Care Home: 126 Castle Lane

Similar services:

• Polesworth Group Friary Road
• Polesworth Group Pooley Heights
• Polesworth Group 32 Station Road
• Polesworth Group 70 Long Street
• Breme
• Polesworth Group 64 Long Street
• Polesworth Group 68 Long Street
• 10 Whitfield Avenue

What the care home does well This service meets the key national minimum standards. All identified areas for improvement made at the last inspection have been addressed in a timely manner to ensure positive outcomes for the people who live there. The home presented with a very relaxed atmosphere. Staff on duty appeared confident and competent in their role, and were careful to ensure that peoples diverse needs and wants were met. Peoples care plans reflect their assessed needs. They are detailed and informative ensuring that staff are able to provide appropriate support. Similarly risk assessments enable people to take meaningful risks in a safe manner. People are actively supported to make decisions about their lives both on a daily and more long term basis by staff. The home is staffed on a 24 hour basis which gives people support to participate in activities of their choosing. These include attendance at a local college and day centre as well as participating in their interests, hobbies and leisure pursuits. These are varied and reflective of individual likes and dislikes. Relationships with families and friends are important to people, and are encouraged and supported by the home.Individual menus are planned on a weekly basis, and a modern, clean, tidy and well stocked kitchen enables people to choose from a range of meal options. Support and encouragement with healthy eating is provided. People`s personal care needs are identified within their support plans. Health and wellbeing is also promoted via attendance at routine and more specialized healthcare appointments as necessary. Where medication is managed on peoples behalf it is done so safely, similarly one person is supported to manager her own medication safely. The home presented as modern, comfortable and clean with no offensive odours apparent. It was decorated nicely with good quality furniture and soft furnishings throughout. Staff numbers are satisfactory for the number of people living in the home. Recruitment procedures are generally robust and designed to safeguard people. Training undertaken by the staff team ensures that a competent and sufficiently knowledgeable team supports the people who live in the home. Management systems now in place are robust. The quality of the service is monitored regularly, and the use of formal systems to test the quality provided ensure that the people living in the home are at the forefront of service development. Health and safety is managed effectively. What has improved since the last inspection? What the care home could do better: CARE HOME ADULTS 18-65 126 Castle Lane 126 Castle Lane Olton Solihull West Midlands B92 8RW Lead Inspector Justine Poulton Unannounced Inspection 7th August 2008 09:00 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 126 Castle Lane Address 126 Castle Lane Olton Solihull West Midlands B92 8RW 0121 743 1110 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) Robinia Care West Midlands Limited Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th July 2006 Brief Description of the Service: 126 Castle Lane is located along a quiet residential road in the Olton area of Solihull. The service is close to local bus routes for Solihull and Birmingham. It is within reasonable walking distance to local amenities. It is currently registered to provide accommodation and support for three adults with a learning disability. The current established group are three women. The premises consist of three single bedrooms one of which is located on the ground floor. There is also a toilet, lounge, dining room and a fully equipped modern kitchen on the ground floor. On the first floor is a bathroom with a bath, shower cubicle, toilet, and wash hand basin. There is also an office that is used as a sleep in room. To the rear of the property is a large well maintained mainly lawned garden and there is limited roadside parking. The building is not accessible for people with mobility difficulties including wheelchair users. The weekly fee for this home was not available in the Statement of Purpose or service user guide looked at. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was carried out to establish the outcomes for people living in the home, and to confirm whether they are protected from harm. Identified key standards were looked at, along with a review of the organisations progress towards meeting any requirements made at the previous inspection of this service. The pre fieldwork inspection record was completed, as well as a site visit to the home, during which time staff, people living in the home and the manager were spoken with. A completed annual quality assurance assessment was received from the service prior to the inspection. Two people currently living in the home were identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for service users. Records, policies and procedures were examined and the environment was looked at. All of the people living in the home were at home for the inspection. The inspector would like to thank the people living in the home, the manager and staff for their hospitality and co-operation during the inspection. What the service does well: This service meets the key national minimum standards. All identified areas for improvement made at the last inspection have been addressed in a timely manner to ensure positive outcomes for the people who live there. The home presented with a very relaxed atmosphere. Staff on duty appeared confident and competent in their role, and were careful to ensure that peoples diverse needs and wants were met. Peoples care plans reflect their assessed needs. They are detailed and informative ensuring that staff are able to provide appropriate support. Similarly risk assessments enable people to take meaningful risks in a safe manner. People are actively supported to make decisions about their lives both on a daily and more long term basis by staff. The home is staffed on a 24 hour basis which gives people support to participate in activities of their choosing. These include attendance at a local college and day centre as well as participating in their interests, hobbies and leisure pursuits. These are varied and reflective of individual likes and dislikes. Relationships with families and friends are important to people, and are encouraged and supported by the home. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 6 Individual menus are planned on a weekly basis, and a modern, clean, tidy and well stocked kitchen enables people to choose from a range of meal options. Support and encouragement with healthy eating is provided. People’s personal care needs are identified within their support plans. Health and wellbeing is also promoted via attendance at routine and more specialized healthcare appointments as necessary. Where medication is managed on peoples behalf it is done so safely, similarly one person is supported to manager her own medication safely. The home presented as modern, comfortable and clean with no offensive odours apparent. It was decorated nicely with good quality furniture and soft furnishings throughout. Staff numbers are satisfactory for the number of people living in the home. Recruitment procedures are generally robust and designed to safeguard people. Training undertaken by the staff team ensures that a competent and sufficiently knowledgeable team supports the people who live in the home. Management systems now in place are robust. The quality of the service is monitored regularly, and the use of formal systems to test the quality provided ensure that the people living in the home are at the forefront of service development. Health and safety is managed effectively. What has improved since the last inspection? What they could do better: Although no requirements have been made at this inspection the following good practice recommendations are made: • • The organisation should ensure that it addresses any requests for replacement for broken appliances within a timely manner It is recommended that consideration be given to providing an en-suite shower room in the garage conversion in preparation for if the mobility of 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 7 • the service user occupying the room deteriorates to the point where she can no longer safely negotiate the stairs to get to the bathroom. Written references should be sought for all people offered employment with the organisation, and be kept in their individual personnel files 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. The summary of this inspection report can be made available in other formats on request. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 8 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 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): x x EVIDENCE: The three women living in the home have lived together for a considerable number of years, as such no one new has moved into the home recently. Key standard 2 was therefore deemed not to be applicable on this occasion. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. Comprehensive care plans and risk assessments continue to ensure that the well being, independence and safety of the people living in the home are promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff are in the process of compiling peoples individual support plans into a new format that makes use of pictures and photographs with a view to making them more meaningful to each person. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 11 Two peoples personal documentation was looked at, one of which included a new format support plan and one which was in the current format. Both were comprehensive and detailed and included information such as “things that are important to me”; “things that I don’t like”; “things I enjoy”; “my support routines”. The information was clear and detailed thus enabling staff to provide care and support as needed. In addition to the support plans each person also had a series of pertinent risk assessments. These included things such as self medication; inappropriate behaviours; financial abuse; communication and one off specific risk assessments relating to a holidays. The risk assessments available were all in need of reviewing, however staff on duty confirmed that they are in the process of doing this to include photographs and pictures in line with the new support plan format, and were seen to do some work in these on the homes computer during the inspection. The abilities of the people living in the home vary greatly from one person who is able to make decisions for herself with minimal staff guidance to one person who requires much more staff support. During the inspection staff were seen to respond appropriately to requests for advice, or support people with making decisions that affected them. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. The people who live in this home have the opportunity to live ordinary and meaningful lives within the community in which they live. Support to maintain and develop family links and friendships is available. A varied selection of food is available that meets service user’s dietary needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A variety of activities are offered to people during the week, ranging from attendance at a local day centre, college courses, horse riding, a multi sensory centre called Relaxaway, the White Room which is also a sensory environment, music therapy and shopping, occasional meals out, trips to the cinema, annual 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 13 holidays and rides and walks around the local community. As well as the daily records that included the activities people had participated in, an activities record was in place in one of the files looked at. This indicated that in one week the person had been to the day centre, had lunch out attended Relaxaway, been for a drive out and spent time listening to music. One person spoken with said how much she enjoyed her independence, and told how she had recently been away on an