Inspection on 22/08/07 for Pottles Court

This inspection was carried out on 22nd August 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

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

CARE HOMES FOR OLDER PEOPLE Pottles Court [ formerly Exe View ] Days Pottles Lane Exminster Exeter Devon EX6 8DG Lead Inspector Stella Lindsay Key Inspection (unannounced) 9:30 22nd August 2007 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 Pottles Court [ formerly Exe View ] DS0000069364.V344054.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. Pottles Court [ formerly Exe View ] DS0000069364.V344054.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pottles Court [ formerly Exe View ] Address Days Pottles Lane Exminster Exeter Devon EX6 8DG 01392 833101 01392 833743 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) Classic Care Homes (Devon) Ltd Mrs Karen Marie Allison Care Home 15 Category(ies) of Dementia - over 65 years of age (15) registration, with number of places Pottles Court [ formerly Exe View ] DS0000069364.V344054.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Dementia over 65 years of age (Code DE(E)) The maximum number of service users who can be accommodated is 15. This is the first inspection under the new management. Date of last inspection Brief Description of the Service: Pottles Court provides residential care for fifteen older people with dementia. The accommodation is set over two floors and there is a shaft lift. Most of the bedrooms have en suite facilities, and all are for single occupancy. There are two assisted baths as well as a walk in shower room. The Home has two lounges, a conservatory and a dining room, and an attractive courtyard garden with level access. External doors are secured with keypad locks. Pottles Court is in the village of Exminster with a shop and post office within a short walking distance. Fees are currently £372 - £400 per week. Escorted travel outside the home, including medical appointments, may be charged at £7 per hour. Pottles Court [ formerly Exe View ] DS0000069364.V344054.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 and took place over two days in August 2007. It involved a tour of the premises and discussion with the Registered Manager, discussion with or observation of all 15 residents, four visiting relatives, and seven staff on duty. Care records, staff files, health and safety records and the medication system were examined. The inspector visited some residents in their private accommodation, and spent time with them in the lounges and dining room. The Manager had supplied supporting information about the running of the home prior to the inspection. Staff, health professionals and residents’ relatives returned surveys and comment cards to the Commission for Social Care Inspection, and their views are represented in the text. What the service does well: What has improved since the last inspection? The new home owners and Registered Manager together have been working to introduce improvements and provide a good service for the residents. Staff levels have been improved, with the Manager now being entirely supernumerary, so that all staff have time to accomplish their work. A training plan has been introduced for staff, with a monthly training sessions, to provide a competent and knowledgeable staff team. Pottles Court [ formerly Exe View ] DS0000069364.V344054.R01.S.doc Version 5.2 Page 6 Refurbishment of the building had started, with the corridors being redecorated and a new carpet laid, which had improved the ambience of the ground floor. Two bedrooms had been refurbished. The garden had been cleared to give more space and light, and plans were being made for more paths to be laid for residents. A major refurbishment of the dining room is also planned. New equipment had been provided for the laundry, and new cleaning products to combat odour. New Enquiry forms and pre-admission assessment forms had been produced, to make sure that full information is shared while anyone is considering moving in to Pottles Court. Communication within the home had improved, with two-monthly supervision sessions for staff provided by the Manager, and Senior Care staff meetings. 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. Pottles Court [ formerly Exe View ] DS0000069364.V344054.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 Pottles Court [ formerly Exe View ] DS0000069364.V344054.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 Quality in this outcome area is good. Clear information about the home is provided, and care is taken to admit people appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new Statement of Purpose has been produced, along with a new Residents’ Handbook. These are available in the entrance Hall of the home, along with the most recent CSCI inspection report. The care records of two recently admitted residents were examined. One had been admitted as an emergency, and the only written assessment available prior to admission had been written previously by a Social worker arranging domiciliary care. Assessment and care planning were recorded in the home in a timely way, and reviewed two months later. The Care Manager involved considered that the home had ‘responded flexibly to the emergency, in a calm way.’ Pottles Court [ formerly Exe View ] DS0000069364.V344054.R01.S.doc Version 5.2 Page 9 The Registered Manager and the Deputy Manager, in order to assess care needs and ensure that the new person would be able to live in reasonable harmony with the current residents, had visited the other recently admitted resident in their previous care home. Most care staff who returned surveys said that they are given information about residents’ particular needs before starting work with a new person. The new management have introduced new Enquiry Forms, to take brief details on first hearing of a prospective new resident, and a new pre-admission assessment format that ensures all areas of care are considered. It did not include a summary or a record of the judgement of whether the home was suitable to meet the person’s needs. The home gives each resident a copy of the terms and conditions, in order that they are clear about what is included in the fee. A copy was seen on the file of this resident, signed on their behalf by their next of kin. Pottles Court [ formerly Exe View ] DS0000069364.V344054.