Care Home: 21 Frome Court House

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What the care home does well Staff at Frome Court provide a very supportive environment for people to live in ensuring they are involved in the care they receive and the way they wish to live. People living in the home are supported to take part in activities appropriate to their needs and abilities. They maintain contact with families and friends, build relationships and join in with the local community. People have rooms that are well decorated and reflect their hobbies and likes and dislikes. People receive a well-balanced and nutritional diet. Staff stated that they felt well supported and received training relevant to their role and the people living in the home. We observed a friendly relaxed rapport between staff and residents. What has improved since the last inspection? The manager and staff have met all the requirements made at the last inspection this means that assessments and reviews are made by staff with the knowledge and understanding of people with a Learning Disability. Care planning had improved and reflected the person`s personal needs and ways to meet those needs. The manager confirmed that staff had done a lot of work to provide people in the home with activities that were appropriate and what people wanted to take part in. Staff training was relevant to people living in the home. Areas in the home showed that on going decoration was being followed and people`s rooms reflected their hobbies. What the care home could do better: No requirements were made as a result of this inspection but we recommended that: The manager needs to ensure that handwritten entries on the medication chart are signed and witnessed. Because we saw handwritten medication records that had not been signed or witnessed and this may result in possible drug errors. The manager needs to ensure staff training records are kept up to date and give sufficient detail on the courses that they have attended. Because although people said they had received training and some records showed training had been done the records were not consistent. CARE HOME ADULTS 18-65 21 Frome Court House Thornbury South Glos BS35 2BU Lead Inspector Juanita Glass Unannounced Inspection 2 December 2008 10:00 nd 21 Frome Court House DS0000003401.V373074.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 21 Frome Court House DS0000003401.V373074.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. 21 Frome Court House DS0000003401.V373074.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 21 Frome Court House Address Thornbury South Glos BS35 2BU 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) 01454 281445 0117 9709301 max@apectsandmilestones.org.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mrs Josie Kathleen Bolt To be appointed Care Home 12 Category(ies) of Dementia (1), Learning disability (12), Learning registration, with number disability over 65 years of age (12) of places 21 Frome Court House DS0000003401.V373074.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 12 persons aged over 45 years with learning disabilities requiring personal care only To accommodate one named person with dementia, will revert back to original registration when that person leaves 10th December 2007 Date of last inspection Brief Description of the Service: Frome Court House is a detached building located in a residential area of Thornbury. The home is operated by the Aspects and Milestones Trust and provides care and accommodation for 12 people who use the service with a wide range of physical and learning disabilities. Mrs Josie Bolt is the registered manager. Arranged over three levels the home offers single occupancy rooms for all service users. The home is comfortable, provides plenty of space and is well furnished. There is a large enclosed garden to the sides and rear. There is a range of shops within walking distance and Thornbury boasts a wide choice of other services such as medical, further education, places of worship and community activities. The Fees at the time of publishing this report were £1200 per week. 21 Frome Court House DS0000003401.V373074.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 stars. This means the people who use the service experience good quality outcomes. This inspection took place over one day and a total of five hours were spent in the home. To gather enough evidence to support our judgments for this inspection, we The Commission asked the service provider to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gives us some numerical information about the service, and how they intend to maintain or improve outcomes for people using their service. We also looked at surveys returned to us by people living in the home and people with an interest such as relatives, social workers and GPs. We received 6 surveys from staff working in the home, 2 from health professionals who are involved in people’s care and 2 from General Practitioners (GP’s) who have regular contact with Frome Court. Once we had received this information we carried out a visit to the home and spoke to people living there and staff. Whilst in the home we also looked at documents maintained for the day-to-day running of the service. These included care plans, staff recruitment, training and supervision. Also records relevant to the administration of medication, service records and health and safety. What the service does well: Staff at Frome Court provide a very supportive environment for people to live in ensuring they are involved in the care they receive and the way they wish to live. People living in the home are supported to take part in activities appropriate to their needs and abilities. They maintain contact with families and friends, build relationships and join in with the local community. People have rooms that are well decorated and reflect their hobbies and likes and dislikes. People receive a well-balanced and nutritional diet. Staff stated that they felt well supported and received training relevant to their role and the people living in the home. 21 Frome Court House DS0000003401.V373074.R01.S.doc Version 5.2 Page 6 We observed a friendly relaxed rapport between staff and residents. