Inspection on 20/04/07 for Palmyra

This inspection was carried out on 20th 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 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

Palmyra 10/01/06

Palmyra 09/08/05

Palmyra 10/03/05

Palmyra 25/08/04

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

CARE HOME ADULTS 18-65 Palmyra 38 Great Georges Road Waterloo Liverpool Merseyside L22 1RD Lead Inspector Ms Lorraine Farrar Key Unannounced Inspection 20th April 2007 12:30 Palmyra DS0000005388.V331660.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 Palmyra DS0000005388.V331660.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. Palmyra DS0000005388.V331660.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Palmyra Address 38 Great Georges Road Waterloo Liverpool Merseyside L22 1RD 0151 949 0529 0151 9207210 manpal@makingspace.co.uk 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) Making Space North West Mrs Valerie Brown Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Palmyra DS0000005388.V331660.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 14 MD Date of last inspection 10th January 2006 Brief Description of the Service: Palmyra is registered to provide support and accommodation for 14 adults who require support to manage their mental health. It is situated in a residential area of Waterloo and is well placed for accessing local community and leisure facilities, shops and transport. The building is a large detached Victorian house that fits in well with other houses in the area. All bedrooms are single and provide washbasins but no en-suite facilities. A number of shared areas are available, these include a smoking lounge, a smaller non-smoking lounge, dining room and private garden. Staff are available twenty four hours a day to provide support. In addition to care staff, the home also employs cooks and cleaning staff, although the people living there are also encouraged and supported to take part in household tasks where possible. The building is owned by Riverside Housing, a local housing association who are responsible for maintaining the premises. The home is operated by Making Space, an organisation and registered charity who provide services for adults who need support with their mental health. Palmyra DS0000005388.V331660.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information for this inspection was gathered in a number of different ways. An unannounced visit took place for five hours on the 20th April 2007. This included reading records and looking at the building. Time was spent looking at the support three of the people living at Palmyra receive. This included looking at the support they get with their care plans, medication, money, activities and environment. The inspector met with four of the people living at Palmyra and had discussions with three members of staff including the manager. Any information the Commission for Social Care Inspection (CSCI) has received since the last inspection about the home is also taken into account in writing this report. This includes information provided by the manager on a pre-inspection questionnaire and comment cards sent to the people living at Palmyra and their relatives. Three comment cards were received from relatives and three from people living at Palmyra. It costs between £272.50 and £317.50 each week to live at Palmyra. What the service does well: In their comment cards one of the people living at Palmyra said “its very nice here” and another explained that, “I have a really nice time here, the residents and staff are nice”. Staff work with the people living at Palmyra to plan their care and ensure they are offered the support that they want whilst retaining their independence. For example the people living there go out and about on their own but staff will accompany them on holiday or shopping if they wish. Staff will also work with the person to ensure their health needs are identified and that they receive the support they want to attend health appointments and manage their medication. Routines are flexible with the people living there able to make daily decisions themselves and choose how to spend their time. People are able to make a drink when they wish and said that meals are varied and they can always ask for something else if they don’t like the day’s menu. Palmyra DS0000005388.V331660.R01.S.doc Version 5.2 Page 6 Staff undertake a variety of training in both basic care subjects and more specialised areas. This helps ensure they have the skills to understand and meet peoples individual support needs. Systems are in place for reviewing the service offered and planning for future improvements. This includes obtaining the views of the people who live there, their relatives and others who support them. Once these have been obtained the manager reviews them and addresses any issues or suggestions that have arisen. The people living at Palmyra said that staff always or usually listen to what they say and that there are enough staff to meet their needs, with one person explaining, “‘there’s always someone to talk to if you need it”. Clear information is provided to the people living there about how to raise concerns and all those spoken with said that they were aware of how to do this and would talk with staff. 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. Palmyra DS0000005388.V331660.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 Palmyra DS0000005388.V331660.