Inspection on 27/02/06 for Welcome House - Ruby Lodge

This inspection was carried out on 27th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 30 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Welcome House - Ruby Lodge 12/06/06

Welcome House - Ruby Lodge 23/11/04

Welcome House - Ruby Lodge 08/06/04

Welcome House - Ruby Lodge 09/03/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

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

CARE HOME ADULTS 18-65 Welcome House - Ruby Lodge Ruby Lodge 58 Pelham Road Gravesend Kent DA11 0HZ Lead Inspector Sarah Montgomery Unannounced Inspection 27th February 2006 10:20 Welcome House - Ruby Lodge DS0000023771.V285275.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 Welcome House - Ruby Lodge DS0000023771.V285275.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. Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Welcome House - Ruby Lodge Address Ruby Lodge 58 Pelham Road Gravesend Kent DA11 0HZ 01474 355594 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) whrubylodge@aol.com Dr Toqeer Aslam Ms Teresa Moss Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th October 2005 Brief Description of the Service: Ruby Lodge is a registered care home for adults with mental health difficulties. It is a large detached property situated on the outskirts of Gravesend. It is close to several local amenities and a bus route. The property is set over three floors and has parking to the front and a garden at the rear. Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Sarah Montgomery (Regulation Inspector) and John Walker (Regulation Manager) conducted this unannounced inspection. Evidence was gathered from a variety of sources and included reading of care plans and risk assessments, inspecting pre assessment documentation, talking with the service users, and speaking with the registered manager. What the service does well: What has improved since the last inspection? What they could do better: Staffing levels are low, and this impacts on the quality of service delivered to residents. Care plans and risk assessments need to have more information regarding specific support needs of individuals. The statement of purpose and service user guide is not specific to the home. Services and opportunities described in these documents are not offered to residents. Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 6 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. Welcome House - Ruby Lodge DS0000023771.V285275.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 Welcome House - Ruby Lodge DS0000023771.V285275.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): 1, 2 and 3. Prospective service users cannot be confident that they have the information they need to make an informed choice about where they live. Prospective service users cannot be sure that their aspirations and needs will be assessed, or that the home will meet their needs. EVIDENCE: The statement of purpose and service user guide fails to meet national minimum standards and Regulation. The inspectors were disappointed to note that information in the above documents remain the same as all (9) Welcome House care homes, and is not (apart from differences in environment) specific to the services offered at the home. The inspectors used the statement of purpose and service user guide as a benchmark to evidence services available at the home to residents. To this end, inspectors spoke with the home manager, and service users, and read specific documentation including care plans, risk assessments, and pre assessment documentation. Daily care notes were also inspected. No evidence from this spectrum of information gathering could be found to support the statement of purpose or service user guide. Prospective service users and current service users might be mislead by these documents. Pre assessment documentation inspected contained comprehensive information about the service user, and recorded assessed support needs and risk assessments. However, evidence obtained indicated that a service user Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 9 assessed as requiring 24 care and support, with a supporting assessment detailing support needs such as personal hygiene, intake of food, and living skills, and risk assessments that detail a catalogue of self harm and suicide attempts, has been reassessed by the home as requiring 4 hours support per day. The home could not evidence how it is meeting the service user’s assessed needs. Furthermore, the home does not employ waking night staff, and inspectors could not evidence that the home is meeting the needs of service users at night. Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9. Service users cannot be sure their assessed and changing needs and personal goals are reflected in their individual plan, or that they are appropriately supported to take risks. EVIDENCE: Care plans and risk assessments inspected did not contain sufficient information which could be considered to be effective. The manager has written service user profiles for all residents. These profiles give a good baseline of information, and serve as a quick reference pen portrait. However, the general information in these profiles have not been enlarged upon in care plans and risk assessments. Consequently, assessed needs and methods of support are not detailed, and service users are not being adequately supported. The inspectors raised their concerns with the manager about care plans and risk assessments for a service user who has a history of self-harm. An example of this is a risk assessment stating the risk as ‘ neglect and self harm’. The approach then states; regular 1-1 sessions with manager and staff’. The risk assessment and care plan for this service user are not descriptive, and do not Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 11 provide adequate guidance for staff on either the triggers for behaviours, or make reference to any pro-active preventative support or interventions. 1-1 records for this service user were inspected. He has had one 1-1 session. This was in February 2005. Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): THESE STANDARDS WERE NOT INSPECTED. EVIDENCE: Welcome House - Ruby Lodge DS0000023771.V285275.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): 19. Service users cannot be confident that their emotional health needs will be met. EVIDENCE: Ruby Lodge has 15 service users living at the home. All have diagnosed mental health problems. Of the files inspected, inspectors noted that many service users displayed behaviours, which were symptomatic of their mental health diagnosis. I.e.: mood swings, depression, self-harm and neglect. The manager confirmed this. The rota presented to inspectors indicated that the home has low staffing levels. Consequently the inspectors question how much time during a shift staff have to spend with individual service users. Staff on duty are responsible for all cooking and cleaning. Conversations with the manager, and information read on individual service users files, did not evidence how, if at all, staff at the home were both knowledgeable about the emotional needs of the service users, or how they were meeting the needs. 