Care Home: Carter House

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What the care home does well People who use the service told us they were happy living there. People said "I am quite comfortable here", "I have no complaints, they look after me very well" and "I like my room, it feels homely". Relatives or friends said "the home has a personal touch and understands how each person likes to do things", "they provide my mother with all her needs", the manager "and staff do a first class job". When asked to comment on what the service does well one person responded "everything, ten out of ten for all aspects". The comments received from people who use the service and visitors indicated good relationships have been developed between staff and people who use the service. We observed good, person centred care being delivered. Staff have a good understanding of the needs and individual preferences of the people they support. Staff are provided with good opportunities for training and feel well supported by the manager and senior staff. What has improved since the last inspection? Since the last key inspection of the service improvements have been made in producing more person centred care planning. People who use the service have been provided with more variety in the activities programme. The introduction of rummage and activities boxes has expanded opportunities for occupation particularly for those people living with Dementia. Staff have continued to develop their skills and knowledge through training in leadership, mentoring and Dementia care. Medication is well managed which assists in safeguarding the health and welfare of people who use the service. New flooring has been laid in two units which assists in ensuring the environment is well maintained. What the care home could do better: The checks carried out before staff start work need to include more information on previous employment to further safeguard people who use the service. To make sure that standards of care planning are consistent across the service regular audits should be carried out. More information should be recorded when care planning is reviewed. Improvements could be made in offering opportunities for people to make informed choices, particularly around meals. The involvement of all staff in the service at the main meal of the day could provide a better service. The environment on the units providing care for people living with Dementia could be improved. CARE HOMES FOR OLDER PEOPLE Carter House 1&2 Farnham Gardens West Barnes Lane London SW20 0UE Lead Inspector Liz O’Reilly Unannounced Inspection 24th June 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carter House DS0000042026.V366103.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carter House Address 1&2 Farnham Gardens West Barnes Lane London SW20 0UE 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) 020 8947 5844 hilma.dunn@ccht.org.uk Central & Cecil Housing Trust Ms Hilma Dunn Care Home 45 Category(ies) of Dementia (45), Old age, not falling within any registration, with number other category (45) of places Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 45 31st May 2007 Date of last inspection Brief Description of the Service: Carter House is a purpose built care home, which can provide nursing care for fifteen older people and residential care for thirty older people, twenty-three of whom may have dementia. Forty-three people are currently living there with two people in hospital. The home is owned and managed by Central and Cecil Housing Trust (CCHT), a charitable organisation who own and manage four other similar services in the Merton and Richmond area. Accommodation is provided over four floors with a lounge, dining room, kitchenette, bathrooms and single bedrooms available on all four floors. People who use the service have access to enclosed gardens to the rear and side of the home. A lift serves all floors. Carter House is situated in a residential area of Raynes Park, close to local shops, public transport, churches of a number of denominations and leisure facilities. The home is staffed twenty-four hours a day by trained nursing staff and care assistants. People receive three meals each day with drinks and snacks available between meal times. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 5 Information regarding the CSCI is available in the Statement of Purpose and Service Users Guide to the home and is displayed in the entrance. The weekly fees are from £418.00, further details are provided on request. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 6 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 this service experience good quality outcomes. This unannounced inspection was carried out by one regulation inspector over two days. We had the opportunity to speak with twelve people who use the service, six staff, three visitors and the manager. Five completed surveys were received from people who use the service and relatives. Three completed surveys were received from staff. The manager carried out her own assessment of the service for the Commission (AQAA) As part of this inspection we used the Short Observational Framework for Inspection (SOFI). This involves an observation of the activity taking place for a small number of people with dementia in a communal area. We have used information from all of the above sources to reach the judgements made in this report What the service does well: People who use the service told us they were happy living there. People said “I am quite comfortable here”, “I have no complaints, they look after me very well” and “I like my room, it feels homely”. Relatives or friends said “the home has a personal touch and understands how each person likes to do things”, “they provide my mother with all her needs”, the manager “and staff do a first class job”. When asked to comment on what the service does well one person responded “everything, ten out of ten for all aspects”. The comments received from people who use the service and visitors indicated good relationships have been developed between staff and people who use the service. We observed good, person centred care being delivered. Staff have a good understanding of the needs and individual preferences of the people they support. Staff are provided with good opportunities for training and feel well supported by the manager and senior staff. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 7 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. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The service understands the importance of having sufficient information when choosing a care home. However at times the service is not given sufficient notice to allow for a more personalised approach to the admission process. This also reduces opportunities for people to make considered decisions about arrangements for their admission. EVIDENCE: Individuals are provided with information on what they can expect from the service through a Service User Guide. Each person who uses the service is provided with a copy of the guide. Consideration should be given to making this document more user friendly with pictures of staff, the service and the local community. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 10 Two people who use the service told us they felt they were given enough information before their admission to make an informed decision about moving in. Three people felt they were not. One person told us that they were “brought in” and another person told us they had not been provided with any choices. The manager informed us that one of the barriers to improvements was the short notice they received about prospective admission which made carrying out assessments and providing the right type of equipment more difficult. Staff within the service told us that they could face difficulties in providing specialist equipment when they were given short notice. The information we received through staff surveys indicated that at times, when people were admitted from hospital, they were not provided with sufficient information. This issue should be taken up by the organisation with the placing authority. We looked at a sample of files and found pre admission assessments were in place. We found staff take care to include the strengths as well as the needs of individuals which can assist in maintaining independence. This service does not provide intermediate care. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The service has a person centred approach to the provision of personal and healthcare. Further work could be done to make sure that person centred care plans are provided consistently across the service. Staff respect the privacy and dignity of people who use the service. The health care needs of individuals are met. EVIDENCE: Four of the five people who completed surveys told us that they “always” receive the care and support they need. All of the relatives surveyed said people were given the support they expected. People we spoke to told us that they were happy with the care they received. Each person who uses the service is provided with a care plan which sets out individual needs. We found examples of good person centred care planning Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 12 which included information on how support was to be provided in line with the personal preferences of the individual. For example staff have included information on when people like to have a shower and that they like to have their light on at night. Staff include information on what people can do as well as what they need assistance with. This helps in providing the right level of support. We found staff generally continue to focus on the physical needs of individuals within the care planning. Information on the social interests of people gathered at the assessment was not always used in the care plan. Further work could be done to make sure that standards are consistent across the service and that plans include more detail on how the needs of individuals will be met. The daily recording we saw also focused on the physical support provided with little information on other aspects of life. We saw that staff are reviewing plans on a regular basis. The majority of the reviews we saw gave very little information on any changes, what has worked or what may not have worked for the person. More detailed information should be provided through the review process. We found records of the nursing care provided to be of a good standard. People who use the service have good access to health care services. A GP visits each week or more frequently if needed. Assessments are carried out and reviewed. We saw that staff make referrals to other health care professionals such as the Tissue Viability Nurse, Community Psychiatric services and Nutritionists if needed. Records showed that the advice of these other professionals was being followed. We looked at a sample of medication records across the service and found these to be well maintained. All staff who administer medication have been provided with training. We observed staff asking people if they were in any pain and providing pain relief if needed. Pain assessments were in place on a number of files. Staff should take care to make sure that they sign and date all documents including care plans and that evidence of consultation with people who use the service on their care plan is in place. This will assist in ensuring that people who use the service are receiving the support they need in the way they want. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People using the service are provided with opportunities to take part in a variety of activities. Staff are provided with guidance on meeting the cultural needs of individuals. Individuals are supported to maintain contact with family and friends. EVIDENCE: Three people who use the service told us through surveys that there was “always” activities on offer they could join in with. One person told us they chose not to join in activities and one person said there usually were things they could join. Individuals we spoke to told us they enjoyed the trips to parks and garden centres. Two staff within the service have been provided with training on activities from a specialist organisation. The activities programme showed a good variety on offer with special events most weeks. Recent events have included Flamenco Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 14 dancers, classical music concerts and interactive drama groups. Plans were being made for a summer garden party, an old time karaoke evening, a race night and a trip to a local Buddhist Temple. An Aromatherapist visits the service each fortnight. Day to day activities arranged included art classes, listening to music and a regular film club. The service is involved in the community through trips to local schools for lunch, tea dances and services at a local church. The service aims to provide two trips each month. The service has a relatives support group whose members will assist with trips and activities. Staff have introduced rummage boxes, particularly for those people living with Dementia. Relatives or friends have been requested to bring in familiar items for these boxes. Activities boxes are also available in lounges. We saw these used for good effect in one unit with people being engaged in using this equipment throughout the morning. We saw staff involving people who use the service in the day to day domestic activities of the unit in a minor way. This is an area which