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. Care plans were completed and reviewed, personal and health care was good and the system for administering medication was sound. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans of three residents were examined. These included information on the residents’ health, self-care skills, communication skills, and their preferred daily and weekly routines. Good practice was seen in recording useful information in a concise way. This included details such as the best way to encourage someone with their bathing. Risk assessments were recorded to show how safety could be maintained. Care plans had been reviewed, but evidence of consultation with residents’ relatives was not seen. A visiting daughter told the inspector that they had not been involved in care planning, though the staff were good at letting her know when there were any problems. Information about residents’ previous lives was not seen. It would be good practice to include life histories, or personal profiles, to help staff understand the person’s life before they came to Pottles Court. Pottles Court [ formerly Exe View ] DS0000069364.V344054.R01.S.doc Version 5.2 Page 11 There was evidence on the files of collaboration with health staff. Equipment and care practices were in place for the avoidance of pressure sores. No bed guards (cot-sides) were in use. Special mattresses and cushions had been supplied where necessary. A Nutritional Assessment had been carried out by a District Nurse. Charts had been kept to record residents’ intake of food and liquid, but none were considered necessary at the time of this inspection. A care assistant had received training on diabetes. Care plans had been drawn up for two residents with respect to their diabetes. There were records of contacts with the Community Mental Health Team. The home has a sound policy and procedure for the administration of medication, which was seen to be followed accurately and carefully by staff. It is the home’s policy to administer all medication, and not to offer the option of self-medication, for the protection of residents. Supplies are kept securely, and records were checked and found to be accurate. There was a list of staff who have received training and are considered by the Manager to be competent to administer medication. Further staff training was given during this inspection, in order that staff should know about the medication that residents are taking. The inspector spent considerable time with residents, and at all times saw staff address them with courtesy, upholding their dignity and self-esteem. Pottles Court [ formerly Exe View ] DS0000069364.V344054.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Staff were engaging well with residents and providing recreational activities to stimulate them. There were good links with the local community. Good nutrition was provided to promote residents’ health and well-being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff maintain a regular routine in the home while accommodating residents’ preferences. Most residents come to the dining room for breakfast, but some have breakfast taken to their room, unless there is a reason for not providing this, which is included in the person’s care plan. Staff observe residents to find what suits them, for instance, someone who turns down the offer of help with bathing in the morning may accept this help later in the day. During the mornings residents were seen to be sitting in the lounge for spells without staff attention. The small television was turned on, and though no-one was watching it, it appeared to provide reassurance. In the afternoons social activities were provided. During this inspection a carer led a group of residents in a game of skittles, successfully engaging people very well in this activity. It would help promote activities to have a white board for recording scores or word games. One of the home’s regular professional activity organisers also Pottles Court [ formerly Exe View ] DS0000069364.V344054.R01.S.doc Version 5.2 Page 13 visited, with musical entertainment, which was seen to be enjoyed by a large group of residents. Some staff said in surveys that they would like to see the residents having more outings. The Manager had arranged an outing to a local air show during the previous week, and was planning a trip for a small group of residents to a local beauty spot. Staff may be needed to volunteer to make outings possible. One resident likes to carry on with household tasks, and sometimes accompanies the cleaner. Others like to lay the tables sometimes. The Manager wishes to promote a range of activities within the home that are of particular benefit to people with dementia, and has decided to designate one of the staff as Activity Co-ordinator. A fete was held at the home during the weekend before this inspection, which had been successful. Funds raised were being used to start a Residents’ Fund. There is good support from a local Church, whose members collect residents and take them for a weekly lunch outing. Breakfast is served at 8.30am, when cranberry and orange juice are offered; the tea trolley comes round at 10.30am. Lunch is served around 21.30, and the tea trolley comes round again at 2pm. Tea is served at 5pm, which is a substantial meal, and supper at 7.30pm might be a hot drink with cheese and biscuits. The cook was seen baking cakes, and there were plenty of fresh vegetables. The lunch served during this inspection was roast pork with fresh carrots, swede and cabbage, plus roast potatoes and gravy. There is not a choice of main course, but an alternative is available. Some residents need a soft diet, and low sugar diets are provided as necessary. The Manager said that she had obtained a white board which she intended to hang in a prominent place, possibly the corridor near the annexe, so that the menu and choices of the day, as well as the date, activities and any other news could be displayed. Pottles Court [ formerly Exe View ] DS0000069364.V344054.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Residents can be confident that their concerns are listened to, and effective action taken when necessary. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Complaints procedure is displayed in the entrance hall. The Commission for Social Care Inspection had been made aware by relatives of a complaint they had made to the management. The owners had made a full investigation and response. The Manager had dealt with a complaint to the home concerning maintenance of cleanliness in a resident’s bedroom. The family had been satisfied with the response. Most staff had received training in the Protection of Vulnerable Adults in June of this year. The Manager said that those who missed the session would be offered another opportunity. All knew that they must inform the management if there was any allegation of abuse. Some had known voices to be raised, if intervention had been necessary to assure a resident’s safety, but this had not been considered to be abusive. Training in dealing with challenging behaviour had been arranged for the following month. Pottles Court [ formerly Exe View ] DS0000069364.V344054.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,26 Quality in this outcome area is adequate. Pottles Court is a safe and comfortable house, but is still in the process of being refurbished to make it a more attractive home, that is easy for residents to get about. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Pottles Court provides a safe and comfortable home for its residents. It is not suitable for people who have major mobility problems. The new owners had made an energetic start on refurbishing the building. The corridors had been redecorated, and a new carpet laid. Two bedrooms had been redecorated. A power tool had been purchased, in order to keep in control the shrubs that surround the garden, to give more space and light. The Manager had plans for increasing the walkways available to residents. Pottles Court [ formerly Exe View ] DS0000069364.V344054.R01.S.doc Version 5.2 Page 16 Some residents like to sit in the corridor because it is bright and they can see people around all the time. It becomes a hazard when they need to elevate their legs. The large lounge is also well used, but would benefit from improved lighting. The chairs in the conservatory were covered in pale blue protective covers and unattractive blankets. These do not promote residents’ dignity. The chairs were low, and would not promote residents’ independence. They all faced inwards, and though some residents may prefer to look at other residents, some might enjoy the view of the garden and the Exe valley. There is another small lounge, called the Well Room. Although this is rather dark for daily use by residents, it is a calm place for residents to entertain guests, and for meetings of all kinds. There are two bathrooms on the ground floor, both with hoists to enable people to get in and out of the bath. There is also a large shower room on the upper floor. All are used inappropriately as storage areas, and do not provide a calm and attractive environment for residents. The shower room is currently not used. This would appear to be a result of the practice in this home for residents who are to be offered a bath, to come down to breakfast in their dressing gown. The downstairs bathrooms are then convenient. When more residents wish to bathe in the evening, they may find it more acceptable to use the facilities close to their private accommodation. Bedrooms varied in their presentation, according to the wishes of the occupant. One resident liked to pack all their belongings away. Another had plenty of family photos. All had been provided with a good door lock, to give privacy, while allowing staff to enter in an emergency. None had been assessed as being able to benefit from lockable storage. A new washing machine and dryer had been provided, with the old ones kept as back-up. The ‘red bag’ system of containing soiled laundry in soluble bags is in use, in order to prevent any possibility of cross contamination. Disposable commode pots are provided. While infection control measures in this home are generally good, the laundry still needed to have its floor sealed at the edges, and there was a crack in the kitchen floor which needed to be sealed. The home was found to be almost free of odours, which is to the credit of staff. Pottles Court [ formerly Exe View ] DS0000069364.V344054.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. Staff levels had improved, a sound system of recruitment is in place, and an appropriate training plan is in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A rota was supplied, showing that a Senior carer is available on duty from 7.30am to 9.30pm,with three other carers till 1.30pm, and two during the afternoons. This is seen to be sufficient to meet residents’ personal care needs, and to provide social activities within the home. A cook and cleaner are also employed, and the Manager is additional to this. Some staff said that they were able sometimes to ‘sit and chat’ with residents, and they appreciated this. It was seen that residents were sitting in the lounge unaccompanied through the mornings, although staff gave attention as and when they could. Management should organise staff to enable this attention to be given. During the inspection, care staff were covering for the cleaner who was on holiday, and also the cook was away for part of the time. This may indicate the need to employ a staff member to cover absences in housekeeping staff. At night there are two staff on duty, one of whom is on ‘sleeping-in duty’. This level of provision has been carefully considered, and will continue to be monitored, as residents’ night-care needs vary, and some are awake during the night. There have been few occasions when the sleeper has been summoned. Pottles Court [ formerly Exe View ] DS0000069364.V344054.R01.S.doc Version 5.2 Page 18 When a member of staff is needed to escort a resident to a health appointment, a charge may be made, if an extra staff member has to be employed. Staff are sometimes asked to volunteer to provide outings. Residents and their relatives all paid tribute to the friendliness of staff, and the inspector saw them treating residents at all times with respect, and communicating effectively with them. The files of three recently appointed staff were examined. All checks had been made to assure protection of residents from potential harm. Staff had been supplied with a job description and professional Code of