Inspection on 13/12/06 for Repton Road,73

This inspection was carried out on 13th December 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 found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Repton Road,73 30/12/05

Repton Road,73 02/08/05

Repton Road,73 22/03/05

Repton Road,73 16/07/04

Similar services:

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Herbert Street

Haven (The)

Charis

Hartley House

Brook Drive, 124

Rugby House Project

City Roads Crisis Intervention

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

CARE HOME ADULTS 18-65 Repton Road,73 73 Repton Road Orpington Kent BR6 9HT Lead Inspector Wendy Owen Key Unannounced Inspection 13th December 2006 09:30 Repton Road,73 DS0000006908.V312097.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 Repton Road,73 DS0000006908.V312097.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. Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Repton Road,73 Address 73 Repton Road Orpington Kent BR6 9HT 01689 836661 01689 836661 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) Community Options Limited Ms Emy Nerveza Care Home 5 Category(ies) of Past or present alcohol dependence (5), Past or registration, with number present drug dependence (5), Mental disorder, of places excluding learning disability or dementia (5) Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 Adults with a mental disorder who may also have past or present alcohol or drug dependence 30th December 2005 Date of last inspection Brief Description of the Service: 73 Repton Road is a large two-storey semi-detached house in a quiet residential area, providing care and accommodation for five adults with mental ill health. This home is part of a group of homes within the community that specialises in residential care for people within the mental ill health category. The home is staffed by a manager and team of support workers, providing twenty-four hour care. Community Options works in partnership with the area mental health teams and Hyde Housing to provide support to service users. Service users accommodation is on both floors, accessed by steep stairs, making it unsuitable for people with significant mobility difficulties. All bathroom, toilet and bedrooms are fitted with locks that can be accessed from the outside in case of an emergency. Service users have appropriate medical cover on admission and each service user is registered with a GP of their choice, whenever possible. They also receive treatment from a range of other health care professionals as required. The fees charged are the same for all service users, £303.28 if they are subject to a S117. If they are not they may be asked to make a contribution. The terms and conditions of residency details what is included in the fees. Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit to the home took place over the course of one day and included viewing of records, discussions with one resident, one health professional, one family member, two staff and the manager. The inspection also included written feedback from five residents, a tour of the home and viewing of records. What the service does well: What has improved since the last inspection? Since the last inspection last inspection there have been improvements in the medication procedures and moving and handling training. Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 6 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. Repton Road,73 DS0000006908.V312097.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 Repton Road,73 DS0000006908.V312097.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission procedures provide staff with the information they require to ensure they are able to meet residents’ needs. Information regarding the terms and conditions of residency could be improved to ensure residents are fully aware of what is expected. EVIDENCE: The home has provided a Service Users Guide to residents which is kept by residents in their rooms. Repton Rd provides residents with the opportunity for rehabilitation with a stay of approximately two years. All residents are referred through, and funded by, the Mental Health teams in the area. The home has admitted no new residents since the last inspection therefore the inspector was not able to fully assess the standard of pre-admissions processes. However, Community Options have a detailed pre-admission process which if implemented ensures that the home is suitable for the residents’ needs. One file viewed contained an assessment provided by Oxleas trust, supporting information by the hospital and an assessment completed by Community Options. The file did not contain a letter conforming after assessment the home is able to meet the resident’s needs. (See requirement 1) Two files were viewed to determine whether contracts are available. They both contained the Hyde Housing tenancy agreement and the terms and conditions Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 9 of residency between Community Options and the resident. It is difficult at times to determine the funding and fees payable especially where these are reviewed each year by the team due to changes in benefits. The inspector suggests that this is made clear by attaching the current years funding and fees payable to the contract. The Community Options contract should also be reviewed to ensure this is clear. The terms and conditions state that the fees are “inclusive of board and some of this consists of staffing and administering the house.” There is no mention of accommodation. None of the files contained a placement agreement from the placing agency. (See requirement 2) Repton Road,73 DS0000006908.V312097.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 at least once during a 12 month period. 