Inspection on 31/10/06 for Primrose Villa

This inspection was carried out on 31st October 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Primrose Villa 06/12/05

Primrose Villa 05/05/05

Primrose Villa 01/12/04

Primrose Villa 02/06/04

Similar services:

32 Beaumont Way

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

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

CARE HOME ADULTS 18-65 Primrose Villa 250 Fishponds Road Upper Eastville Bristol BS5 6PX Lead Inspector Peter Still Key Unannounced Inspection 31st October 2006 12:15p Primrose Villa DS0000026549.V317443.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 Primrose Villa DS0000026549.V317443.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. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Primrose Villa Address 250 Fishponds Road Upper Eastville Bristol BS5 6PX 0117 9519481 0117 9519481 primrose.villa@craegmoor.co.uk www.craegmoor.co.uk Parkcare Homes Limited 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) Ms Carol Clay Care Home 8 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (2) of places Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 6 persons aged 18 - 64 years May accommodate up to 2 persons aged 65 years and over Date of last inspection 6th December 2005 Brief Description of the Service: Primrose Villa is registered with the Commission for Social Care Inspection to provide accommodation and personal care to six people aged 18-64 and two people aged over 65 years with learning disabilities. The home is operated by Parkcare Homes (no 2) Ltd (a wholly owned subsidiary of Craegmoor Group Ltd). The home is situated on a busy road, in a residential area close to shops, bus routes and other local amenities. The property has a good-sized garden, a barn, and a garage. It is in keeping with the neighbouring properties. The home has six single rooms, one double, and one staff sleep-in room, all accessible by stairs. The cost of placement is between £491.13 – £904.17, the price dependent upon assessed need. Prospective residents can be provided with information about the home and this will detail the services and facilities available. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. Evidence was gathered from a number of different sources: - Information taken from the pre-inspection questionnaire - Comprehensive audits on all aspects of the running of the home - Information taken from 6 resident, 5 relative and 2 professionals survey forms, plus the outcome of a relatives and guest survey of 30/05/06 - Directly speaking with residents - Case tracking a number of residents - Speaking with care staff - A tour of the premises - Examination of some of the homes records - Observations of staff practices and interaction with the residents. The home manager and her deputy were present during the inspection and assisted in the inspection process. The deputy manager was about to leave her position at the home but will continue working at the home as a Bank member of staff, which will be valuable in providing continuity of care for residents. The overall analysis is that the home is a good place in which to live and to work, where the provider and staff team work hard and imaginatively to develop practice at the home. What the service does well: Staff have a focus of supporting residents to lead lives as individuals and of promoting choice, rights and decision-making. The enthusiastic and committed staff team, supported by their experienced manager, constantly look for ways of developing the home and making residents lives better. A key element of the home is activity and the happiness of residents is promoted to a great extent by enthusiastic staff, led by a member of staff who has the nominated coordination responsibility. Views of residents and supporters are being obtained from surveys and quality assurance review, to ensure residents are listened to and the feedback helps the home to develop. Primrose Villa DS0000026549.V317443.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. Primrose Villa DS0000026549.V317443.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 Primrose Villa DS0000026549.V317443.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, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes admission procedure ensures that placement is only offered to those whose needs can be met. Prospective residents are provided with information about the home, which they understand. EVIDENCE: A review of the service user guide has taken place and the new guide has been developed specifically for the residents of Primrose Villa and uses pictures and formats to ensure good understanding. This was considered to be very good and innovative practice. It involves the residents and promotes residents decision-making. The importance of residents understanding their contracts was considered at the last inspection and a requirement was made to ensure residents understand and sign their contracts. At this inspection, of two files case tracked, one was not signed by the resident. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 9 The manager had concerns about residents signing a document if they do not understand it. Following the last inspection, she had explored and produced a new three-page contract document, which was seen. It was clearly much easier for residents to understand and in a format suitable for each individual. The new document and approach had only just been finalised and the manager needs to gain approval from the provider to formally introduce it. She was also considering how it would link to the very formal contract currently being used. The manager should be praised for the work she has done to comply with the requirement and clearly intends to fully comply in the near future. The inspector considered the homes positive track record in compliance and the excellent focus of empowerment and improving resident’s lives. The inspector considered that a further repeat of the requirement was not necessary. Whilst the home currently has one vacancy in a double room, there were no plans to consider a new resident at this time. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that good care planning and review processes to support their own decision-making will meet their needs. The focus of staff in promotion of individual choice and considered risk taking ensures residents have an independent life style. EVIDENCE: Two care files reviewed found good recording and review. Examples in these and other files showed that residents are fully involved in processes so that support was provided in the way residents prefer. Resident involvement in reviews was seen and care plans had been signed by them. Two residents spoken with said they knew whom their key workers were, that their needs were listed to and actions taken. Medication records reviewed for the day of inspection were all signed and accurately completed. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 11 The last inspection noted that a risk assessment was needed for one resident who smokes occasionally and an assessment had been provided. Two care files, case tracked found evidence of clear risk assessments, with strategies for responding to risks, which had been reviewed. Primrose Villa DS0000026549.V317443.