Inspection on 24/10/05 for Wall Hill

This inspection was carried out on 24th October 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Wall Hill 27/04/10

Wall Hill 18/02/10

Wall Hill 22/10/09

Wall Hill 15/06/09

Wall Hill 26/07/07

Wall Hill 14/08/06

Wall Hill 12/07/05

Wall Hill 23/11/04

Wall Hill 12/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Wall Hill Broad Street Leek Staffordshire ST13 5QA Lead Inspector Peter Dawson Unannounced Inspection 24th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wall Hill DS0000005030.V260843.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. 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. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Wall Hill Address Broad Street Leek Staffordshire ST13 5QA 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) 01538 399807 Wall Hill Care Home Limited Mrs Susan Jane Briand Care Home 31 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (9), Old age, not falling within any other category (31), Physical disability (9), Physical disability over 65 years of age (9) Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 9 PD - 1 of whom may be minimum age 50 years on admission 1 MD minimum age 55 years on admission Date of last inspection 12th July 2005 Brief Description of the Service: Wall Hill is a care home that is registered for 31 older people, 9 of who may have needs associated with a physical disability, and 9 of whom may have mental health needs. The home is located close to the centre of Leek, which has a wide range of community facilities. Close to the home itself there is a large supermarket and there are also pubs and other amenities. There is good access to local transport, and the home also has its own minibus, a well used and popular facility. The home was opened in 1992 and consists of a 2 storey building that has undergone considerable refurbishment to meet the needs of the service users. There are 29 single bedrooms, and 26 of these have en-suite facilities. There is 1 double bedroom. The rooms are pleasantly decorated and furnished, and have been personalised by the service users to reflect their individual tastes and interests. A range of attractive communal sitting areas are provided at Wall Hill, with four lounge areas and a large and attractive dining room that opens onto the rear grounds. There are ample toilet and bathing facilities in addition to the en-suite bedrooms. The home is set in large grounds that are well maintained and easily accessible. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At the time of this unannounced inspection there were 29 people in residence including 1 in hospital. There were 2 vacancies which is unusual for this home. There was also an anticipated transfer to another home following reassessment of needs. It is suggested that the home considers extension of categories of admission to include DE (Dementia Care). The home was bright, warm, welcoming and inviting on this bleak October day at 9 am. Some residents were rising, others had already had breakfast and sitting in the lounge areas, all later confirmed their rising times and preferred lifestyles were known and accommodated. The hairdresser arrived also at 9 a.m. and continued to provide a service to residents throughout the morning. The social and psychological benefits of the service being quite apparent. This is a weekly service provided to residents, additionally 2 residents go to a hairdresser of their choice in the community. The morning shift is inevitably a peak time for resident care but staff were facilitating personal care in a relaxed and professional way. It was pleasing to see most residents in the lounge areas mid-morning enjoying reading newspapers, engaging with other residents or simply enjoying the peaceful background music instead of compulsory TV viewing which becomes the staple diet for many homes. Residents willingly engaged in conversation with the inspector and all commented that they were happy with life at Wall Hill, speaking highly about staff care, activities, food and their preferred routines which were implemented. All showed a positive interest in the running of the home and ably expressed their opinions together or separately. The home seemed very much “alive”. The high standard environment continues to be enhanced with the ongoing redecoration/refurbishment taking place. This inspection was carried out by 1 inspector for a period of 4.5 hours, who had not visited the home for some years. Most residents were seen and the majority spoken to individually or in small groups, their views about the home were solicited. There was a tour of the environment including all communal areas and a sample of bedrooms. Records inspected included: care plans, fire records, staff files, medication records and other records relating to relevant aspects of the standards inspected. The Manager, who is “hands-on” providing care during the morning period was helpful and assisted greatly with the inspection process, hopefully without detriment to her care duties. A proprietor arrived during the morning and provided information concerning the administrative, management and practical aspects of the home. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 6 The impression gained was of a high standard environment with complementary standards of care. What the service does well: What has improved since the last inspection? What they could do better: Risk assessments must be provided for all resident activity. All staff must received regular fire drills. Recommended times by the Fire Officer are 6 monthly for day staff and 3 monthly for night staff. CRB/POVA First checks must be obtained prior to commencement of employment. Consider the extension of categories for admission to include Dementia Care (DE) Food hygiene training updates required for catering staff and consideration of similar training for care staff handling food. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 7 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. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3-5 Standards inspected relating to Choice of Home were found to be met. EVIDENCE: Records seen relating to a recently admitted person showed that pre-admission procedures had been followed. There was a copy of the Care Management Assessment and the homes own assessment. There had been appropriate introductions to the home prior to admission and a period of respite care. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7`- 10 Care plans were completed to a good standard based upon assessed need. Two plans were tracked and one did not contain a moving & handling risk assessment. Health care needs and interventions by health care professionals were well recorded chronologically allowing good monitoring of health care issues. Medication records were completed clearly and accurately. Residents were seen to be treated with respect and afforded privacy and this was supported in discussions with them. EVIDENCE: Care plans were sampled provided comprehensive information required to deliver care. Plans were based upon previously assessed needs on information provided by Care Management Assessments and the homes own assessments. Care plans are reviewed on a 1-2 monthly basis, changes made to plans as required or new ones established in instances of significant changes in need. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 11 Information contained photographs of residents, health care record sheets showing interventions of external health professionals. There is a reported good chiropody service to the home (NHS) and regular optical and dental checks. Information also recorded activity participation sheets – record of activities undertaken. In one instance there had not been a moving & handling risk assessment for a resident as required in standard 7.3 and this must be completed. It was reported that there were risk assessments relating to other resident activity e.g. smoking (not seen) and risk assessments are reviewed on a regular basis as part of the care plan. All residents were weighed regularly and this was recorded. Weighing is monthly for all unless there are concerns about weight loss. Daily notes are made for residents – sometimes twice (day/night) but these were not completed daily for all (sometimes there were 3-4 day gaps) but the home felt that this was adequate and avoided unnecessary reporting. It was confirmed that night staff check all residents hourly and similarly record any significant events. At this time there are no pressure area management issues in the home. The District Nursing service were visiting one resident 2-3 times per week in relation to ulceration and another resident to monitor occasionally skin viability following previous ulceration. The home reported a good service from the local GP surgery with visits to the home where appropriate. The GP required resident to visit the surgery where possible and this is the preferred course to promote independence and access to community facilities. One resident uses a wheelchair permanently, some require transport within the home for distances only. All are encouraged to sustain and improve mobility. One resident has insulin and self-administers (pen). Several residents are in the MD category (mental disorder) and well maintained on medication and their needs known, understood and carefully monitored by staff. Some staff have had recent training in mental health awareness covering the range of mental health conditions. A resident is currently being reassessed following indications of symptoms of dementia, she is being transferred to another home. The home report that this is at the request of relatives. The medication system was inspected. The Nomad system of MDS medication administration is provided by local pharmacy (Lloyds Chemists, Leek). MAR sheets were inspected and found to be complete and accurate when checked against the MDS system. MAR sheets are written by staff as monthly Nomad cassettes are received. It was suggested that the home could request printed completed MAR sheets for the Nomad system from the pharmacy thereby possibly ensuring accuracy but the Manager felt that the system they knew and operated was quite safe and they were comfortable with it. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 12 One resident part self- medicates. This is kept in her bedroom which is locked but there is no locked facility in the bedroom. All returns to the Pharmacy are recorded with a count of medication and countersigned by the pharmacy upon receipt thereby completing the medication audit trail. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 Routines are flexible and based upon residents choice of lifestyle. There are excellent activities provided and evidence of good social stimulation. Autonomy and choice are central to the homes philosophies. Food choice was reported to be good by residents and the attractive dining area provides a setting conducive with homely and social dining facilities. EVIDENCE: The majority of residents were seen and many spoken to in the communal areas of the home and some in bedroom areas. There are 4 lounge areas and it was refreshing to see that the compulsory TV (seen in many homes) were not switched on, instead background music was playing allowing social interactions or preferred peace whilst residents read newspapers, magazines etc. All commented that they liked to watch TV selectively but not consistently. The lounge areas allow small grouping of residents who can choose their seating and preferred company. There was good-natured bantering between a male and female group who sit together in the recessed areas of the lounge. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 14 Discussions with residents in these areas confirmed that their preferred lifestyles were known to staff and promoted and their choices known and respected. All commented positively about the activities provided in the home and also externally. There are the usual range of indoor activities including handicrafts, bingo, pop mobility etc. Some residents showed their jigsaws framed and hanging in the home. Entertainment is brought regularly into the home, this is very popular and is listed in the home. There are photographs of various activities to record and reflect upon the enjoyment provided. The home has its own mini-bus used very regularly to take residents either on trips to local places of interest or to take them to the town centre – uphill only ½ mile away. Some residents are able to go out alone and will visit the town or local large supermarket 100 metres away or will be taken to town, will shop and walk home. Residents spoke with enthusiasm already about the Christmas Party arrangements. Discussions with residents indicated their interest and enthusiasm for life in the home. This was particularly striking in this home. Residents are free to access their bedrooms throughout the day, in practice the majority clearly enjoy the social setting that the home provides and enjoy the interactions in the lounge areas. Family contacts are considered an integral part of care. There is an open visiting policy with regular visitors reported daily in the home. None were seen during the time of this unannounced inspection. It was reported that all residents had regular visitors, one that did not attended local social group and was active and able to self-advocate. Most residents seen were asked about food provision and all stated they were highly satisfied with the quality and quantity of food provided. There is an extremely attractive and spacious dining area with doors opening onto the rear patio area. Tables were attractively laid and the mid-day meal later seen served. Residents said their food choices were known and confirmed choice of dishes at mealtimes including hot choice always at teatime. Residents make main dish choices today for tomorrow. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Only one standard was inspected in this section in relation to complaints. This was found to be met. EVIDENCE: There is a complaints procedure in the home for visitors and residents, this complies with regulation 22. No complaints have been received by the home since the last inspection and no complaints received by the Commission. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 - 26 There is a high standard environment which is well maintained. Facilities for people with disabilities are good and there is registration for up to 9 PD (physical disability) residents. Bedrooms are comfortable, well furnished and well personalised reflecting individuality. The inspector commented particularly upon the high quality carpets, soft furnishings and bedding in the home. EVIDENCE: The home presents a very good standard environment. The reception area is welcoming and homely and all parts of the home are furnished and equipped to a high standard and there is an ongoing maintenance and redecoration/refurbishment programme. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 17 Since the last inspection two bedrooms have been re-carpeted/refurbished, others decorated. New beds have been purchased also. A lounge area was refurbished earlier this year with new chairs and furniture provided. Upgrading is on an ongoing basis in the home and is evident from the high standard environment. A bathroom was re-designed/refitted entirely earlier in the year and now presents a pleasant setting along domestic lines for bathing, with new bath hoist fitted to re-located bath position. Toilet areas were pleasant, clean and had appropriate toileting aids, grab rails etc. Handwashing facilities in most areas had soap dispensers and paper towels to ensure good infection control. Handrails/grab were seen to be fitted to all bathroom/toilet areas and en-suite areas as required and were evident in the corridor areas also. The standards of hygiene in the home were observed to be high - (there are 52 domestic hours per week). There were no mal-odours in the home. There are 9 bedrooms on the ground floor and 21 on the first floor. 26 have en-suite facilities and those that do not are located very close to toilet areas. There is one double bedroom shared for sometime by 2 residents. The call system was spot checked and found operative throughout the home. Hot water temperatures in bedrooms were sampled and were satisfactory. It was surprising to learn that the 3 bathroom areas did not have fail-safe devices fitted to ensure safety. The proprietor said that the 2 central thermostats on the main boilers controlled water temperatures and they were manually checked daily by staff in the bathroom areas prior to bathing with thermometers. The proprietor felt this was adequate to ensure safety. The inspector was not satisfied with the fact that full-body emersion areas were not protected by fail-safe valves and the options available to ensure protection of residents will be further discussed with the proprietors following the inspection. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30 The numbers and skill mix of staff appeared satisfactory for the operation of the home. A new member of staff had commenced duties prior to required police checks. These must always be carried out prior to employment. The inspector was unable due to time limitation speak directly to care staff but all were observed busily providing the care required to meet the needs of residents. Residents spoke highly about all staff. EVIDENCE: Staffing was discussed (staffing rota not seen). It was confirmed that staffing levels remain the same as at the last inspection which is as follows: 8–2 2 carers 1x carer 7 – 11 Plus Manager 2–7 2 Carers Plus Manager 7 – 10.30. 2 Carers 1x carer 7 – 9 Nights: 10.30 – 8 2 x Waking night staff Plus 1 person sleeping in. There are 52 domestic hours per week Catering staff work: Cook 7 – 2 Kitchen assistant 10 – 2 and 3 – 6.30. Additional care hours are provided as above to cover peak resident times e.g. 7 – 11am and 7 – 9 pm. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 19 The agreed staffing hours appear adequate for the needs of the current resident group. There is presently one vacancy for Care Assistant. There are 23 care staff and more than 50 have trained to NVQ 2 standard or above. 1 new member of staff undergoing induction training to NTO standards another new member of staff commencing. They will progress to NVQ training. Half the care staff received first aid training in September the remainder to train on 14.11.05. The home has an approved Moving & Handling trainer and all staff reported to have received this training with required updates. Basic food hygiene training has not been provided for care staff as recommended in the last report. 3 members of the catering staff are due to complete further Food Hygiene training on 21st and 23rd November. Staffing records were sampled relating to new appointments. One member of staff commenced duties before CRB was requested and therefore no POVA First check undertaken. Staff must not commence work until such checks have been made. It was noted that there were no copies of birth certificates on file, although these have been used to request CRB checks, it was suggested that a copy should be kept on file. Written references had been obtained as required. A training matrix is kept on computer and was inspected on the last visit. This was not done on this visit. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 – 33 and 37 - 38 The home is well managed by experienced managers. There is an open and inclusive atmosphere, proprietors closely the standards in the home with a daily accessible presence. Records seen were to a good professional standard. Fire drill times are being re-arranged to ensure all staff have required drills. Catering staff are to receive updated training in Food Hygiene and training for care staff should be considered as part of good practice. Infection control practices are good and standards of hygiene throughout the home excellent. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 21 EVIDENCE: The Registered Manager has the required experience to run the home. She was demonstrably readily available when approached by residents or visitors. At the time of the last inspection it was reported that the Manager was to enrol on a course of study for the Registered Managers Award. This was not discussed during this inspection and will be clarified on the next inspection. There are 3 proprietors who take an active daily role in the home. Two take responsibility for Care Practice, one being the Registered Manager. Another proprietor takes responsibility for administration, repairs/renewals and provides transport to residents as required. The system appears to work very well. Residents feel secure in the knowledge that there is always a member of the Management Team present who can be approached. The home provides written resident feedback forms which assesses service delivery. It was suggested to a proprietor that visitors could similarly usefully comment as there is usually a constant flow of visitors into the home. The home understand the importance of involving relatives/visitors in the lives of residents and telephone calls received during the inspection indicated there was an ongoing relaxed but professional involvement with relatives. The home understand the importance of keeping relative informed of the changing health and welfare needs of residents. Residents finance and finance relating to the home were not inspected on this visit. Records seen were well written, concise and to a good professional standard. Policies and procedures were not inspected on this visit. Fire records were inspected and all checks of the system and servicing evidenced and carried out as required. In relation to fire drills a requirement of the last report was to ensure that timing of drills ensured that all staff had at least one fire drill every 6 months. This has not been done and the timing of drills is reported to be in the process of change. This must be done. The fire risk assessment requires updating and the proprietor is in the process of doing this with required changes following his recent attendance on a Fire Training Course. Three catering staff are due to receive updated training in Food Hygiene on 21st & 23rd November, this must be done. A recommendation of the last report to provide basic food hygiene training for care staff who handle food has not been actioned and the home are asked to further consider this. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 22 There were good infection control practices observed in the home during the inspection. Handwashing/drying facilities in all areas are good and there are gloves/aprons readily available at strategic points throughout the home. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x x 3 2 Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? yes 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 OP38 Regulation 23(4) Requirement Timescale for action 30/11/05 2 3 OP7 OP29 13(4) 19(1)(b) Ensure that the timing of fire drills are varied so that all staff take part at least once every six months. Previous timescale of 30/09/05 not met Risk assessments must be 24/10/05 completed for all resident activity. Police/POVA checks must be 24/10/05 provided for all staff prior to employment. 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 OP38 OP4 Good Practice Recommendations Food hygiene training for 3 catering staff arranged for November is necessary and consider training for care staff in food hygiene. Consider application for extension of registration category DE to provide a service to existing and new residents. Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Wall Hill DS0000005030.V260843.R01.S.doc Version 5.0 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. 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. 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