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. Overall the staff have the information they require to ensure they are able to meet residents’ needs. Residents are well supported in making decisions and undertaking tasks which promotes their independence. EVIDENCE: The inspector viewed three residents’ files and found them all to contain care plans, individual support plans and risk assessments in place. Risk assessment detailed how residents’ independence is being promoted whilst minimising the risks. The care plans and risk assessments have improved over the last twelve months with more guidance and information in place on the needs identified and the action the home is to take in order to meet their identified needs and goals. The care plans now include physical as well as mental health needs and how the home is supporting them in promoting their independence. Each care plan also contained the individual’s needs in respect of their nutrition. Crisis plans were also evident detailing the interventions when the individual is in relapse. There were gaps in both care plans and risk assessment noted. One care plan did not record a resident’s heart problems or how the home was supporting the Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 11 resident in respect of managing their finances. There was no risk assessment regarding the potential for violence to others where this had been identified in other records. If this is no longer the case then there must be evidence of how this has changed. In another care plan there was no information on how the individual’s needs in respect of their Aspergers were being met and no risk assessment regarding the individual’s self-neglect. Once again the care plan had not identified the support required in managing the individual’s finances. (See requirements 3 & 4) It is clear from the observations, discussions with two residents and records of the residents’ meeting minutes that residents are actively involved in making decisions about their lives. Where there are restrictions this should be recorded in the individuals care plans as commented previously regarding the management of residents’ finances. Repton Road,73 DS0000006908.V312097.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 at least once during a 12 month period. 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. The service encourages residents to be part of the community and participate in activities which benefit them physically and mentally. EVIDENCE: The home provides a rehabilitative service to residents with the expectation that within two years of more they will be able to move to independent community living. To meet this end the home supports residents to undertake daily living tasks to ensure they are able to support themselves. This is identified in the individual care plans. Most of the residents visit community support projects such as those provided by Anchor Housing and Horizon. Some residents also attend more educational pursuits including computer training. Staff where required support residents in undertaking shopping tasks and to participate in community activities such as cinema visits, meals out and maintaining physical health through gym or visits to the swimming baths. The inspector observed staff supporting a resident in paying their rent. This activity was undertaken independently with staff ensuring they were fully aware of what to do. One CPN said they felt the home did a “brilliant” job in Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 13 rehabilitating the resident from a year spent in hospital. They are now undertaking many daily living tasks and looking to move into a place of their own. A relative of one resident was also very positive about the way the home improved their family members independence and living skills. In the main residents visit families rather than the family visit them at Repton Rd. Some visit for the day whilst others for the weekend. A relative told the inspector that there is good communication between the home and them and that they include the family in all areas of the residents life if the family and resident wish. The home assists residents in applying for their benefits to ensure they have sufficient financial support. Participating in the electoral process is also encouraged with residents entered onto the electoral register. Residents hold keys to their rooms and also the front door to the home. In general they are able to come and go as they please although where medication is required at night residents should be in the home before the night staff retire. Community Options terms and conditions of residency detail the rules of the house and restrictions on drugs, alcohol and smoking. The fees payable by the residents do not include food (please note the standard on contract) and therefore residents are expected to purchase food provisions out of their benefits. The support provided varies and is dependent on the individual needs of the residents. It was positive to note that the dietary and nutritional needs of the residents together with the action to be taken by the home to support them is included in the support plans. The last inspection required the home to ensure there are records in place regarding the food provided/taken by the residents. This is particularly relevant where there are dietary/nutrition concerns. This is now in place. Residents are provided with lockable cupboard space for their food provisions and are supported in preparation and cooking tasks as their abilities determine. Repton Road,73 DS0000006908.V312097.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 at least once during a 12 month period. 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. The service ensures the health and well-being of the residents through monitoring of their health and accessing appropriate healthcare, including specialist support, when required. EVIDENCE: None of the current residents require personal support from the staff. All are independent in the undertaking of personal care tasks. The only support required is encouragement for some, especially where there may be individuals or neglect this aspect of their care. Three residents’ files were viewed and found to contain information on the individuals’ health care needs. However, previous comments show that there were some gaps in this area. For example a resident has angina but this is not included as part of their identified healthcare needs. It is evident from the records that residents are supported in managing their healthcare. Records showed visits to GPs, specialist mental health teams and NHS services and optical services. The residents are also supported by their Care Co-ordinator who have regular contact with the resident and the home. Each resident also has a crisis plan relevant to their mental health needs. This identifies the triggers, signs and symptoms and what action the home is to take where the resident relapses. Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 15 Discussions with a CPN confirmed these findings in respect of the resident they support. They had regular reviews and discussions on how the resident is doing and regarding health and medication. Since the last inspection individual has been living in the home there has been significant improvements in their mental health. The CPN also felt that staff were knowledgeable about mental health needs of the resident and provided a supportive and caring environment. The medication records relating to three residents were viewed and were found to be of a good standard. The home has stages towards residents selfadministering of medication and the individual care plans detail which stage the resident is at. Some areas required further clarity and these were discussed with the staff in the home. For example: the recording process where residents are one of the stages towards self-administering their medication. The records were completed in full with records of receipt, administration and disposal. The inspector discussed the “on leave” procedures. These currently meet the medication guidelines produced by the Commission. The one area requiring improvement relates to the “as required” where guidelines should be in place for the administering of such medication. The guidelines should include the amount, dosage, including maximum dose and when to administer. (See requirement 5) Repton Road,73 DS0000006908.V312097.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 at least once during a 12 month period. 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 home has an open approach to ensuring any concerns raised are listened to and dealt with. There are adult protection procedures in place which adequately safeguard individuals living in the home. EVIDENCE: A copy of the home’s complaints procedure is on display in the home and included in the Service Users Guide. With the exception that it refers to the NCSC rather than the Commission, the procedure meets the regulations. This should be amended. Residents meetings are held regularly and minutes show that the home ensures complaints can be raised at this time and also staff reiterate how residents can complain. The home also has a system for recording complaints and subsequent investigations. However the last complaint received was in February 2005. Many issues or concerns are raised and managed informally without the need to go through the formal processes. This is appropriate to the service type. The home also has adult protection procedures in place and staff spoken to were aware of what they should do if they were aware of any allegations or observed any incidents which gave them concerns. All would ensure this information is passed on to the manager. However, the procedures require updating to detail how referrals are made to the Protection of Vulnerable Adult register where allegations have been substantiated. It must also be made clear that Social Services are the lead agency in co-ordinating. (See requirement 6). Staff receive some information on adult protection during the induction training. However, more specific guidance should be given to staff in relation Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 17 to the role of other agencies in the protection of individuals. (See recommendation 1) There have been no concerns or allegations made over the last twelve months Repton Road,73 DS0000006908.V312097.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Repton Rd provides the residents with a warm, comfortable and homely environment. EVIDENCE: Repton Rd provides a good standard of accommodation for the residents living there. The communal areas are reasonably decorated with furniture that is comfortable and homely. The home is reasonably well maintained. Each resident has a bedroom which they can personalise and when needed are involved in the choice of decoration. There are two lounges one of which is a smoking room. Meals are taking in the kitchen which has its own dining area. The inspector noted that two of the fire exits require the use of a key. This is important to the security of the home. Subsequent discussions with the fie officer showed that this is acceptable for this type of service, as long as the means of escape are included in the fire risk assessment. The service offers rehabilitation to the residents living there. This requires them to be involved in the daily tasks associated with living in your own home and a schedule of such tasks was on display. In general the home was found to Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 19 be of a satisfactory level of cleanliness with hand-washing facilities located in the required areas. Repton Road,73 DS0000006908.V312097.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 at least once during a 12 month period. 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 staffing levels ensure that the needs of the residents can be supported through a flexible approach. Staff have a sound understanding of the residents’ mental health needs with good training which allows them to respond effectively and in an appropriate manner. Recruitment procedures are satisfactory and ensure the safety and protection of residents. EVIDENCE: Repton Rd has adequate staffing in place with two members of staff working during the day shifts and one staff member “on call”. Discussions with residents, family and a health professional provide evidence that staff are able to meet their needs and provide support in a constructive, supportive and caring way. Records viewed and discussions with members of the staff team also showed that staff receive training appropriate to the residents’ needs. Core training such as first aid, food hygiene and moving and handling has been provided along with specific training in relation to the mental health needs. The inspector has previously