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 21 Frome Court House DS0000003401.V373074.R01.S.doc Version 5.2 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 21 Frome Court House DS0000003401.V373074.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 4 and 5. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People benefit from sufficient information in an appropriate format to help them make an informed choice of home. They can visit and have a trial period before they decide to stay. They also benefit from an in depth assessment that looks at their personal needs, and a contract in a format that they can understand. EVIDENCE: We asked the manager for a copy of the Statement of Purpose and Service User Guide. These were readily available and contained all the information we would expect to see to help people make an informed choice about where they want to live. The Service User Guide was also available in an Easy Read Picture format for people who may have difficulty understanding the written guide. We looked at the care plans for people living in the home. We saw that they contained very in depth preadmission assessments, which identified people’s personal needs. They also showed that the manager had met with people who wanted to move into the home and discussed their needs and expectations. We also saw care plans from Social Services which may identify needs the service user was not aware of. The three preadmission assessments we looked at 21 Frome Court House DS0000003401.V373074.R01.S.doc Version 5.2 Page 9 showed that all their needs could be met by staff working in the home and did not include complex needs requiring nursing care. The three people who’s care plans we looked at carried out quite a few visits and a couple of sleepovers at Frome Court before moving in. This meant that they met other people living there and staff were able to decide whether the home could meet their needs. When they moved into the home staff from their previous care home worked at Frome Court for a while to help them adapt to a new environment and routine. We looked at contracts held between the people living at Frome Court and the organisation; these set out clearly the rights and responsibilities of both the resident and the home. They contained all the information we would expect to see and included details about the fee and any extra charges that may be made. 21 Frome Court House DS0000003401.V373074.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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from clear person centred care plans that have been discussed and agreed with them, showing that they are consulted and make decisions about their life. They also benefit from clear risk assessments that enable them to take reasonable risks as part of their lifestyle. EVIDENCE: Since the last inspection the manager and staff have worked very hard to ensure that peoples care plans clearly show what their needs are and how to help them to meet those needs. The care plans were written in a person centred way, with easy read pictures and photographs making a storyboard of how the person liked their day to be. A person centred facilitator had continued to help staff develop very clear care plans that were easy to read and gave staff very good guidance about how people wanted to be looked after. The care plans we looked at varied in the way they were written, however they followed the clear titles of what ‘I need,’ 21 Frome Court House DS0000003401.V373074.R01.S.doc Version 5.2 Page 11 ‘How will I’ achieve and ‘who will help.’ They included the names of specialists who would help as well as emotional and psychological needs. We saw that people had been involved in the planning of their care meaning they could control the way they wished to live. A care plan we looked at showed that the person had helped write it as it included additions made in their handwriting. Staff continually assess and review those residents who have difficulty communicating to ensure the care provided is appropriate to the individual. Staff showed us that they understood the needs of the people living at Frome Court and that it was important to involve them in deciding about the way they wanted to live. We saw that staff had developed a very good rapport with the people in their care. We looked at some of the risk assessments and they showed that people are supported in taking part in a wide range of activities and are able to take risks within a supportive community. 21 Frome Court House DS0000003401.V373074.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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from appropriate leisure and social skills activities relevant to their assessed needs. They maintain contact with friends, family and the local community. They are supported to be independent and are involved in all areas of daily living in the home. People benefit from a healthy and nutritious diet. EVIDENCE: Staff spoken to confirmed that people living in the home were supported to take part in activities appropriate to their needs and abilities. They were encouraged to maintain contact with family, friends’ peers and the local community; one resident was assisted to continue a relationship with a friend who does not live at the home. During our visit we saw very detailed activities programmes for everyone living in the home, we also noted that through the day people had been shopping for Christmas presents, out to regular clubs, day centres and were planning with staff to play skittles in the evening. One 21 Frome Court House DS0000003401.V373074.R01.S.doc Version 5.2 Page 13 persons care plan showed that the level of support they received enabled them