unaccompanied holiday, into Birmingham shopping and how she enjoys going away for unaccompanied weekends. During the inspection one person was looking forward to going to music therapy and chatted about how she enjoys horse riding. Another person who has non verbal communication has a variety of multi sensory objects that she was observed to be enjoying throughout the inspection. Peoples’ individual routines were known and respected. There were records in place to confirm people’s participation in any domestic tasks including laundry, making drinks, clearing the dining table and cleaning their bedrooms. Relationships between the staff and the people living in the home were seen to be positive and friendly with lots of laughter. Records looked at confirmed that one person has regular visits from two of her sisters and goes out with them at weekends while another has been in a long term relationship for a considerable number of years which staff have been very supportive of. Another person does not have any family contact although she has regular contact with an advocate from the Advocacy in Action group based in Solihull. The home has a modern, clean kitchen that has the usual domestic appliances in it. Menus are planned on a weekly basis with the people living in the home using a variety of communication methods including pictures and photographs of meals for people to choose from as necessary. Individual preferences and dislikes are also taken into consideration and the staff support people with choosing a healthy diet. Individual records of foods eaten are maintained. Food is shopped for on a weekly basis. On the day of the inspection there were plentiful stocks of fresh, frozen and processed foods available as well as snacks and a variety of hot and cold drinks. Records were also available to confirm that all of the necessary food hygiene and kitchen health and safety checks are maintained. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 21 Quality in this outcome area is good. People can be satisfied that they are supported to maintain their personal care and healthcare needs. Medication is managed safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people who live in the home have a wide range of support needs in relation to their personal care. These range from being completely independent to requiring hands on support with personal care tasks. Records looked at confirmed that their personal care needs were clearly detailed within their care plans, thus ensuring that the staff were able to provide people with the assessed levels of support. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 15 Each person had a health action plan in place in which details of their Doctor, Dentist, Chiropodist and Optician were recorded. Information was available to confirm that they are offered routine healthcare appointments with these healthcare professionals at the recommended intervals. Information was also available to demonstrate that more specialised healthcare needs are addressed as appropriate, with appointments with speech and language therapists and psychiatrists along with the outcomes from these appointments recorded. One person is responsible for managing her own medication. Staff give her a weeks worth each Monday morning and she tells them when she has taken it. A risk assessment was in place for this, but she has been doing this for some considerable time and sees it as part of her independence. The home manages any prescribed medication on behalf of the remaining two people. Medication is supplied by a local pharmacist and is accompanied by medication administration record charts (MARS). Medication is booked into the home by senior staff, and is then stored in a locked, wall mounted cabinet in the homes office. Examination of the cabinet found it to be clean and well ordered and there were no gaps on the administration charts looked at. Sample signatures of the staff trained to administer medication were available at the front of the MAR chart file. Training records looked at indicated that four out of the six support staff had received medication training within the previous 12 months. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. The home has a satisfactory complaints system and can evidence that people’s views are listened to and acted upon. There are policies and procedures in place for the protection of people from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure available in a format that is appropriate to the people that live there. Information contained in the homes AQAA stated that no complaints have been received since the last inspection. Records held in the home confirmed this. We have not received any complaints about the home. The home also has a policy and procedure on the safeguarding of vulnerable adults. Training records looked at confirmed that five staff have received training in this area, and staff spoken with were able to explain the procedure they would follow if abuse were suspected, witnessed or disclosed. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 30 Quality in this outcome area is good. The appearance of this home creates a comfortable and homely environment for the people living there. The home is clean and hygienic with policies in place to ensure that the risk of infection is minimal. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 126 Castle Lane is located along a quiet residential road in the Olton area of Solihull. The service is close to local bus routes for Solihull and Birmingham. It is within reasonable walking distance to local amenities. The premises consist of three single bedrooms one of which is located on the ground floor. Also on the ground floor are a toilet, lounge, dining room and a 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 18 fully equipped modern kitchen. On the first floor is a bathroom with a bath, large shower cubicle, toilet, and wash hand basin. There is also an office that is used as a sleep in room. To the rear of the property is a large well maintained mainly lawned garden. The décor of the home was pleasant, with modern good quality furniture throughout the communal areas, along with pictures and ornaments to give it a comfortable, homely feel. Two of the three bedrooms were looked at, and they were both decorated to individual tastes with lots of individual personalisation to them which included jewellery trees, perfumes and photos. One person spoken with said she was “happy with her bedroom, and very proud of it”. The home was clean and tidy on the day of the inspection with no offensive odours apparent. Infection control procedures were in place to minimise any risk of cross infection. One person commented on her dissatisfaction that the washing machine had been broken for a couple of weeks, and despite the best efforts of the manager and deputy, it had still not been replaced due to a hold up at head the organisations office. This person said she was having to do her washing by hand as she felt uncomfortable sending to another of the homes in the group that was an all male household. During the inspection the manager again rang the office to request a new washing machine, and was advised that one would be ordered and delivered within two to three days from a local electrical store. Confirmation that this has now been resolved was still awaited at the time of writing this report. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. People benefit from a well-trained, and enthusiastic staff team who work towards common goals. People are supported and protected by the homes recruitment policy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs seven staff including the manager and deputy manager to support three people. Examination of the homes rota indicated that one staff member is on duty per shift, with additional floating hours provided by either the deputy manager or manager. Staff spoken with said that this was sufficient to meet the needs of the three ladies currently resident in the home. The files of three staff were checked. In all cases the records confirmed that staff had been subject to POVA first checks (vetting checks) where necessary 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 20 and Criminal Record Bureau checks had been applied for prior to staff starting work at the home. In two out of the three files written references were available, however it was brought to the managers attention that there were no references available in one file looked at. The records also demonstrated that staff are taken through a proper interview procedure and the outcome of the interview is recorded. With the exception of the missing references, which the manager undertook to obtain, the homes recruitment procedure demonstrates a commitment to ensuring that the people living in the home are safeguarded. A staff training matrix was available which summarised the training provided to existing staff within the previous twelve months. Examples included first aid, food hygiene, moving and handling, fire, infection control, safeguarding against abuse, autism and equality and diversity. In addition it also confirmed that three staff had completed the learning disability awards framework induction and foundation training, two staff had obtained their NVQ II and three staff had obtained their NVQ III qualifications. Staff spoken with said that they enjoyed the training they were provided with, and felt equipped to undertake their roles. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. Every indication is that the leadership, guidance and direction provided to staff will ensure people receive consistent quality care and support. People are consulted about the quality of life within the home. Health and safety is managed appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has recently employed a new manager who has yet to apply for registration with us. This person has the relevant qualifications and experience necessary to manage a care home, and a proven track record of managing 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 22 homes within the provider organisation. Although she had only been in post for two months at the time of the inspection, both staff and the people living in the home reported positive changes since her arrival. The organisation undertakes annual quality surveys to determine people’s satisfaction with the service provided. A completed relatives survey from January of this year was seen, and contained comments such as “excellent service to my relative and staff are lovely and caring, thanks”. In addition to annual surveys, quality is also monitored by regulation 26 visits, where the provider undertakes unannounced visits to the home and completes a report on a monthly basis, regular staff team meetings, staff supervision, regular residents meetings and a general open door ethos that encourages everyone that either lives or works in the home to participate in the running and development of the service. Heath and safety in maintained within the home. A sample of certificates and records were seen, providing evidence that gas and electrical equipment has been checked to ensure it remains safe to use. Records were seen verifying that hot water temperatures are routinely monitored to ensure that people are not placed at risk of being scalded. The home records also indicate that routine checks of fridge, freezer and food temperatures are carried out. The fire safety records were also sampled and were completed satisfactorily. It was noted that the fire risk assessment had not been reviewed since June 2006, however, so this was brought to the attention of the manager who made a commitment to address it as soon as possible. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA27 Good Practice Recommendations It is recommended that consideration be given to providing an en-suite shower room in the garage conversion in preparation for if the mobility of the service user occupying the room deteriorates to the point where she can no longer safely negotiate the stairs to get to the bathroom. Not assessed. 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 126 Castle Lane DS0000043658.V369917.R01.S.doc Version 5.2 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. 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!