1-1 records of a number of service users were read, as were monthly reports. Notes from these meetings did not address support needs, and many were Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 14 exactly the same from one month to the next. Information recorded was considered too general, and in several examples seen, the reports seemed to focus on commenting about the weather, rather than focussing on specific issues regarding service users. Welcome House - Ruby Lodge DS0000023771.V285275.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 Service users cannot be sure that their views are listened to and acted upon. EVIDENCE: Although the home has a complaints procedure, a conversation during the inspection with a service user indicated that they did not know of its existence, did not appear to be knowledgeable about their right to complain, nor would they feel confident about using it. The home must ensure that all service users are informed about the complaints procedure, and feel confident about using it. The inspectors recommend that service users are given ‘training’ during house meetings on the complaints procedure, and how to complain. Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 16 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): THESE STANDARDS WERE NOT INSPECTED. EVIDENCE: Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 17 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): 33 and 34. Service users cannot be confident that an effective staff team supports them. Service users cannot be confident they are supported and protected by the home’s recruitment policy and practices. EVIDENCE: The current staffing hours allocated to Ruby Lodge are 22 hours per day Monday to Friday, and 14 hours per day Saturday and Sunday. A total of 138 hours per week. The manager informed inspectors that the home goes above those hours, and the total staffing hours per week are 153. The home is registered for 17 service users. Figures from the Residential Forum for this number of service users in a registered care home providing support to service users with mental health issues are 353.84 per week. The home is running a deficit of 200.84 hours per week. Evidence gathered from the inspection not only suggests that service user’s needs are not being met, but also indicates that the Welcome House mission statement ‘To promote independence through supporting and encouraging our service users to lead as normal life as possible and to reach their full potential’ may not be fulfilled with the substantial gaps in staff numbers. Staff files inspected did not comply with Regulation. Welcome House have not taken appropriate steps to ensure service users are protected from harm, in that, they have not followed correct procedure when taking up references of Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 18 employees. Two staff files contained references that were unsatisfactory, both in content of what was written, and in information sought from Welcome House. The registered provider and registered manager must ensure that all references are satisfactory and comply with legislation, prior to offering employment. Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 19 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 and 43. Service users benefit from having a manager who is committed to excellence in service delivery, but cannot be sure that this is achieved because of overall shortfalls in management of the service. EVIDENCE: The manager impressed both inspectors. She displayed insight and knowledge regarding the service users in her care, and also demonstrated management skills. However, evidence gathered throughout the inspection demonstrated that service delivery is compromised, and that overall, outcomes for service users are poor. Support given to service users appears to be minimal, and care plans, risk assessments and pre assessments are inadequate documents which do not serve the needs of the service user, or assist staff in providing clarity regarding methods and approaches of care and support. The underlying factor in the above would appear to be the significantly low staffing levels. Shortfalls in staff numbers must be rectified. Without an adequate staff team the home will not be in a position to properly support Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 20 individual service users in line with National Minimum Standards and Care Home Regulations. Inspectors recognise that the registered person determines staffing levels, and that the overall management of the service is determined by his leadership and by the resources he deploys to the home. The registered person is required to undertake a review of all service delivery at Ruby Lodge, as determined by the homes own statement of purpose, and by National Minimum Standards and Care Homes Regulations. Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 21 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 1 2 1 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 x 33 1 34 1 35 X 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 X X 1 X LIFESTYLES Standard No Score 11 x 12 x 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 1 X X 1 X X X X X 1 Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 22 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 YA1 Regulation 4(1)(a) Requirement The registered person shall compile in relation to the care home a written statement (in these Regulations referred to as “the statement of purpose”) which shall consist of – (a) a statement of the aims and objectives of the care home; The registered person shall compile in relation to the care home a written statement (in these Regulations referred to as “the statement of purpose”) which shall consist of – a statement as to the facilities and services which are to be provided by the registered person for service users; and (c) a statement as to the matters listed in Schedule 1. The registered person shall supply a copy of the statement of purpose to the Commission and shall make a copy of it available on request for DS0000023771.V285275.R01.S.doc Timescale for action 27/04/06 2 YA1 4(1)(b) 4(1)(c) 27/04/06 (b) 3 YA1 4(2) 27/04/06 Welcome House - Ruby Lodge Version 5.1 Page 23 4 YA1 4(3)(a) 4(3)(b) 5 YA1 5(1)(a) 5(1)(b) 6 YA1 5(1)(c) 5(1)(d) inspection by every