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, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lead busy lives, with a range of activity and are supported by staff that focus on the importance of resident choice. Residents are provided with good meals. EVIDENCE: The member of staff who has a key responsibility for organising activity was spoken with and great enthusiasm was shown by this and other staff. Residents spoken with were clearly happy with their life style and the range of activities arranged. Coffee mornings have been held and a recent auction was a great success. Staff had been imaginative in acquiring auction prizes, including a car service and shampoo and blow-dry hair cut. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 13 On the day of inspection residents were busy getting ready for a Halloween disco and the home computer was being used to find good face painting ideas to use on residents. Photos were seen of a recent fun day event, which raised funds to provide further activity. Face painting was a part of this event too and the local MP was involved with residents. All residents have enjoyed holidays, arranged to meet their individual wishes. Residents have access to company transport and also enjoy going out in members of staff’s own cars and are often out. Three residents spoken with said they enjoy an active lifestyle, where they have individual choice about what they want to do. Resident surveys seen before the inspection also referred to the range of activity and how much they enjoy it. Certificates, pictures and information in the main living/dinning room show residents involvement in choices about their daily lives. One resident wanted to talk to the inspector about their role within the company and of the forum meetings they attend with residents from other homes. The resident showed the inspector files they use, with minutes of meetings and spoke of their value, also saying that they would give support to other residents attending with particular issues they were raising. This resident gave very high praise for the way Primrose Villa was run and the way residents are involved in making decisions about their lives. The resident said they had lived in a number of different places during their life and that Primrose Villa was the very best and where they wanted to stay for the rest of their life. The resident also said they had nominated the home manager for a special award for the excellence of her care. One relative responding to the pre inspection survey said, “We are very pleased with staff, …. is wonderfully looked after”. Resident’s responding said: “It’s a great house”, “They are a lovely bunch of staff”, “The home has a good atmosphere”, “I think the staff at Primrose Villa are all…….wonderful”. Healthy eating is promoted and residents are involved in choice of food and the menu record seen showed evidence of a balanced diet. One resident spoken with said they like the food and enjoy helping with cooking. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff knowledge and commitment for each resident, ensures good personal support for their physical and emotional health. A robust medication system protects residents. EVIDENCE: One resident responding to the pre inspection resident survey noted that staff were sometimes busy. On the day of inspection, the inspector observed that staff were very busy. The home had a happy buzz of interaction between residents and staff, who were also seen to be working or relating individually to residents. The inspector considered that staff being busy sometimes was a positive comment although it was possible that residents would sometimes want more individual staff time. During the inspection the inspector was able to talk with the identified resident and four others and none mentioned a lack of staff. Their comments were positive and praised staff for the way they support them. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 15 The commission had received proper information from the home under regulation 37 about incidents involving a resident who was a challenge to the service. The staff team should be praised for the steps taken to support the resident. Contact with professionals was undertaken and the staff of the home developed a strategy to help the resident. On the day of the inspection, clear evidence was seen and observed that the approach had been entirely successful and that the individual was very happy and content with their life. The last inspection noted that the local pharmacy needed to provide a change to ensure medication was given at the right time. This was responded to immediately and the identified record was reviewed with the adjustment seen at this inspection. The medication for two residents case tracked was correct. Care file records contained evidence of personal support, promoting physical and emotional health. These files also contained comprehensive risk assessments. There was evidence of regular review and they were well organised and with informative information recording. The good recording in files provided key information sharing for staff and for the key worker in producing their reviews. Appointments with healthcare professionals were seen and also found in the home main diary. Equality and diversity was discussed with the manger during the inspection with some examples of how the home promotes this. Relationships were discussed and the way residents are supported to live the lifestyle they wish, with staff who are not judgemental. One resident who was observed to be loud in speech, had a hearing aid and staff spoken with were confident about the cleaning needed. Another resident had also raised this within the survey as an issue. Further support had been sought for the residents’ hearing difficulty and other needs. One professional who returned a survey response said, “I have no concerns regarding treatment of residents. All staff have been helpful and respectful of residents and seem caring, carers well informed, home easy to contact. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that any concerns they have will be listened to and acted upon. Residents will be cared for by staff that are aware of abuse issues and will safeguard them from harm. EVIDENCE: Residents have regular meetings and the minutes were reviewed, they were well recorded, providing detail about key issues and that points of view from residents were being listened to and addressed. One meeting of 03/10/06 showed evidence of an issue being raised and this was acted upon. The inspector also reviewed a resident survey with the following headings: What do you like about the home; what don’t you like; how could staff improve; what would you change. This was considered to be an excellent initiative of good practice. It was completed a year ago and had been repeated 13/09/06 and was being analysed. This was very good evidence of one way of ensuring quality assurance for the home. The home focuses on promoting residents confidence and supporting them to raise issues, encouraging complaints. One complaint examined had been addressed and evidence of the matter was found within a complaint form; regulation 26 visit; the resident’s file and the quality assurance file. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 17 The last inspection noted a financial error with the money held for one resident. The manager said the error was rectified immediately after the inspection and that she had taken steps to ensure further mistakes do not occur. The resident’s money is checked and recorded at each staff handover and this record was seen. The record and money for two residents, being case tracked was checked and found to be correct. Staff had received training in adult protection and two staff spoken with were very clear that if they had no evidence of abuse but did have a concern they would take immediate action to ensure the resident was safe and report the matter for action. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely well-maintained environment, which currently meets their needs. EVIDENCE: A number of points raised at the last inspection, had all been addressed. The newly refurbished kitchen had been well thought out and the new units, equipment, including dishwasher were appreciated. A cleaning schedule had been put in place for one identified resident, following a comment by a resident about one area at the home. This also gave evidence of residents being listed to and of actions taken to respond. On the day of inspection, the home had two problems, which were being addressed at the time. The upstairs shower/WC has a leak through the flooring and had been out of action for a month. Significant work was needed and there were plans to deal with the problem. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 19 The laundry also had a leak, which was being resolved. It is not considered that a requirement is needed since the matters were being responded to and the track record of the home is that action is taken when necessary. A tour of the building and outside area was undertaken and the inspector was taken into three resident bedrooms by them and with a member of staff. Bedrooms were personalised, clean and tidy and two residents were clearly proud of their rooms, which were spacious. At the end of the property there is a further two story property, with garage. It is called the barn and is in need of significant work if it were to be used. Currently there are thoughts about its potential but no plans. All residents were currently mobile and do not have any difficulty with the stairs at the home. This was considered since there is no lift and the issue had been raised by a relative within the home survey. The inspector considers that no action is necessary, however the provider may wish to start to consider the future needs of residents and if any considerations may be needed in the longer term. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 20 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. Residents will be cared for by enthusiastic staff that are trained, able and competent, to meet their needs. EVIDENCE: The last inspection noted that POVA training dates needed to be added to the staff training matrix and the manager had responded to this. One staff file reviewed for POVA training included the dates of the training. The last inspection found that not all staff had a CRB check. The pre inspection questionnaire recorded that there were CRB checks for all staff and of two staff files reviewed, both had a CRB check and evidence of good recruitment process, including two references. The file and induction for one recently appointed member of staff was reviewed and showed good induction. The provider should be praised for the induction approach including training and documentation. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 21 Staffing levels were considered satisfactory. A minimum of two staff were on duty and during the inspection this increased from three to four due to the Halloween party event needing more staff. The manager confirmed that staff often increase dependent on what residents were doing. It was noted that the deputy manager was due to leave her position on 10/12/06 but that she will continue to work at the home in the position of a bank member of staff. This is very positive since it shows her continued commitment and it will provide continuity for residents. Staff should be praised for their hard work with their NVQ qualifications and it is much to their credit that the number of staff qualified has raised since the last inspection, even though a qualified member of staff had left. The current situation is that of the nine staff, six have completed training and two were about to finish. Supervision of staff was conducted in accordance with the national minimum standard. The supervision programme was organised and all staff were booked onto the programme. The manager should be praised for producing a ‘supervision performance guidance list’, to help ensure that all key points are covered. Supervision notes for two staff reviewed, had a good level of recording and did included key points. Two staff spoken with confirmed that supervision was meaningful and that they were well supported by the manager and her deputy. Staff accountability was considered at the last inspection and the need for a revision of the staff signature list because two staff had the same initials. This was examined and the new signatures were in place. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 22 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. Strong and effective leadership ensures that the management of the home is good and the home is run in the best interests of the residents. EVIDENCE: Staff spoken with said their focus was on ensuring the very best quality of care for residents. Prior to the inspection, the manager forward a comprehensive bundle of evidence to support the inspection. Contained within this were a significant number of Audits, covering all aspects of the running of the home. An action plan also made it very clear that steps were being taken, where issues had been identified. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 23 The last inspection noted that staff needed more frequent fire training. Records were reviewed and showed that the training is three monthly for all staff. A record for the next training was seen in the home diary for 08/11/06 and dates were also recorded in the fire logbook. The UK Fire Company had made requirements in July of 2005 and evidence of their completion was seen in a letter of response, dated 23/08/05. Further evidence was found in the homes works project document, dated 04/08/06. Comments from supporters indicated they were not aware of where to find the inspection report and the manager agreed to emphasise this. Unannounced regulation 26 visits were being undertaken monthly and reports read before the inspection showed a clear knowledge of the home and needs of residents. The manager said she found the visits and reports very helpful and supportive. Residents have a role in considering issues at the home and routinely make a tour of the building with staff to make checks and raise any points. It was clear that quality assurance was high on the agenda for the home and review of further ways of engaging with residents and people important to the service were on going. A survey was completed on 25/04/06 and an action plan was finished on 01/08/06, with nine key points made. Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 24 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 3 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 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 3 X X 3 X Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 25 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. Refer to Standard Good Practice Recommendations Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Primrose Villa DS0000026549.V317443.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!