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&4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Before anyone moves into Palmyra detailed information about their support needs and choices is obtained. This helps everyone to decide if Palmyra is the right place for them to live. EVIDENCE: Before anyone is offered a place to live at Palmyra staff meet with them and completed a series of assessments. These assessments cover the persons physical and mental health support needs and their everyday choices including hobbies and education. Records for one person who had recently moved into Palmyra showed that staff also obtain a copy of any assessments carried out by health and social professionals such as the Community Mental Health Team and Occupational Therapist. This information helps staff and the person to decide if Palmyra would be a suitable place for them to live in and if it could meet their needs and choices. Once all the assessments have been obtained the person is invited to visit Palmyra and stay overnight if they wish. One person explained, “I came for an afternoon visit and then Staff came to see me in hospital with the rest of the team to do the paperwork”. Another explained that he stayed overnight twice and met with staff to see if he was “happy to come live here”. Palmyra DS0000005388.V331660.R01.S.doc Version 5.2 Page 9 The opportunity to visit and stay at Palmyra provides people with the opportunity to meet the other people living there and experience life in the home, enabling them to make a more informed decision as to whether Palmyra is the right place for them to live. Palmyra DS0000005388.V331660.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. The people living at Palmyra are supported to make choices, live the lifestyle they choose and increase their independence EVIDENCE: Everyone living at Palmyra has an individual care plan that has been written with their keyworker and agreed with themselves. These plans give clear information about the persons’ choices and the areas of their life they need support with. This includes their physical and mental health needs and social and cultural needs and gives information about ‘what the carer needs to know’ to support the person. The level of detail ensures that staff are aware of the support people need and are able to plan with them to provide this. In one care plan the person had written their own ‘pen picture’ telling staff about himself and his lifestyle. This is good practice as it ensures the information is individual to the person and provides them with the opportunity to be fully involved in planning their own care. Palmyra DS0000005388.V331660.R01.S.doc Version 5.2 Page 11 All care plans had been regularly updated and are audited by the manager monthly. This helps to ensure that any changes to the persons support needs and choices are quickly noted and can be acted upon. All of the people living at Palmyra who completed comment cards said that they can always or usually make decisions about the things they do each day, with one person explaining, “I have a really nice time here, the residents and staff are nice”. During the site visit the people living at Palmyra were seen to make everyday decisions about how to spend their time. This is backed up by detail in care plans which gives the person the opportunity to state the support they want from staff with various activities such as managing their money or going to visit health professionals. Support is provided to people to manage their money as independently as possible. The organisation acts as appointee for some peoples benefit money, others manage their own. If needed they provide a safe for people to keep their money and bank accounts in, however if they wish to do so people have a lockable safe in their rooms which they can use. This personalised support and planning ensures that people are able to be as independent as possible and receive support where needed. Individual risk assessments are part of the care plans. These identify any risks for the person and give clear guidelines about how to identify and minimise the risk. These are written with the person and help to ensure that they can maintain their independence and choices whilst being as safe as possible. Palmyra DS0000005388.V331660.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. The people living at Palmyra receive support to be as independent as possible and live the lifestyle they chose. EVIDENCE: One of the people living at Palmyra explained in their comment card, “I am very independent and like socialising. I go out often”. The relative of another person explained, “they allow my son to be independent and within reason to come and go as he pleases – he is very happy with the Staff, his room the food in fact all aspects”. During the site visit it was evident that the people living at Palmyra are independent and decide where they wish to go and when, with many people coming and going out throughout the day. One man explain he has a key to his bedroom and front door, can have visitors whenever he wants and “come and go as I want”. A leaflet compiled by staff is located in the hallway. This provides information for people, about local amenities including, libraries, churches, drop in centres and cafes. Palmyra DS0000005388.V331660.R01.S.doc Version 5.2 Page 13 The manager explained that they have been working with IMAJINE, a group who work with people with mental health support needs, to access local education and leisure facilities if they wish. Staff will provide support to people to go out if they wish. An annual holiday is arranged for anyone who wishes to go and the home can borrow a mini bus on occasion from the organisation for days out. The people living at Palmyra state in their care plan whether they would like a key to the front door and their bedroom, throughout the day staff were seen to respect this and always obtain permission before entering peoples bedroom. Plans also state the level of support people need with their personal mail, for example some people receive this unopened whilst one plan stated the person needs ‘help to read mail’. This individual planning again supports people to be as independent as possible. One of the people living at Palmyra explained that there are set meal times but “they will always fix something else”. Breakfast is served as a buffet so that people can help themselves when they get up. There is always fresh fruit, and juice available in the dining room along with hot water in flasks for people to make a drink. The Chef explained, “I never refuse a cuppa, after all it’s their home”. Through care planning people can identify if they want a kettle in their room to make a drink and any risks that may be associated with this. Menus showed that a choice of meals is always available and the Chef confirmed that he will make further alternatives on request. The manager explained in her questionnaire that different diets can be catered for and diets for people from different ethnic backgrounds would “be addressed if required”. Palmyra DS0000005388.V331660.