mentioned that one resident has a mental health diagnosis and a diagnosis of Aspergers. Staff have received very little training in this area and would benefit from this as soon as possible. The inspector Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 21 suggested that the manager contact the Learning disability team in the area to ask for their support and advice. (See requirement 7) Community Options provides induction training external to the home that covers core areas. This is supported by in house induction and includes shadowing of staff. The home has a high percentage of staff who have achieved the NVQ qualification with member of staff qualified to NVQ 3. Staff spoken to also told the inspector theta they are regularly supervised by their line manager with a signed record of the discussion maintained by both partied. Personal development and training is discussed together with the care and support provided to the residents. Recruitment records had been viewed by an inspector who visited the Head Office. These were found to be satisfactory. Repton Road,73 DS0000006908.V312097.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39, 41 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and well managed with sound systems in place which ensures the safety and wellbeing of residents. There are also adequate system in place for monitoring the quality of care provided and to ensure they are continuously improved. However, there are some areas which need to be improved. EVIDENCE: The registered manager has recently transferred from Repton Rd t another of the projects and a new manager (from the other project) is now managing the home. The home has been managed well in the past and it is hoped that this continues under the new management. The current manager is experienced with a number of qualifications relevant to managing this service. She is aware of the need to apply to the Commission for registration as the manager. The organisation monitors the quality of the service provided through regular visits by the Area Manager. However, the quality of these reports do not Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 23 provide much information on the quality of the service and are often difficult to read due to the handwriting. The inspector suggests that more detail and evidence is included in the report and they are made more legible. (See requirement 8) Community Options is also part of the Business Excellence quality assurance system which use key performance indicators to assess whether the objectives have been met. These objectives are service user focussed with the key performance indicators reviewed each month. The organisation is also accredited to Investors in People and has regular audits associated with re-accreditation. The inspector saw evidence of regular resident meetings with minutes made of the discussions. Recording what action is to be taken and by whom would ensure that the discussions are being taken seriously and individuals own responsibility for ensuring action is taken. (See recommendation 2) The last survey involving residents and which reviewed the quality of care provided took place in 2002. These should occur more regularly and include a report on the findings. (See requirement 9) The health and safety of resident is well managed by the manager with regular servicing of the systems and equipment used. Staff and residents receive fire training/instruction and the fire alarm is checked weekly with a regular service of the system and equipment used. Please note the comments made in the environment standards regarding the fire exits. The home has appropriate insurance in place with the Employers Liability certificate on display in the hallway. The registration certificate is also on display. The manager’s name requires changing to ensure it reflects the current management position. Repton Road,73 DS0000006908.V312097.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 3 2 3 3 x 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 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 3 x 3 X 3 3 x Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 25 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14 Requirement The Registered provider must ensure that written confirmation is provided to state that they are able to meet the assessed needs of the prospective service user. The Registered provider must ensure that contracts provide clear and accurate information on the terms and conditions of residency. The Registered provider must ensure that care plans include all areas of social, personal and healthcare needs identified. The Registered provider must ensure that risk assessments are developed where there risks have been identified. Where the risks are no longer present this should be made clear. The Registered provider must ensure that “as required” medication has full administration guidelines in place. The Registered provider must ensure that the adult protection procedures are reviewed and updated in line with current good practice. DS0000006908.V312097.R01.S.doc Timescale for action 01/04/07 2 YA5 5 01/04/07 3 YA6 15 01/03/07 4 YA9 13 01/03/07 5 YA20 13 01/03/07 6 YA23 13 01/04/07 Repton Road,73 Version 5.2 Page 26 7 YA35 18 8 YA33 26 9 YA33 24 The Registered provider must 01/06/07 ensure that staff are provided with Aspergers training to ensure they are able to fully meet the needs of the individual. The Registered provider must 01/03/07 ensure that Regulation 26 reports are clear and legible and provide sufficient information to determine the quality of care provided. The Registered provider must 01/06/07 ensure that the service is reviewed regularly and a report of the outcome of the review provided to the Commission. Any review must include consultation with the service users. 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 YA23 YA33 Good Practice Recommendations Al staff should be provided with training on safeguarding adults. Minutes of meetings should detail the action being taken and by whom. Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Repton Road,73 DS0000006908.V312097.R01.S.doc Version 5.2 Page 28 - 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!