to go shopping when previously they would not enter a shop with out displaying either challenging or disruptive behaviours. Records showed that staff had also organised a Halloween party at the Saracens Rugby Club and they had planned Turkey and Tinsel weekends away. The aroma therapist confirmed she visits the home on a weekly basis and as well as seeing people on a one to one basis had introduced natural oils to aid relaxation and a healthy atmosphere. We noted when we looked around the home that peoples rooms also reflected their hobbies, one room had a persons artwork displayed on the wall and another was decorated through out to reflect their favourite football team. People living in the home were also supported to continue to follow the religion of their choice. We saw records for one person who liked to attend the local Baptist Chapel regularly. People have the use of the homes mini bus for regular trips and outings; they are expected to help out with the running costs, which is clearly agreed in their contracts. Care plans showed that people are supported in maintaining contact with family and friends as they included a list of dates so that people living at Frome Court could remember a birthday or anniversary and send their families’ cards or presents. Menus showed us that people living in Frome Court are offered a nutritional and healthy choice of food. Mealtimes were unrushed and a social affair, assistance was given sensitively. Care plans included what people like and dislike as well as any specialised diet that may be needed. 21 Frome Court House DS0000003401.V373074.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 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living in the home benefit from personal and specialist healthcare support that is provided in a person centred way respecting choices and rights. They benefit from and are protected by the homes policies and procedures for the administration of medication, however staff need to make sure they sign handwritten entries. EVIDENCE: The care plans we looked, as we have previously said, showed a marked improvement since the last inspection. They showed personal likes and dislikes including very clear guidance for staff on how people preferred their needs to be met. They also included a statement about whether a person would prefer their care to be carried out by a male or female support worker. Staff then supported and respected the person’s wishes. Care records included all the relevant documentation that we would expect to see, they ensure the needs of the person are met. Nobody living at Frome Court had nursing needs but staff could seek support from the local community nursing team if they needed to. One survey from a GP said that ‘staff are 21 Frome Court House DS0000003401.V373074.R01.S.doc Version 5.2 Page 15 dedicated and loyal to their client group’ which meant that they needed to accept when a person required nursing care. The manager confirmed that they were more proactive in helping people to move on to homes that can provide nursing care. We saw evidence to show that personal health care plans were completed and being followed by staff. Male and female routine health checks were seen and appointments at the dentist, optician audiologist, chiropodist and learning disabilities team were recorded. Staff spoken to were aware of the diverse needs of people in their care and training records showed that staff had attended training relevant to the needs of people in the home. One staff survey said that they received appropriate training but it was ‘sometimes slow to happen.’ Surveys from healthcare professionals who were also involved in the care of people at Frome Court were positive with comments that indicated staff were caring, supportive and aware of the needs of people in their care. The home has very clear policies and procedures for the receipt storage and administration of medication and staff receive training before they can give medication to people. We looked at the records kept by the home for medication given to people we found that they were up to date and showed clearly when staff had given them. We did note that there was occasions when people had to hand write the entries on the medication charts, the person making the entry had not signed some of these. People need to make sure that they sign and get a witness to sign any handwritten entries. 21 Frome Court House DS0000003401.V373074.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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from and are protected by the complaints and safeguarding procedures in the home. Staff are fully aware of the procedures to follow to protect people from abuse. EVIDENCE: Copies of the homes complaints policy and procedure are included with the Service User Guide these are written in Easy Read format for people to understand fully. People spoken to did not comment on their ability to approach people but we saw a very good rapport between residents and staff. The manager confirmed she had dealt with one complaint since the last inspection. The complaint was recorded with action taken and outcome for the complainant. The complaint received was not about care in the home but about the removal of trees in the garden area. We saw a copy of the Local Authority policy and procedure for Safeguarding Adults under No Secrets, which is available for all staff to read. Staff spoken to said they knew who to inform if they suspected abuse and they all knew about the homes whistle-blowing policy. Staff records showed that they had all received appropriate training in Safeguarding Adults. 21 Frome Court House DS0000003401.V373074.