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 excellent. This judgement has been made using available evidence including a visit to this service. The people living at Palmyra receive individual support to manage their personal and healthcare as independently as possible. EVIDENCE: Care plans contain information about any support the person requires with their personal care. One of the people living at Palmyra explained that staff support her with this, “on request” and that this can differ daily depending on her choices and health. There are some aids and adaptations provided within Palmyra to help people with mobility difficulties. These include a lift, bath chair, walk in shower and grab rails. Health record plans are in place for everyone living at Palmyra. These are detailed documents, written with the person and the keyworker and contain clear information about the person’s health needs, their choices and the support they require. They include guidelines about how to explain information to the person in a format they can understand, how the person feels about their health and about attending health related appointments and the support they do or do not require with this. The information is individual to the person and differs for Palmyra DS0000005388.V331660.R01.S.doc Version 5.2 Page 15 everyone. For example one plan explained the person wants support with all appointments, another that the person does not require support with most appointments but would like a member of staff to visit the psychiatrist with them. Detailed information is also recorded about how to support the person with their mental health. This includes details about how to recognise when the person is well, starting to have a relapse, or unwell and the actions staff need to take to support them. This information, along with regular reviews of the plan and recording of appointments and health issues ensures that the people living at Palmyra receive support to manage their health as independently as possible and that any health issues are quickly noted and acted upon. Risk assessments are written to support people who want to manage their own medication. Again these are individual to the person. For example one plan recorded that the person had chosen not to manage their own medication, whilst another had support to manage their own medication as part of their plans to move to more independent living. Clear systems are in place for recording medication received, given to people and returned to the pharmacist. All staff who support people with their medication have had training in this area. This along with the systems used helps to lessen the risk of mistakes being made. Medication is stored in lockable cabinets. However these are overcrowded with boxes of tablets placed on top of each other and falling out of the cabinet when opened. This could cause confusion and lead to mistakes if medication falls out of the container it was delivered in. Palmyra DS0000005388.V331660.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. The people living at Palmyra are confident any concerns or complaints they have will be dealt with appropriately. EVIDENCE: The people living at Palmyra said in their comment cards that they know who to speak to if they are unhappy or have a complaint, with one explaining, they would speak to their “keyworker or any member of staff that is on duty”. This was confirmed during the site visit with one of the people living there explaining they were aware of local advocacy services who could support them, and another that they knew about the complaints procedure as “its on the notice board”. No complaints or concerns about the service provided at Palmyra have been received since the last key inspection. There are polices and procedures in place to guide staff on how to deal with any complaints that arise and inform the people living there of how their complaint will be dealt with. Staff have training in recognising and dealing with any allegations of abuse and have copies of the local authority adult protection procedures to follow if needed. Palmyra DS0000005388.V331660.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 adequate. This judgement has been made using available evidence including a visit to this service. Palmyra provides a clean, safe and comfortable home for people to live in. EVIDENCE: Palmyra is a large detached house located in a residential area of waterloo. It is very well placed for accessing local shops, churches, pubs and colleges. The house fits in well with other family homes in the area and provides some parking facilities with easy access to bus and train routes. Everyone living at Palmyra has their own bedroom, which they can personalise with décor and their possessions. There are three communal sitting rooms within the house. The largest, based downstairs is a smoking lounge and is used by most of the people living there. Patio doors open onto the enclosed garden and provide some ventilation. Staff explained that the room is painted frequently and this was evident. However due to the number of people who smoke the room appears shabby and there are holes in settee covers. Palmyra DS0000005388.V331660.R01.S.doc Version 5.2 Page 18 A small lounge on the first floor is currently not in use and is in the process of being turned into a computer room for the people living there to use. A second small lounge on the upper floor is decorated and used as a relaxation room and for visitors if people wish. Both small lounges are non-smoking and staff explained they are kept locked, to ensure they remain non-smoking. However people can use them at anytime by requesting the key. There is a large back garden with patio, ramps and seating which is well used by the people living there in warmer weather. The people living at Palmyra who completed comment cards said that the home is always fresh and clean and this was observed during the site visit. A laundry room is located in the cellar and is used by both staff and the people living there. This provides sufficient washing and drying facilities to meet people’s needs. Disposable gloves and aprons are provided to help lessen the risk of an outbreak of infection. Palmyra DS0000005388.V331660.