Conduct. An experienced and qualified new carer had been allowed to work a ‘shadow shift’ and given time to read residents’ care plans. All but one of the care staff who returned surveys said that have enough support to do their job. There is a new induction programme available for new staff, which is intended for accomplishment in the first three months and leads towards NVQ training. Of the current 15 care staff, eight had either achieved at least NVQ2 or equivalent, and two more were due to start working towards this qualification. This shows good progress towards achieving a qualified workforce. The new management had introduced a Training Plan, stating that training to NVQ2 is available to all staff, and will be paid for by the company on the understanding that the employee would stay for an agreed length of time. Monthly Group Training sessions had been introduced. Topics already covered included Fire Safety and Protection of Vulnerable Adults and a training session on medication was delivered during this inspection. The topics booked for the following two months were ‘Dealing with Challenging Behaviour’, and ‘Moving and Handling’. Further training on care of people with dementia should be provided, including Person Centred care, and appropriate social stimulation. Pottles Court [ formerly Exe View ] DS0000069364.V344054.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. Pottles Court is well managed by a team who are qualified and fit to be in charge. The home is run in the best interests of the residents. Safe systems of work are in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Pottles Court is under new management. The new owners, Classic Care Homes (Devon) Ltd took over on 13th March 2007. The Responsible Individual for the organisation is Henrietta Coxon. She is well qualified and has a good track record as the Responsible Individual at Classic Care’s other care home. The Registered Manager, Karen Allison, is a qualified Nurse (RNI, ENB), who has achieved the Registered Managers Award. She had previously been the Manager of a care home with Nursing. She is interested in continuing training to keep up to date with good practice in care, and recently attended a sixmonth course on ‘End of Life’ support. Pottles Court [ formerly Exe View ] DS0000069364.V344054.R01.S.doc Version 5.2 Page 20 Staff said they felt positive about the changes introduced by the new management. One said in a survey that conditions had ‘improved drastically’ under the new owners. The Manager meets regularly with the home owners, most recently in July when topics discussed included the environment, including plans for making the shower room into another bedroom; staff training; and activities for residents. Classic Care are members of the National Care Association, who provide professional representation, and keep the team up to date with changes in policy and legislation, such as the Mental Capacity Act and how it might affect their work. The Quality Assurance process is in its early stages, with questionnaires for feedback having been sent to staff, relatives, and regular visitors such as the optician. Some replies had been received, but more were anticipated, and the Manager said that in due course she will meet with the directors and draw up a plan incorporating suggestions and views that have been expressed. The Manager keeps some cash on behalf of all 15 residents, to pay for their toiletries, hairdressing etc. A sample were checked for accuracy, and it was seen that receipts are kept, and records with a running balance and two signatures to assure safe-keeping on behalf of residents, who are unable to check this for themselves. The Manager had started a programme of individual supervision sessions for staff, and the inspector saw that records were being kept. Though not everyone had as yet been included, the Manager was confident that this would be completed within the year, to provide six of these meetings for care staff, in order to give them feedback on their performance, an opportunity to discuss any concerns or issues, and to plan their training. The Manager was ensuring safe working practices within the home. She said that the Directors make spot checks, and that training will continue. All staff are to have the Food Hygiene certificate as well as all mandatory training. Safer Food Better Business is to be implemented in the kitchen, with tuition provided for the cook. The COSSH information is readily available for staff. Gas installations had been checked in March 2007, and a check of the electrical system was booked in the week following this inspection. The fire precaution system had been professionally checked on 1st August 2007. A hold-open device that was found to be necessary was arranged during this inspection. All but one staff member had received Fire Safety training, and the Manager said a session would be arranged for that person. A Fire Risk Assessment for the building was in place, and was being up-dated. Pottles Court [ formerly Exe View ] DS0000069364.V344054.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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 2 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Pottles Court [ formerly Exe View ] DS0000069364.V344054.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. 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. 2. Refer to Standard OP3 OP7 Good Practice Recommendations When the decision to admit a resident has been made, this should be confirmed in writing to the resident (or their representative). It would be good practice to include where possible a life history or personal profile in the service users’ personal file, and to involve residents’ relatives in care planning and reviews. The furnishing of the conservatory should be reconsidered. The bathrooms should be cleared and made into more attractive environments. Kitchen and laundry floors should be fully sealed, so that they can be kept clean and hygienic. Staff should be available to give attention to residents in the lounge throughout the day. All care staff should receive training in the care of people with dementia. 3. 4. 5. 6. 7. OP20 OP21 OP26 OP27 OP30 Pottles Court [ formerly Exe View ] DS0000069364.V344054.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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