Inspection on 22/05/06 for 25 Old Mill Park

This inspection was carried out on 22nd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

25 Old Mill Park 15/01/08

25 Old Mill Park 30/01/06

25 Old Mill Park 28/07/05

25 Old Mill Park 19/03/05

25 Old Mill Park 18/10/04

25 Old Mill Park 22/03/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 25 Old Mill Park Louth Lincolnshire LN11 ONY Lead Inspector Sue Hayward Key Unannounced Inspection 22nd May 2006 13:30 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 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 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 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. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 25 Old Mill Park Address Louth Lincolnshire LN11 ONY 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) 01507 608052 www.sense.org.uk Sense East Mr Andrew Kennedy Care Home 6 Category(ies) of Learning disability (6), Sensory impairment (6) registration, with number of places 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories: Sensory Impairment (SI) 6 Learning Disability (LD) 6 The maximum number of service users to be accommodated is 6. 2. Date of last inspection 30th January 2006 Brief Description of the Service: 25 Old Mill park is one of a number of homes within the county that is operated by SENSE East. It is registered to provide care and accommodation for up to six service users between the ages of eighteen to sixty-four years who have been affected by a dual sensory impairment (deaf/blindness) caused by rubella and who also have a moderate or severe learning disability. The home is located in the market town of Louth, which has a range of services and facilities. It is a domestic style house providing six single bedrooms, one on the ground floor. There are stairs but no lift facility so service users at this home who are accommodated on the first floor need to be able to manage stairs. There is a lounge, dining room, kitchen and sensory/activity room on the ground floor. The home is fully occupied and there have been no new admissions since the last inspection. Transport for service users is provided in the form of a minibus. The current yearly charges for the service as confirmed by the manager range from £66000 - £78000. The manager said there are no additional charges. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home was undertaken by one inspector and formed part of a key inspection. It started at 13:30 and lasted six hours. Information already held on file was used to plan the visit. This included reports provided to the CSCI by representatives of the organisation and checking records of any incidents that had been notified to the CSCI since the last inspection. Comment cards had not been received on this occasion from relatives, visitors or other professionals to contribute to the inspection. The manager confirmed that these had been sent out to service users relatives as in view of their needs service users would be unable to complete them themselves. The CSCI did not receive a copy of the pre-inspection questionnaire although the manager said that this had been sent on 03/05/06. The site visit focussed on key standards and checking whether requirements issued from previous inspections had been met. A tour of the home was made. This included checking residents’ bedrooms and bathrooms as well as communal areas of the home, the kitchen and laundry. “Case tracking” was the main method used. This involved checking the care records of two residents with a range of needs and discussion with all care staff on duty. As service users have very individual communication needs it was not possible to involve them directly. Therefore, observation of staff working with service users who were participating in the weekly shop and at a mealtime was the method used to assess the manner in which care is provided. What the service does well: Service users live in a clean, comfortably furnished and well-maintained home where they are enabled to be as independent as possible. There are various opportunities for them to participate in a range of activities and leisure interests such as sailing, horse riding and attending a local resource centre also operated by SENSE. Staff are attentive to and have a good knowledge of service users needs and the help and support they require and involve them in various tasks such as the weekly shop and meal preparation. Care records are well maintained. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 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. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 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 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 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): 2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is a satisfactory assessment process in operation. This ensures that service users needs are fully identified prior to their admission to the home and information is available to service users or their representatives about the service. EVIDENCE: There have been no new admissions to the home for a number of years. The previous inspection identified that the service user guide is available in symbol form and both files inspected contained information about terms and conditions of residency at the home. A staff member spoken to gave a good description of the admission procedure, which is undertaken by the management team involving any other relevant professionals and service users relatives. The staff member confirmed that the procedure would include service users visiting the home over a period of time. He said relatives are also welcome to visit. All personal records checked on this occasion contained a detailed personal support plan for service users and individual risk assessments indicating that the needs of service users were properly assessed and planned for. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Care plans contain detailed information to ensure service users individual needs and routines are met and they are supported to make choices about their lives. EVIDENCE: The care plans of three service users were checked and all contained risk assessments identifying their needs and how to meet them. Care records are readily available for staff to refer to. The manager is in the process of improving the system for recording care plans. The one checked, which had been implemented was very detailed and was clearly laid out to indicate the help and support the service user required. Records demonstrated that care plans are reviewed formally on a six monthly basis or more often if required and significant people are invited to attend such as relatives and representatives from placing authorities. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 10 Staff spoken to had a good knowledge of the needs of service users asked about and they were observed to put this into practice. For example in the different ways they used to communicate with them and the type of activity they involved them in. Service users records indicated a wide range of activities that they have the opportunity to participate in. Staff were aware of their particular preferences and it was observed at the time of the inspection that a range of activities had occurred on the day of the visit, for example a horse riding activity, a walk and attendance at the local resource centre. Records and observation also indicated service users preferred routines are respected e.g. bedtime routines. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staff support service users to participate in a range of activities and leisure interests both within the home and community, which are based on individual preferences. Service users independence is promoted and visitors are welcomed at the home. A well balanced diet, which incorporates their individual preferences, is provided. EVIDENCE: Discussion with staff, records and observations made during the inspection indicated that service users are provided with varied opportunities to participate in a range of activities. For example, on the day of the visit two service users accompanied by staff purchased the weekly shop. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 12 Records indicated when service users had participated in activities such as sailing, archery or aromatherapy. A staff member also commented that one service user enjoyed attending the local theatre sometimes. They also have opportunities to be involved with household tasks such as helping prepare meals to promote their independence. The home has obtained a new mini-bus. This provides a more appropriate form of transport as it has a high roof, tail gate and electrically operated steps to assist service users who have difficulty with access, or who need to use wheelchairs. Discussion with staff confirmed that the home welcomes visitors and records are kept of any communication between staff and relatives. A system is in operation giving specific staff responsibilities for specific service users. Staff comments indicated that service users have opportunities for social contact through attending the resource centre, participation in community activities and events and also on the occasions when they meet up with service users from another home in the area operated by SENSE East. There is a four weekly menu. This takes into account service users personal preferences and dietary needs. Staff prepare meals and individual records are kept of each persons diet. Staff were observed to assist a service user appropriately during the meal ensuring their dignity was maintained. Weight is monitored on a monthly basis. Meals are generally eaten together in a family type setting. There is flexibility about times these are taken depending on the activities that service users participate in. Records confirmed that Basic Food Hygiene training is incorporated into the staff-training programme. An Environmental Health Officer visited the home on 11/05/06 and gave a 3 star “excellent” rating in relation to the food safety inspection. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive care that promotes their health, welfare and independence and respects their individuality. Service users are protected as far as possible by the medication procedures in place. EVIDENCE: Discussion with the staff and records checked all demonstrated that service users health care is promoted. Other professionals are consulted as needed such as G.P’s, psychiatrists, chiropodists and dentists and staff accompany them to appointments to help with communication. The organisation also employs a behavioural therapist who is involved in developing behaviour management guidelines for staff to follow should service users require this. Records demonstrated service users have an annual healthcare check. None of the current service users are able to administer their own medication. Care staff undertake this task. Those spoken to confirmed they had had recent 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 14 training in relation to this. Records checked indicated that training had taken place on 14/11/05. The manager confirmed that further training had been provided in March ‘06 for those staff who required it but there was no recorded evidence of this. There are policies and procedures about medication and the sample of medication records checked were up to date. Medication is dispensed from individual ‘blister’ packs and staff were aware of the correct method of disposal. There have been no medication errors notified to the CSCI since the last inspection. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are satisfactory procedures in place to address any complaints. Information is not provided in an accessible form for service users. Staff have had training to ensure they know what to do to protect service users from any possible abuse. An updated version of the local authority adult protection procedure is not available in the home. Some financial procedures have been reviewed in order to safeguard service users. EVIDENCE: Since the last inspection storage arrangements for money and valuables has changed and offer more security. Appropriate records of any transactions including staff signatures are kept. There has been an audit undertaken by the organisation and further recommendations have been made which the manager confirmed would be addressed when alterations to the building have been completed. There are written procedures in place as to how to raise concerns as well as copies of Lincolnshire County Councils adult protection procedure however it was noted that the latter was out of date and the manager was advised to obtain a copy of the February 2005 version to display. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 16 There have been no issues raised with the CSCI relating to safeguarding adults since the last inspection. The complaints record in the home also indicated that no concerns had been raised. Matters were raised prior to the last inspection relating to an adult protection issue of which requirements were made. These related to staff having training about adult protection procedures and “whistle blowing” and the installation of a power shower. Records checked indicated that training had occurred on 22/03/06 and 30/03/06. Staff spoken to on the day said that they had attended this and were aware of the forms abuse could take. They said that matters would be reported to a member of the management team should they occur and that there was always an on-call person who could be contacted. The power shower has not yet been installed, as there is a difficulty with the plumbing however the manager confirmed that authorisation had been given for a different type of shower to be fitted, which is on order. Copies of the homes complaints procedure on the notice board in each bedroom, however staff said that service users understanding of it in this form would be limited. Staff rely on their observations of service users regarding their satisfaction with the service although it was said that some would be able to use Braille. Therefore, it is recommended that the complaints procedure be provided to service users in a format that is the most accessible to their individual needs. It was understood that this is something that the manager is already in the process of addressing. Service users looked well cared for and staff were noted to be kind, caring and attentive to their needs. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is clean, tidy and well maintained which helps to ensure service users live in a safe and comfortable environment. EVIDENCE: The property is of a domestic style and is well maintained, looked clean and smelt fresh. Bedrooms are individually furnished according to service users needs and preferences. For example one service user has chosen to have a double bed another can only tolerate the minimum of furniture and personal items are being introduced gradually. One room is due to be redecorated and the service user is being involved as much as possible in the choice of colour scheme. Protective clothing is available for staff to use in bathrooms and doors are lockable to ensure privacy. There are also symbols on doors denoting whether bathrooms are in use. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 18 There are two lounges one which is generally used as an activities room and has some sensory equipment. The sensory room is however, currently being used temporarily as an office whilst alterations are made to the staff bedroom/office. Service users were observed to be able to move around the home, as they wished supported by staff. It is planned to increase the communal space by the building of a conservatory. This will enable service users to have further privacy if they wish. The manager confirmed that permission for the extension was still being sought from the planning authority and is aware that any alterations will need to meet National Minimum Standards and the recommendations of other authorities such as fire and environmental health. There is a garden to the rear and side of the property, which is well maintained. The manager said that some service users are involved in gardening. Laundry facilities were clean and contained an industrial washing machine and tumble dryer. There is equipment provided for staff to ensure good hygiene practices such as gloves and aprons and COSHH materials are stored securely. The fire brigade visits the home periodically. The last visit occurred on 24/02/05 and fire precautions were considered to be satisfactory at that time. The organisation has its own health and safety officer and records checked indicated that a health and safety inspection was carried out on 28/09/05, which included a fire risk assessment of the premises. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels within the home are sufficient to meet current needs and staff have training to ensure they have the necessary skills and knowledge to care for service users appropriately. Training records are not up to date in some instances. There is a thorough recruitment procedure in operation. This ensures as far as possible that service users are adequately protected. EVIDENCE: Staffing levels within the home have improved since the last inspection specifically to meet the needs of a service user. Four staff were on duty at the time of the inspection. Rotas checked for the previous week indicated that staffing levels in the morning ranged from 3 to 4 staff and there were generally four staff in the evenings. At weekends there are an additional seven and a half hours of staff time to support a service user. At night there is one wakeful staff member and one sleeping in who is on-call. Staff were of the opinion that levels were sufficient to meet the needs of the current service users. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 20 During the visit two staff members accompanied two service users on a shopping expedition whilst two remained in the home with the four other service users. Agency staff on occasions cover for staff absence or vacant posts however it was noted from the rotas that where possible the same agency staff are used to ensure continuity of care. As well as care responsibilities staff also have catering and house keeping duties. Service users are supported to be involved with these tasks to increase their independence and skills. The records of two staff employed within the last twelve months were checked and demonstrated that a thorough recruitment procedure is in operation. There was evidence that references and a satisfactory criminal records bureau check had been obtained prior to both staff being employed. Records of the interview process are also kept. A staff member on duty confirmed as did records that there is a formal induction procedure that new employees attend which takes a modular form and covers matters such as manual handling, communication, fire training and challenging behaviour. Comments from staff also confirmed that training is periodically updated. Training records were available however were not up to date in some instances such as when and who had attended the most recent medication training. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is well managed. The systems in place ensure that service users if able, relatives and staff can make their views known in order to contribute to the development of the service. There are satisfactory systems in place to help ensure the safety and welfare of service users. EVIDENCE: The organisation has a range of policies and procedures in order to promote the health, safety and welfare of service users. Records are in place to demonstrate how systems are monitored to ensure service users welfare. For example on this occasion records of tests of fire alarms, drills and training were checked and were up to date as were kitchen-cleaning rotas. Certificates 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 22 were available to demonstrate that systems such as the central heating are serviced on a regular basis. Staff said that they felt supported by the management team in the home and confirmed that there was a staff supervision and appraisal system in place. Records checked also demonstrated that the frequency of staff supervision had improved since the last inspection. Staff meetings are held on a monthly basis and staff said they felt comfortable to raise any issues and that their comments were listened to. An example of this was given by a staff member who said that in the staff meeting, held that day, it had been raised that a service user who could feed herself independently at breakfast time may be able to do so at other meals if she used the same dish. This suggestion was being put into practice at the time of the visit and the service user was able to eat her meal in a more independent manner. The organisation has a quality audit system, which was last undertaken between May-July 2004. It indicated that questionnaires had been sent to staff, service users representatives and other professionals. This self-audit identifies areas where the home could be improved and developed. Staff commented that current service users would be unable to complete a questionnaire however, staff feedback any observations they make which may indicate that a change in the service is needed to benefit service users. The manager confirmed that the home is due for another audit on 27/06/06. In addition the organisation has a system where a health and safety audit of the home is done and the report seen indicated that this was last carried out on 22/09/06. A management representative also visits the home at least monthly and produces a report, which comments on the quality of the service. This includes discussion with staff, involvement with residents and checks on record keeping systems and the environment. The CSCI have been receiving copies of the reports. The manager confirmed in a telephone discussion on 30th May 2005 that there are three staff who have completed National Vocational Qualification (NVQ) awards at level III, one at level II and the manager is in the process of completing his level IV award. In addition five staff are currently in the process of completing a care procedures course, which leads to an NVQ level II award. 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 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 2 23 2 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 3 34 3 35 2 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 3 X 3 X X 3 X 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 YA22 YA23 Good Practice Recommendations The complaints procedure should be given to service users in a format that is most appropriate for their needs such as Braille or symbol. An up to date version of the Local Authorities Adult Protection procedure (February 2005) should be obtained for display. Appropriate bathing facilities, which meet the needs of all service users, should be provided. It is acknowledged that a power shower is on order. Training records should be kept up to date in order to ensure that staff training is regularly updated. 3 YA35 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 25 Old Mill Park DS0000002310.V292397.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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