could be developed further. Feedback from relatives indicated that they felt people were supported to live the life they chose and all of those surveyed felt that they were supported to keep in touch. Visitors told us they felt welcomed by staff and could visit at any time. Representatives of different religious groups visit the service. These include the Salvation Army, the Free Church, and Roman Catholic church. A service is held in the local Church of England twice a year for all of the providers homes in Merton. We saw that staff have not always noted on records the religion of individuals. In order to meet these needs staff should request this information and make appropriate arrangements. The food we saw was of a good quality. Dining tables were attractively set. One relative told us, ‘the dining tables are always laid complete with napkins’. The majority of people we spoke to told us they liked the food. Two people told us they did not like the food but could not say why or what else they would prefer. We saw staff providing sandwiches and tea for one person who felt they could not eat the meal on offer. One relative informed us that staff discussed the food with their relative to try and find out what they like. Records showed that one person was regularly provided with cornflakes in the evening at their request. As we arrived on the first visit to the manager was holding a meeting with people who use the service to discuss the menu. The manager informed us that a review of the menu was about to be carried out. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 15 The cultural needs and wishes of individuals are discussed with them. One person using the service has chosen to have rice and plantain occasionally. Special occasions are celebrated and events such as a Welsh day and a Caribbean day are held with food and drink. Tasting meals are made where people who use the service can try out different things. In order to improve the choices on offer consideration should be given to providing the menu in a more accessible format particularly for those people with Dementia. Consideration could also be given to offering alternatives at the meal time so that people can be shown what is on offer. This would assist people who have difficulty with their short term memory who may not recall choices they made earlier. We observed staff assisting people with their meal in a sensitive manner. Individuals were offered support in a discreet way which respected their dignity. In order to make mealtimes a more social occasion consideration should be given to implementing protected mealtimes where all staff within the service and relatives, should they wish, join with people who use the service at the main meal of the day. This could provide opportunities to increase independence with the use of serving dishes and drinks on tables for people to help themselves. The additional staff could also assist people who are reluctant to eat. We observed three people on one unit turn down the offer of a meal. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use the service or their representatives know how to make a complaint and feel confident they will be listened to. Policies and procedures for safeguarding the people who use the service are in place. EVIDENCE: The majority of people who use the service and all of the relatives surveyed knew how to make a complaint. One person using the service told us they did not know how to do this. However everyone told us they knew who to speak to if they were not happy with the service. We found staff understood the complaints system and their role in passing on any concern or complaint brought to them. People who use the service told us that staff listened to them and acted on what they said. Systems are in place for any complaint to be recorded along with actions taken and outcomes. The organisation has in place policies and procedures to be followed in relation to safeguarding issues. A copy of the local authority safeguarding procedure is Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 17 in place and the manager is aware of when any complaint or allegation should be passed on to the local authority. At the time of this visit information on how many staff had completed training on safeguarding people was not easily available. The manager will be providing this information to the Commission in the near future During observations we noted that a group of people who use the service were making regular derogatory comments towards another individual who lived there. This was discussed with the manager at the end of the observations and would be addressed by the manager. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 & 26 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use the service are provided with a comfortable, well maintained environment. The building is clean and free from odours. EVIDENCE: This is a purpose built home with separate units on four floors. We found the building to be well maintained. People who use the service told us “it’s very well kept” and “if there is anything wrong they come and fix it as soon as they can”. Furnishings and fittings are of a good quality. New flooring has been laid in two of the units. The manager informed us that fifteen new chairs would be Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 19 purchased in the near future. These chairs will ensure there are a variety of chair types to meet the needs of individuals. One person told us “the security is very good, but you can feel like a prisoner” and another person felt that having bedroom doors open increased the risk of someone taking things from the rooms. The manager could consider bringing up these type of issues at the next resident and relatives meeting. Staff have improved the environment in the communal use bathrooms and toilets with the addition of pictures and shelving. This assists in reducing the clinical appearance of these areas. Consideration should be given to providing a more stimulating environment for those people living with Dementia. This was discussed with the manager and staff. People who use the service told us that the home was “always” or “usually” fresh and clean. One person told us “the home is nice and clean”, another person said “they work hard to keep it clean”. All areas of the home we saw were cleaned to a high standard. Domestic staff are provided with training and we found staff take a pride in maintaining high standards of cleanliness. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use the service express confidence in the staff to provide them with the support they need. Progress continues to be made in recruiting permanent staff. The organisation provides good training opportunities. EVIDENCE: People who use the service made positive comments about the staff group and individuals. We were told “the staff are very good here and very kind”, “staff are supportive”, “they are good, look after me very well” and “nothing is too much trouble”. Visitors to the service felt staff “work hard” to meet individual needs. We spent time observing the daily life of a number of people living on one unit. During this time we saw staff working to a high standard. Staff were seen to adapt their approach and support to meet the needs of individuals. Their approach was caring and they took time to talk to everyone in the lounge. They were regularly checking that individuals were comfortable and had what they needed. Interactions were very good with clear evidence that the well Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 21 being of people was improved by this contact. There was a great deal of laughter and caring physical contact. Two people who use the service felt that there were not enough staff. A lack of staffing has been a recurrent concern about this service from people who use the service and visitors. At the time of this visit we observed there to be sufficient staff to meet the needs of individuals. The manager is aware of previously raised concerns and regularly monitors staffing levels. We found progress continues to be made to recruit permanent staff for the service. The importance of recruiting the right staff to deliver good quality care was seen to be important to the manager. We looked at a sample of staff files. These were well maintained with information on pre employment checks in place. In order to further safeguard people who use the service and meet amended regulations a full employment history must be requested from staff before they commence work in the service. Any gaps in employment must be explained and recorded. Where the last employment for staff involved contact with vulnerable adults or children the organisation must request, from this employer, in writing, the reason why they left. The manager informed us that she was looking at involving people who use the service in the interviewing process for new staff. This development would add to user involvement in the operation of the service. At the time of this visit the manager was updating the training record. This meant we could not get a clear picture of the overall training completed. This will be looked at during the next inspection. Staff did inform us that they felt they had good opportunities for training. We were informed that all senior staff have completed a training course on leadership. Nursing staff told us the organisation supports them through training to keep up to date with their practice. A number of staff have completed an introduction to Dementia course, others have gone on to completed another one day course and some staff have completed a five day course. This training should be on going to make sure that all staff working with people with Dementia have a good understanding of Dementia care. Consideration should be given to subscribing to journals on dementia and nursing care. Staff told us they felt well supported by the senior staff team through regular staff meetings and supervision. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The manager has the experience and qualifications to run the service. The manager promotes equal opportunities and understands the importance of person centred care. The views of people who use the service are sought and help shape the way the service is delivered. Health and safety checks are carried out. EVIDENCE: People who use the service and staff made positive comments about the manager. Staff felt they were “supported and encouraged” by the manager. People who use the service felt they were listened to and could approach her if Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 23 they had any concerns. We found the manager had an in depth knowledge and understanding of the people who use the service. Visitors told us she kept them well informed and was approachable. The views of people who use the service are sought through regular meetings. The organisation has its own quality monitoring systems which include surveys for people who use the service and other people involved. Facilities are available for small amounts of money to be kept for individuals who use the service. We looked at a sample of the money held. We found well maintained and up to date records were kept along with receipts for any expenditure. Staff make regular checks on the building and equipment to ensure the health and safety of people who use the service, staff and visitors. We looked at a sample of these records. We found these to be up to date. Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 19 Schedule 2 (4)(6) Requirement To assist in safeguarding people who use the service; • A full employment history must be obtained from staff as part of the recruitment process. Any gaps in employment must be explained and recorded on file. Where a person has previously worked in a position which involved contact with children or vulnerable adults, written verification of the reason why he ceased to work in that position unless it is not reasonably practicable to do so. Timescale for action 01/10/08 • Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations Consideration should be given to making the Service User Guide more accessible. The organisation should make sure that people who use the service have been provided with sufficient information and time to make an informed choice about moving in. To make sure that care planning is of a consistent standard across the service regular audits of plans should take place and include checks on:• Evidence of consultation • The inclusion of social, emotional and cultural needs • The inclusion of information on how needs will be met. • That all plans are signed and dated. • To make sure that the changing needs of individuals are known and met staff should include information on any changes, outcomes, what has worked or what may not have worked as part of the review of care planning. Consideration should be given to improving opportunities for people who use the service to make informed choices, particularly in relation to food. In order to provide more support for people who use the service at the main meal of the day consideration should be given to protecting mealtimes. Consideration should be given to improving the environment for people who use the service in line with current good practice in Dementia care. 2. OP7 3. OP7 4. OP14 5. 6. OP15 OP19 Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Carter House DS0000042026.V366103.R01.S.doc Version 5.2 Page 28 - 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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