picture cards when making choices. Staff have developed good relationships with service users and have a good understanding of the communication needs of each person. A member of the team explained to the inspector that when one person, who has limited verbal communication, vocalises, this is an indication of pleasure or agreement. Two people living at the home take part in activities arranged by the Ormerod resource service, a day service nearby. Activities include work on self-advocacy and these individuals also attend an advocacy group facilitated by Fylde and Wyre Advocacy service. Staff provide guidance regarding safety, such as in the kitchen, as part of their day-to-day support worker role. Risk assessments are in place and are being regularly reviewed. It was noted that a new risk management plan had recently been introduced regarding an individual who now requires a ‘soft’ diet and this plan had been made available to all staff. Staff were observed following risk management plans, such as prompting an individual to sit down with her hot drink and ensuring that this person uses plastic crockery. One person at the home requires bed rails and a risk assessment is in place to support this. However, the risk assessment does not adequately address potential risks but merely states why it is being used. Any use of such equipment must be properly considered and risk minimising action, such as ensuring the rails are appropriately spaced and regularly checked, must be in place. A stair gate is in place, used to prevent a service user who has a bedroom on the ground floor, from possibly falling on the stairs. Although the other service users are able to open this gate, the risk assessment must thoroughly address all potential risks associated with the use of the gate, including fire safety issues. Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 and 16 Quality in this outcome area is good. Activities are arranged according to people’s preferences and interests and family links are maintained. Meals take into account individual needs and preferences. Service users take part in household jobs according to their wishes and abilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Education, occupation and personal development opportunities are addressed on an individual basis. Two people take part in activities arranged by the organisations resource centre. These activities include trips out, dance, music, art sessions and voluntary work. The third individual has one to one staff support from the house staff team each weekday and has a programme of activities, which includes attending a sensory drama class. Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 12 Service users are part of the local community and staff confirmed that there are positive relationships with neighbours. The home is well placed for good access to the towns’ facilities and the organisation has a car available for staff to use when taking service users further afield. One person has one to one staff support each weekday and there are two staff on duty each evening. Service users are involved in a range of community activities including attending church social events. The home is close to the centre of St Annes, giving easy access to a large range of community facilities. Good records are kept of all activities undertaken and these include walking, attending church, swimming, eating out, shopping and the cinema Assessment and care planning information includes details of who individuals have close links with. The current service users all have relatives living out of the local area. Staff help individuals to maintain contact via phone calls and provide support for visits home. Relatives are also able to visit the home and are made welcome. Ormerod, the provider organisation arranges family and friends events, when relatives are invited and are able to keep up to date with service developments. Relatives are also invited to person centred planning meetings. Staff keep good records of all family contact and the organisation provides staff training regarding working with families. Daily routines are flexible and vary according to individual plans and activities. Individuals are supported to take part in household tasks such as cooking and cleaning, according to their wishes and abilities. During one of the inspection visits a member of staff and one service user went out to do the weekly household shopping together. The layout of the home and large kitchen dining room, mean that service users can choose to spend time alone or join in with household activities. Written menus are available and remain flexible, serving as a guide to the weekly shopping choices. Staff take on the main responsibility for cooking, with service users either watching or taking part in some elements of food preparation. Files contain information regarding likes and dislikes and as the staff team has remained stable for some time staff are aware of any preferences. One person’s needs have changed and now requires a ‘soft’ diet. Staff have responded to this and provide appropriate meals. The large dining kitchen provides a pleasant place to eat and individuals appeared to enjoy the meals provided during the inspection. Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. Good monitoring, recording, staff training and consistency, result in service user receiving a high standard of personal and health care support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user care plans provide good information regarding the support required with personal care. Each person has a key worker and files contain guidance regarding any specific personal care needs. Records are kept of personal care, such as showers. Health care needs are addressed extremely well and files contain good information in this area, including multi agency health care assessments and health action plans. Staff keep good records, which include records of weight and details of all health care appointments. For one individual, staff also record and monitor continence and seizures. Another person is having her mental health closely monitored and staff are working closely with other professionals to determine how best to provide support and meet her changing needs. A psychology report in relation to this service user was viewed, giving