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): 32,34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at Palmyra are supported by an experienced staff team who are able to meet their needs and choices. EVIDENCE: The three people living at Palmyra who completed comment cards said that staff always or usually treat them well, with one describing them as “professional” and another that they are treated with “respect”. The relative of one person living there, explained, the staff are very welcoming and friendly” and all relatives who completed comment cards said they felt staff always or usually have the skills and experience to look after people. All staff who are new to Palmyra undertake an introduction course to care, which covers basic care practices, including health and safety, equal opportunities and peoples rights. The majority of care staff have achieved an NVQ qualification in care. These training courses help to ensure staff are aware of their role and how to support people effectively. In discussion with members of the staff team it was evident that they have a good understanding of their role in providing support to people whilst Palmyra DS0000005388.V331660.R01.S.doc Version 5.2 Page 20 maintaining their independence, it was also clear that staff have a good knowledge of peoples individual support needs and how to meet these. Throughout the site visit staff were seen to talk appropriately to people and respond positively to their requests. One of the people living at Palmyra said that there are enough staff to support people when needed and explained, “there’s always someone to talk to if you need it” Staff files looked at all contained copies of the person’s application form, references and evidence that a Criminal Records Bureau check had been carried out. These checks help to ensure that staff are recruited who are suitable to work with the people living at Palmyra. Training for staff is well planned and organised by the organisation and Manager. A member of staff explained that if they identify a course that would be useful to them in supporting the people living at Palmyra then the manager will support them to attend. Training for staff has taken place in a number of basic care areas such as fire, food hygiene and equality and diversity, as well as courses in more specialised areas such as epilepsy and palliative care. Future training is planned around the needs of the people living there, with courses arranged in the Mental Capacity Act and Care Programme Approach. The variety of training staff attend helps to ensure they have the knowledge and skills to effectively support people and meet their individual needs. Palmyra DS0000005388.V331660.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. Palmyra is a well run home that operates for the benefit of the people living there. EVIDENCE: Mrs Val Brown is the registered Manager of Palmyra. She has many years experience in managing a care service for people who need support with their mental health and holds qualifications in care and management. During the site visit Mrs Brown had a clear insight into the support needs of the people living at Palmyra and was clear about the role of staff and herself in supporting people to maintain their independence as much as possible. She attends regular training to ensure that she is up to date and can support the people living at Palmyra and the staff team, effectively. There are several systems used within Palmyra to check the quality of the service offered and plan future developments. Palmyra DS0000005388.V331660.R01.S.doc Version 5.2 Page 22 Systems are in place for regular checks of medication and care plans to ensure these are completed, up to date and reviewed. An external audit of the service was carried out in January 2007, following which Palmyra was awarded a 5 star rating for the service they provide. In October 2006 the organisation who operate Palmyra carried out a quality assurance review. This included sending surveys to the people living there, their relatives and health and social care professionals who support people living there. The results of these were looked at and a plan to meet the outcomes was put together. One of the outcomes identified was that interested parties would like the opportunity to meet. As a result twice yearly Forum meetings have been arranged. All parties are invited and guest speakers attend. The first meeting was attended by a local organisation who discussed leisure and education opportunities for people who need support with their mental health, and a Mental Health professional attended, who spoke about the process of Statements. Regular checks are carried out on equipment and the building to ensure that they are working correctly and safe to use. This includes checking fire procedures, gas and electrical installations and appliances within the home. Palmyra DS0000005388.V331660.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 3 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 3 33 X 34 3 35 4 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 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 3 X X 3 X Palmyra DS0000005388.V331660.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations Further storage for medication should be provided. This will help to lessen the risk of mistakes occurring. 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