Inspection on 09/11/05 for Seven Springs Cheshire Home

This inspection was carried out on 9th November 2005.

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Seven Springs Cheshire Home 11/11/08

Seven Springs Cheshire Home 13/11/06

Seven Springs Cheshire Home 08/07/05

Seven Springs Cheshire Home 01/12/04

Seven Springs Cheshire Home 23/07/04

Seven Springs Cheshire Home 28/01/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Seven Springs Cheshire Home Seven Springs Cheshire Home Pembury Road Tunbridge Wells Kent TN2 4NB Lead Inspector Debbie Sullivan Unannounced Inspection 9th November 2005 10:00 Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 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 Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and 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. Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Seven Springs Cheshire Home Address Seven Springs Cheshire Home Pembury Road Tunbridge Wells Kent TN2 4NB 01892 531138 01892 533522 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) Leonard Cheshire Mr Jason Robert Semple Care Home 32 Category(ies) of Physical disability (32) registration, with number of places Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registration is restricted to three residents PD(E) whose dates of birth are: 9 February 1935, 18 September 1931 and 20 February 1929 8th July 2005 Date of last inspection Brief Description of the Service: Seven Springs Cheshire Home occupies a large building, part of which is within a period house and part developed around the premises. Accommodation is on two floors with access to the upper level via stairs or a shaft lift. The premises include a day centre, hydrotherapy pool and physiotherapy unit. There are two double bedrooms for residents; one is in a newly furnished bungalow adjoining the main building. Communal areas include the dining room and lounges. The home has spacious, attractive grounds and a patio area. A number of independent living bungalows are situated within the grounds, these are not included in the registration. The home is approximately one mile from the centre of Tunbridge Wells, a bus service is within a short distance and the train station is in the town centre. Plans are in place for substantial refurbishment of the property. Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours. Time was spent with the homes’ manager, other members of staff, volunteers and residents both individually and in communal settings, touring the premises and reading documentation. Throughout the inspection staff were knowledgable, open and helpful and there was a friendly atmosphere in the home. At the time of the inspection there were two resident vacancies and staffing vacancies in terms of a carer and physiotherapist. Comments made during the inspection by residents included, “The care is excellent” “The manager listens to what I am saying” “I am seen as an individual” and “I have a very nice room”. Comments from staff and volunteers included, “There is a nice atmosphere” “I am quite lucky being here” “I am impressed by the organisations’ policies and structure” A visiting professional said, “ The home is friendly and welcoming”. What the service does well: Care plans include information on all aspects of residents’ lives and give a very clear picture of individual needs. Health care needs are well-supported and outside professionals consulted regarding any changes or concerns. Residents are able to be involved in activities within the home and day centre and can book transport for individual trips. Staff are well trained and supported and show commitment to their roles. Meals are varied and well cooked. Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 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. Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 4. The home provides prospective residents with written information and the opportunity to visit the home so that they can make an informed choice. Needs are fully assessed and a place only offered if they can be met. EVIDENCE: The homes’ statement of purpose and service users’ guide provide written information for prospective residents. The needs of residents are fully assessed prior to admission by the homes’ manager or the head of care. Prospective residents are able to visit, one resident spoke of spending some time at the home for respite and then choosing to stay and a visiting care manager had seen three possible homes with a client who subsequently made a decision to move to Seven Springs after spending a week’s trial there. Reviews are held within a few weeks of moving in to ensure that needs are being met and to Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 9 address any matters or problems that may have arisen during the settling in period. A fairly new resident was settling in well and becoming more confident. The pre admission assessment identifies any specialist needs and where these are not within the remit of the home input from outside professionals such as District Nurses and Speech therapists is requested. Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 and 10. Care plans contain comprehensive information and show that residents are involved with making decisions about their care. Residents are consulted regarding the running of the home. Records are kept safely and confidentially. EVIDENCE: A number of care plans were read; they were very comprehensive and included information on health, personal care, social activities and interests, risk assessments, and statements regarding personal needs and preferences from residents. Organisational forms are used for each section and whilst information was clear and easy to find there was a lot of paperwork that in some instances could have been combined or reduced. The home accommodates a small number of residents who are over 65; currently their Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 11 needs are reviewed at the same intervals as other residents, they will need to be reviewed monthly in future. Care plans and discussion with residents showed that residents are able to make decisions and choices about their daily lives and that they are invited to become involved in the running of the home. Residents are included in interviews for new staff, have been consulted regarding plans for refurbishing the home and can take part in residents’ meetings or the Disabled Peoples’ Forum. A residents survey is circulated annually. Residents take part in a wide variety of activities both within the home and the community and the opportunity to book the homes’ transport for local and more distant journeys considerably widens the scope for choice of regular or other trips. Residents are supported to manage their own finances if they wish to and are given information on advocacy if this is an identified need. Advocacy information was displayed on a notice board Care plans and other records are kept confidentially in the care or managers’ office. Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16 and 17. The home offers opportunities for social, leisure and recreational activities and for individual interests to be pursued Residents rights to privacy, choice and to maintain relationships are respected. Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 13 Meals are varied and of a high quality. EVIDENCE: During the inspection residents were taking part in activities of their choice. Some residents were attending the day centre and others were in communal areas or their rooms. A morning quiz session was well attended in the day centre, as was a music group in the afternoon, which was coordinated by a volunteer and designed to help residents relax and express their thoughts in drawings. Work had begun on a Christmas production that residents were to present for staff. Trips into Tunbridge Wells and places of interest are arranged and residents are supported to pursue personal interests in the community. One resident spoke of attending a singing group and regularly going to Tunbridge Wells to shop and attend to personal finances and another had arranged to go to country and western concerts. Information on events and activities was displayed on notice boards throughout the home such as trips to the cinema, theatre and football matches. Visitors are welcome at any time and a room is available for residents to see them in private. Residents rights to privacy and independence are respected, locks are fitted on bedroom doors and those spoken with said that they felt able to exercise choice and although occasionally they were not able to go out when they wished due to lack of drivers or transport this was not a huge problem. The dining room is spacious and lunchtime was a relaxed and sociable time, residents are offered a choice of meal with a vegetarian option. The cook is very aware of individual preferences and residents said that they could always go to the kitchen and ask for something different. Special diets are catered for; a resident who was following an organic diet said that the home supported them to do so. Importance is placed on using fresh fruit and vegetables, the meal was well presented and those needing help with eating were appropriately assisted. Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) 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 and 21. Residents’ personal and healthcare needs and preferences are respected and good health promoted. Equipment is available to aid and maintain independence. Support is given sensitively to residents near the end of their lives and their relatives. EVIDENCE: Care plans included clear details of residents’ preferences regarding personal support needs, one example being gender preference. Residents spoken with said that they were happy with the care they receive and were complimentary about care staff. Health needs were also clearly recorded and care plans include a section to record contact with health and other professionals such as G.P.’s, dentists and District Nurses. The home’s physiotherapist post had been vacant for some time despite advertisement, so consideration was being given Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 15 to securing support from a physiotherapist in another service to undertake assessments. Specialist equipment is very much in evidence in the home so that independence can be maintained as far as possible and residents’ rooms contained equipment for personal use. One resident was in hospital, the manager and care team leader were concerned that the specialist support needed was not forthcoming in that setting, so additional visits from staff to the resident were planned and contact made with the hospital to air concerns about nutritional intake and the general comfort of the resident. The medication room and lunchtime medication round were observed, medication is stored correctly and medication given according to procedures. Residents are given the option to self medicate, this is recorded on the MAR sheet and well documented in care plans. A resident had passed away since the last inspection, the manager discussed support offered to residents, relatives and staff when a resident dies or is terminally ill. Counselling is available and staff are offered specialist training although not many take this up. A memorial service had been held for the resident. Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16, 18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 16, 18 and 35 (Older People) 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. Residents can feel confident that concerns and complaints will be listened to and taken seriously. Residents are protected from abuse by the policies and procedures adhered to by the home. EVIDENCE: The organisational complaints procedure is used at the home. Complaints are documented and responded to according to procedures. There had been one complaint since the last inspection that had been resolved. Staff and residents spoken with were aware of the procedure and residents said they would feel confident in referring any concerns to the manager, one said they felt that the manager listened to what they said. New staff are provided with adult protection training and have CRB and POVA checks prior to commencing employment. Staff confirmed that POVA training was given; this was also evidenced on training records. If any new staff commence employment before their CRB disclosure is through they do not work unsupervised. The home had recently recruited a cook to cover weekends who was still awaiting CRB clearance so other kitchen staff were needing to double up until it was through, this was not cost effective but necessary to comply with standards and procedures. Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 17 Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 and 30. Individual accommodation meets the needs of residents. Refurbishment planned will improve the building and make the home more suitable for the needs of residents. EVIDENCE: Seven Springs occupies a period building and newer premises built around it, consequently some bedrooms in the older part of the building are much more in need of refurbishment than those in the newer part of the building. Bedrooms on the lower and upper floors of both parts of the home were seen; Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 19 those inspected were clean with no odours and were well decorated, some have recently been redecorated and others especially on the upper floor in the old building will benefit from a planned programme of refurbishment scheduled for 2006. Residents, relatives and other interested parties have been extensively consulted regarding plans and residents spoken with were interested to know if they would be offered different rooms following the work. Individual bedrooms seen were personalised with the interests and personality of the resident clearly reflected via posters, pictures and other decorations. En -suite toilets and bathrooms afford privacy. Communal toilet and washbasin areas on the upper floor in the old part of the building are not suitable for use by residents as they are in a poor state of repair, for example there is peeling wall covering, tiles are off the wall and there are holes in the plaster. The manager was very aware that these repairs were due and were to be dealt with during the refurbishment. Whilst the work is planned, the decor on the upper corridor is becoming more run down and it is not an attractive area for residents. Shared space includes a recently redecorated large lounge, smoking/television lounge, dining room and the patio area used in good weather. Residents were making good use of the smoking/television lounge during the inspection although the large lounge was mainly unoccupied and residents preferred to access the day centre or individual rooms. Volunteers at the home occupy a further upper floor. . Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 and 36. A well-trained and confident staff group supports residents. Staff are well supported and the recruitment process protects residents. EVIDENCE: Seven Springs has a well-established staffing structure; staff observed and spoken with were clear about their roles, enjoyed working at the home, responded appropriately to residents and were aware of individual needs. A volunteer had decided to give up a day off to take a session in the day centre for the benefit of residents. A member of the care staff liked having the opportunity to take residents out, due to two new admissions additional staffing was needed; existing staff had advised the manager that time to assist residents with socialising was curtailed due to the need to prioritise care needs Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 21 and as a result recruitment was taking place, which was seen as very positive response. Residents spoke well of staff; one comment was, “ they are a caring lot”. Residents are involved in interviews; a record of this is kept on staff files. Files were sampled, information was easy to find and included CRB and POVA disclosures and references. Staff receive induction and update training which is given by the Leonard Cheshire organisation and other providers. Recent training had included, key working, Health and Safety and manual handling. Training is tracked and the staff notice board contained information on courses. Ten care staff and four day centre staff have recently enrolled on an NVQ course. Care and other staff spoken with said they had regular supervision and staff meetings are held. Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41 and 42. Residents and staff benefit from a well managed home with an open management style. Organisational policies and procedures protect the health and safety of residents. EVIDENCE: Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 23 The home is well run in the best interests of residents, both staff and residents spoken with felt that the manager was approachable and supportive. The atmosphere in the home was friendly and open, day-to-day operations are underpinned by the organisations’ policies and procedures that give clear direction and structure. Some policies and procedures were inspected and maintenance and safety checks seen were up to date. The fire safety records showed that regular fire drills are held at varying times of day the last being in October at night and other fire safety checks take place. Fridge and freezer temperatures were recorded daily and in range, as were drug fridge temperatures, bath temperatures are recorded on care plans. The views of residents are sought via surveys and residents meetings are held. Recently much consultation has taken place with residents and others over plans for the home. Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 4 35 3 36 3 CONDUCT AND MANAGEMENT 37 3 38 3 39 3 40 3 41 3 42 3 43 X Standard No 6 7 8 9 10 LIFESTYLES 11 12 13 14 15 16 17 Score 2 3 3 3 3 3 3 3 3 3 3 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 3 Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 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 YA24 Regulation 23(2)(b) Requirement “The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally” In that should major refurbishment not take place within a proposed timescale necessary repairs especially to the environment in the upper corridor must take place. “ The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home” In that repairs to toilet and washroom areas on the upper floor must be made if planned refurbishment is delayed. Timescale for action 31/12/05 2 YA42 13(3) 31/12/05 Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 26 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 OP7 YA6 Good Practice Recommendations 1 2 It is strongly recommended that the needs of residents who are over 65 be reviewed on a monthly basis. It is recommended that care plan documentation be reviewed to establish if some sections can be combined or condensed. Seven Springs Cheshire Home DS0000024006.V265346.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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