staff Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 14 advice regarding communication and certain ways of working, which were being followed by the team. This includes giving clear prompts and using key words and short phrases. A social work review is being arranged in order to look at increased funding in order to provide more one to one support for this person. All staff have undertaken dementia training in order to be better equipped to provide appropriate support. The healthcare support is very good, with staff keeping good records, monitoring changes and liaising with other professionals to ensure that service users get the best possible health care provision. All staff have undertaken training regarding medication and have also had additional training regarding administering rectal medication for one individual. Specific guidance is available on this persons file and this protocol has been agreed by her GP. Medication is safely stored in a locked cupboard within the sleep in room, which is also kept locked. The two medication administration sheets viewed were appropriately maintained. Most medication is provided in blister packs and information about the medication prescribed is available for staff. It is recommended that containers used for taking medication out of the home, such as on a day trip out, should be clearly labelled, with details of the contents. At present staff are dispensing medication into unmarked containers, which could pose risks for service users. Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. Service users are able to raise concerns. Policies, good practice and staff training help to promote the protection of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been received since the last inspection. A complaints procedure is in place, with a version available, which uses pictures and symbols in order to make the process of raising a concern easier for service users. Service users have opportunities to talk to a senior manager during monthly visits to the home and self-advocacy is promoted. The two service users who completed feedback comment cards for the inspection both responded that they would know who to speak to should they be unhappy. Policies and procedures are in place regarding abuse, protection and whistle blowing. Staff training addresses issues of abuse and challenging behaviour, which is also covered in NVQ programmes. The robust and well established recruitment procedures and the regular checking of service user finances also help to protect service users. The finance records for one individual were viewed, showing that staff keep a good account of all personal income and expenditure. Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. Warwick Road is clean, attractive and very well maintained, providing a lovely home for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is well maintained and provides lovely accommodation. All areas are decorated and furnished to a high standard. A comment card completed by a service user included the response; “ I love my home.” Service user bedrooms are individually decorated and reflect personal taste and preference. Since the last inspection the kitchen/dining room has been refurbished, with new flooring being laid and the communal areas of the home redecorated. The large kitchen dining room provides good opportunities for service users to get involved with or watch the meals being prepared. There is also a lounge, with patio doors to the garden. At the time of the inspection visits one person was having their bedroom re decorated. The ground floor bedroom has an ensuite shower, in order to meet the needs of the occupant. Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 17 Ormerod has a maintenance person/ decorator who carries out remedial work at the home, who confirmed that any problems are either forwarded by staff or picked up on the monthly health and safety audit of the home. The rear garden is well kept, with a patio area outside the main rooms and an enclosed garden area, which is accessed by steps. The inspector was informed that consideration was being given to making the lower part of the garden easier for service users to access. The home is very clean and staff must work hard to keep this high standard as well as fulfil all other aspects of their role. The washing machine is located in the kitchen and the drier in the garage. Staff are aware of hygiene/infection control issues and have undertaken health and safety and food hygiene training. Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is excellent. Service users are supported by a qualified, capable and well-trained staff team, who receive excellent support and supervision from managers. The robust recruitment procedures help to maintain this high standard of staffing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All members of the team are qualified, having achieved NVQ level 2 or above, exceeding the target of 50 qualified as detailed in the National Minimum Standards. Staff have also undertaken dementia training in order to better meet the changing needs of one person at the home. The staff spoken to had good communication skills and demonstrated a clear understanding of their role. The team has remained constant, with no recent changes, meaning that staff have got to know service users extremely well. A number of staff have worked at the home for many years. File recordings indicate that staff have built up and maintained good working relationships with other professionals. Ormerod has well established recruitment procedures in place. Recruitment records for the most recently appointed member of staff were viewed. Records Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 19 include; an application form, a pre employment health questionnaire, details of the interview, evidence of criminal records bureau clearance and two references. Ormerod operates a six-month probation period. A number of service users within the organisation have received specific training and are involved in staff selection. Ormerod provides excellent training opportunities for staff. The organisation has a dedicated training team, which also provides training for other social care providers in the area. Staff undertake Learning Disability Award Framework accredited training and then move onto NVQ awards. There is also a good programme of core training, which includes all key areas of health and safety. Training regarding specific needs, such as dementia and rectal medication, is arranged according to the needs of individual service users and has been provided for staff at Warwick Road. A staff member spoken to, in post for six years, stated that there are excellent opportunities to update existing knowledge as well as develop skills in new areas. Excellent training records are maintained. There are excellent supervision arrangements in place for staff. Each staff member signs a supervision agreement. The two files view showed that supervisions take place approximately every six weeks and address various topics, including training, and identify any action required. There is a good appraisal system in place. An appraisal takes place at the end of the six-month probation period, and then annually. Appraisals include a self-appraisal and a personal development plan. The records viewed showed that appraisals take place at least annually and more often for some staff. Monthly staff meetings also take place and minutes of these were viewed. The supervision and appraisal system is excellent, meaning that staff are well supported and guided in their work. Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. Management and quality monitoring systems are in place. Staff training, policies and good practice promote the health and safety of those living and working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been management changes at the home. The registered manager retired last year and temporary management arrangements were put in place. The current manager has had responsibility for Warwick Road for five months and is applying for registration with the CSCI. The manager is experienced, already registered as manager for another Ormerod home and has gained the NVQ level 4 award. The manager aims to complete the Registered Managers Award by the end of May. Current qualifications include NVQ level 3, a Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 21 supervisory management certificate and NVQ assessor and verifier awards. Regular staff meetings and supervision sessions take place. The home is well run, with good systems in place and information maintained in an organised manner. There are internal and external quality monitoring systems in place. Ormerod has achieved the Investors in People Award and is also affiliated to the Quality Review network, which carries out quality monitoring work with and for people with learning disabilities. The most recent work of the review team has been focussed on the lives of people within the area who have complex needs and work is soon to start regarding looking at the experiences of people who challenge services. There is a suggestion box in the entrance to the Ormerod main office, where staff and service users can put forward any ideas and provide feedback about the service. The manager of the home carries out a monthly audit and a senior manager within the organisation undertakes monthly visits, with reports being sent to the CSCI. Copies of both these different monitoring reports were viewed. The manager’s audit includes the monitoring and relevance of policies, which helps to ensure that they are appropriate and being put into practice. Questionnaires have recently been sent to all people using Ormerod services, including those living at Warwick Road. This is another opportunity to gain feedback about the service provided. This questionnaire focuses on rights, choices and the support received. Ormerod has recently introduced a new logo for the organisation, with staff and service users voting on the logo of their choice, showing that the views of people who use the service are valued. Staff and service users from Ormerod are represented at learning disability and community partnership forums, where there is opportunity to contribute to wider planning and decisionmaking. Person centred planning is a key element of quality assurance, giving all those involved, including relatives, an opportunity to give feedback about the service and to support the individual to plan for the future. Person centred plans at Warwick Road are outdated and this is an area for improvement, which will further strengthen the existing, very good quality monitoring arrangements. . The organisation has a health and safety manager, who carries out monthly visits to Warwick Road, producing a written report highlighting any areas for improvement. The most recent report was viewed. Staff training is in place regarding all key elements of health and safety. The fire records viewed show that fire drills take place approximately every six weeks. Staff monitor fridge and freezer temperatures with records being maintained. The pre inspection information completed by the manager of the home confirms that the electrical and central heating systems were checked in July 2006 and that there are appropriate health and safety policies in place. Safety information is available in pictorial format, such as regarding spillages, helping service users to be Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 22 aware of certain safety issues. There are risk assessments in place regarding potential hazards at the home. Ormerod Home Trust DS0000010004.V331613.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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Ormerod Home Trust DS0000010004.V331613.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. 1. 2. Standard YA9 YA37 Regulation 13 8 and 9 Requirement Timescale for action 15/05/07 Thorough risk assessment and risk management strategies must be in place. An application for a manager to 31/07/07 be registered with the CSCI must be submitted. 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 YA6 YA20 YA37 Good Practice Recommendations The process of annual person centred planning for each person should be addressed. Containers used for taking medication out of the home should be clearly labelled. The manager should achieve NVQ level 4 in Management. Ormerod Home Trust DS0000010004.V331613.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Ormerod Home Trust DS0000010004.V331613.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. 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