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a homely well-maintained environment that is individual to their personal needs, likes and dislikes. All areas are clean and hygienic. EVIDENCE: Frome Court is a detached property in a residential area of Thornbury. There is a wide range of shops within walking distance and Thornbury boasts a good choice of other services such as medical, further education, places of worship and community activities. Frome Court is arranged over two levels and everybody living there has their own bedroom. We asked if we could look at a few rooms. We saw rooms that had been decorated to reflect the persons likes, dislikes and hobbies. One person’s room used to be very untidy but since they decided on how it was to be decorated they have shown a pride in helping to keep it clean and tidy. Another room was decorated and had posters in the style of their favourite football team whilst another contained a person’s own artwork. 21 Frome Court House DS0000003401.V373074.R01.S.doc Version 5.2 Page 18 There is level access throughout the home with a lift providing access to the upper floor. All doors and corridors are suitable for wheelchair access. Other aids and adaptations were available for people to use. A rolling plan of maintenance and decoration is on going and areas that looked worn and tired at the last inspection had been improved. All areas of the home were clean and tidy with no offensive odours; people living there are encouraged to help with the daily chores especially keeping their own rooms tidy. 21 Frome Court House DS0000003401.V373074.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 and 36. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People benefit from a staff team who are competent and qualified and trained to meet the diverse needs of people in the home. They are also protected by clear policies and procedures for the recruitment of new staff and supervision of existing staff in the home. EVIDENCE: Staffing levels are determined by the assessed needs of people living in the home as well as the activities planned for people to attend. We looked at the staffing rotas and saw that the staffing levels are appropriate to the needs of the people in the home and flexible to support extra needs or activities. We looked at the personnel files and they showed that all staff had a job description, which clearly stated what their roles and responsibilities were to support people in achieving a normal lifestyle. Records to show that people had been encouraged to attend training were not consistent so although people said they had received training and some records showed they had, it was difficult to evidence all the training had been 21 Frome Court House DS0000003401.V373074.R01.S.doc Version 5.2 Page 20 carried out. People demonstrated that they were well aware of the needs of people in their care and how to meet them. We spoke to staff who felt they received all the support and training they needed to carry out their roles in the home. It was evident that people were encouraged to obtain an NVQ qualification, which had resulted in 80 of the staff in the home with an NVQ 2 or 3 In Health and Social Care. Staff also confirmed that they received regular supervision from management and we saw documentation that showed all staff had attended supervision meetings. 21 Frome Court House DS0000003401.V373074.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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a home that is well managed in an open and approachable way, which considers peoples personal input into the day to day running of the home. Health and safety practices in the home safeguard people living there. EVIDENCE: The manager of Frome Court has experience in the care of people with a Learning Disability. She has attained the Registered Managers Award and an NVQ level 4 in Management in Health and Social Care. The manager has shown that she can move the home forward by enabling staff to improve care planning and activities for people living in the home. People we spoke to could not communicate their feelings about the manager but we observed a rapport that indicated they had a fondness for her. Staff felt they could approach the manager with ideas and ways to improve care for the people in the home. One 21 Frome Court House DS0000003401.V373074.R01.S.doc Version 5.2 Page 22 survey from a Health Professional stated that the manager was very competent and provided clear leadership for staff in the home. People living in the home are encouraged to take part in resident meetings and their opinions are sort to underpin the running of the home. The manager develops an action plan from comments made by people living in the home either made at meetings or from surveys. We looked at records relating to the servicing of equipment used in the home. All the records were up to date and available for inspection, these included the COSHH records, which are the guidelines for staff to follow if they spill, drink or are splashed by chemicals used in the home. The implementation of health and safety within the home was satisfactory. All residents have personal risk assessments. Generic risk assessments are in place and reviewed regularly. A review of the firelog showed all tests, training and drills were being carried out to Local Fire Brigade guidelines. 21 Frome Court House DS0000003401.V373074.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 3 2 X 3 X 4 3 5 3 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 3 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 4 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 21 Frome Court House DS0000003401.V373074.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 2 Refer to Standard YA20 YA35 Good Practice Recommendations The manager needs to ensure that handwritten entries on the medication chart are signed and witnessed. The manager needs to ensure staff training records are kept up to date and give sufficient detail on the courses that they have attended. 21 Frome Court House DS0000003401.V373074.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 21 Frome Court House DS0000003401.V373074.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. 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