service user and any representative of a service user. Nothing in regulation 16(1) or 23(1) shall require or authorise the registered person to contravene, or not to comply with – (a) any other provision of these Regulations; or (b) the conditions for the time being in force in relation to the registration of the registered person under Part 2 of the Act. The registered person shall produce a written guide to the care home (in these Regulations referred to as “the service user’s guide”) which shall include – (a) a summary of the statement of purpose. (b) The terms and conditions in respect of accommodation to be provided for service users, including as to the amount and method of payment of fees; The registered person shall produce a written guide to the care home (in these Regulations referred to as “the service user’s guide”) which shall include – A standard form of contract for the provision of services and facilities by the registered provider to service users; (d) The most recent inspection report; The registered person shall produce a written guide to the care home (in these Regulations referred to as “the service user’s DS0000023771.V285275.R01.S.doc 27/04/06 27/04/06 27/04/06 (c) 7 YA1 5(1)(e) 5(1)(f) 27/04/06 Welcome House - Ruby Lodge Version 5.1 Page 24 guide”) which shall include – A summary of the complaints procedure established under regulation 22; (f) The address and telephone number of the Commission. The registered person shall supply a copy of the service user’s guide to the Commission and each service user. Where a local authority has made arrangements for the provision of accommodation, nursing or personal care to the service user at the care home, the registered person shall supply to the service user a copy of the agreement specifying the arrangements made. The registered person shall – (a) keep under review and, where appropriate, revise the statement of purpose and the service user’s guide; and (b) notify the Commission and service users of any such revision within 28 days. The registered person shall not provided accommodation to a service user at the care home unless, so far as it shall have been practicable to do so – (e) 8 YA1 5(2) 27/04/06 9 YA1 5(3) 27/04/06 10 YA1 6(a) 6(b) 27/04/06 11 YA3 14(1)(d) 07/04/06 12 YA2 14(1)(a) 14(1)(b) (d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. The registered person shall not 17/04/06 provide accommodation to a service user at the care home DS0000023771.V285275.R01.S.doc Version 5.1 Page 25 Welcome House - Ruby Lodge 13 YA2 14(1)(c) 14 YA2 14(2)(a) 14(2)(b) 15 YA6 15(1) 16 YA6 15(2)(a) 15(2)(b) 17 YA6 15(2)(c) 15(2)(d) unless, so far as it shall have been practicable to do so – (a) needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so – (c) there has been appropriate consultation regarding the assessment with the service user or a representative of the service user; The registered person shall ensure that the assessment of the service user’s needs is – (a) kept under review; and revised at any time when it is necessary to do so having regard to any change of circumstances. Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall – (a) make the service user’s plan available to the service user; (b) keep the service user’s plan under review; The registered person shall – (c) where appropriate and, unless it is impracticable to carry out such consultation, DS0000023771.V285275.R01.S.doc 30/04/06 30/04/06 30/04/06 30/04/06 30/04/06 Welcome House - Ruby Lodge Version 5.1 Page 26 18 YA6 12(1)(a) 12(1)(b) 19 YA9 13(4)(b) 13(4)(c) 20 YA19 12(1)(a) 12(1)(b) 21 YA19 12(2) after consultation with the service user or a representative of his, revise the service user’s plan; and (d) notify the service user of any such revision. The registered person shall ensure that the care home is conducted so as – (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care, and where appropriate, treatment, education and supervision of service users. The registered person shall ensure that – (b)any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The registered person shall ensure that the care home is conducted so as – (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. The registered person shall so far as is practicable enable service users to make decisions with respect to the care they are DS0000023771.V285275.R01.S.doc 30/04/06 17/04/06 30/04/06 30/04/06 Welcome House - Ruby Lodge Version 5.1 Page 27 22 YA19 12(3) 23 24 YA22 YA33 22(2) 18(1)(a) 25 YA34 19(4)(a) 19(4)(b) 26 YA34 19(4)(c) to receive and their health and welfare. The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feeling. The complaints procedure shall be appropriate to the needs of service users. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users – (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person shall not allow a person to whom paragraph (2) applies to work at the care home in a position to which paragraph (3) applies, unless – (a) the person is fit to work at the care home; (b) the employer has obtained in respect of that person the information and documents specified in – (i) paragraphs 1 to 7 of Schedule 2; and has confirmed in writing to the registered person that he has done so; and The registered person shall not allow a person to whom paragraph (2) applies to work at the care home in a position to which paragraph (3) applies, unless – DS0000023771.V285275.R01.S.doc 30/04/06 30/04/06 17/04/06 30/03/06 30/03/06 Welcome House - Ruby Lodge Version 5.1 Page 28 27 YA37 10(1) 28 YA43 24(1)(a) 24(1)(b) 29 YA43 24(3) 30 YA43 24(2) (c) the employer is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person, and has confirmed in writing to the registered person that he is so satisfied. The registered provider and the registered manager shall, having regard to the size of the care home, the statement of purpose, and the number and needs of the service users, carry on or manage the care home (as the case may be) with sufficient care, competence and skill. The registered person shall establish and maintain a system for – (a) reviewing at appropriate intervals; and (b) improving, the quality of care provided at the home. The system referred to in paragraph (1) shall provide for consultation with service users and their representatives. The registered person shall supply to the Commission a report in respect of any review conducted by him for the purposes of paragraph (1), and make a copy of the report available to service users. 30/04/06 30/04/06 30/04/06 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 29 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. Extracts may not be used or reproduced without the express permission of CSCI Welcome House - Ruby Lodge DS0000023771.V285275.R01.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!