Care Home: Dearne Valley Care Centre

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What the care home does well The registered manager provided good leadership. The home was well maintained, clean and hygienic, and there were no offensive odours. People living at the home were well cared for, and they were treated with respect. Their needs were in the main met and choices were given. Staff attitudes were good and comments received were, "Staff at the care home are very pleasant and friendly" and "...(staff) Seeks and listens to advice by professionals. Tries to keep a calm atmosphere" The majority of staff were undertaking or had achieved National Vocational Qualification training in CareThe company had a good quality assurance system to ensure that the home was run in the best interest of people living at the home. A further comment about the service was, "The whole team within the care home have always shown consideration, care and enthusiasm to fulfil any goals or problem solve during my involvement over 12 months visiting frequently. I feel they deliver a good care service." What has improved since the last inspection? All previous requirements had been met. Since the last inspection staff training had improved and staff had undertaken mandatory health and safety training, adult protection training and medication training. Daily records of people`s care were now being maintained but further work was needed (see below). Night care plans now included the frequency of checking, to ensure that people`s care needs were fully met. What the care home could do better: To provide a more person centred approach, entries in the daily records need to be specific to the physical care needs that have been met. The daily records also need to include people`s daily routines to provide more rounded and in depth knowledge of each person. This would include any one to one interactions, individual leisure pursuits and participation in any group activity. Training in dementia and sensory awareness would enable care staff to better understand and empathise with people living in the home. CARE HOMES FOR OLDER PEOPLE Dearne Valley Care Centre Furlong Road Bolton On Dearne Rotherham South Yorkshire S63 9PY Lead Inspector Christine Rolt Key Unannounced Inspection 09:10 11th October 2007 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 DS0000036246.V332785.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. DS0000036246.V332785.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dearne Valley Care Centre Address Furlong Road Bolton On Dearne Rotherham South Yorkshire S63 9PY 01709 893 435 01709 892 128 none None Guardian Care Homes (UK) Limited 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) Mrs Sharon Elizabeth Tinsley Care Home 34 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (14) of places DS0000036246.V332785.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The managers hours are full time supernumerary to the care staff hours. The minimum staffing levels specified in the Residential Forum Care Staffing in Care Homes for Older People must be maintained at all times, in accordance with actual occupancy levels. The upper floor is to be used exclusively for service users in the category DE, the ground floor is to be used exclusively for service users in the category of OP. 29th June 2006 3. Date of last inspection Brief Description of the Service: Dearne Valley Care Centre is a purpose built care home in the village of Boltonon-Dearne. The home provides personal care and accommodation for thirtyfour older people, including care for twenty with dementia. All bedrooms have en suite facilities. Ample car parking is provided at the front of the property and there is a small, enclosed garden to the rear of the property. The home stands back from the main road. The village has a range of amenities. There is a railway station on the Sheffield to Leeds line. The A1 motorway is approximately ten minutes drive from the home. A copy of the combined Statement of Purpose/Service User Guide and the most recent inspection report were displayed in the entrance hall. The fees ranged from £341.50 for residential care to £370.50 for dementia care for people placed by Barnsley council. Self-funding fees were from 375.00 for residential care to £400.00 for dementia care. Items not covered by the fees include toiletries, hairdressing, chiropody, taxis and newspapers other than those provided by the home. The manager supplied this information during the site visit on 11th October 2007. DS0000036246.V332785.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection and comprised information already received from or about the home and a site visit. Prior to the inspection a copy of the Preinspection Questionnaire was sent to the home and the manager was asked to complete this document and return to the CSCI. The completed document provided information about the service in readiness for the site visit. The site visit was from 9.10 am to 3:55 pm on 11th October 2007. The majority of people living at the home were seen throughout the day but the main focus for this inspection was the service provided to people with dementia in the dementia unit on the first floor. The care provided for four people was checked against their records to determine if their individual needs were being met. Questionnaires were sent to five people living at the home, five staff, ten relatives and five health and social care professionals. Completed questionnaires were received from one person living at the home, three relatives, two staff and four health professionals. During the site visit a visitor was asked for their comments about the service provided. Care practices were observed, a sample of records was examined, a partial inspection of the building was carried out and service provision was discussed with the registered manager. The inspector wishes to thank the manager, members of staff, people living at the home, relatives and health and social care professionals for their assistance and co-operation. What the service does well: The registered manager provided good leadership. The home was well maintained, clean and hygienic, and there were no offensive odours. People living at the home were well cared for, and they were treated with respect. Their needs were in the main met and choices were given. Staff attitudes were good and comments received were, “Staff at the care home are very pleasant and friendly” and “…(staff) Seeks and listens to advice by professionals. Tries to keep a calm atmosphere” The majority of staff were undertaking or had achieved National Vocational Qualification training in Care DS0000036246.V332785.R01.S.doc Version 5.2 Page 6 The company had a good quality assurance system to ensure that the home was run in the best interest of people living at the home. A further comment about the service was, “The whole team within the care home have always shown consideration, care and enthusiasm to fulfil any goals or problem solve during my involvement over 12 months visiting frequently. I feel they deliver a good care service.” 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. DS0000036246.V332785.R01.S.doc Version 5.2 Page 7 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 DS0000036246.V332785.R01.S.doc Version 5.2 Page 8 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 and 6. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People had the information they needed to make an informed choice. Assessments were carried out to ensure that the home could meet people’s needs. This home does not provide intermediate care. EVIDENCE: People considered that they always or usually had sufficient information about the home. Comments were ““Went and had a look round and was quite satisfied”, “Information is usually well displayed on notice boards or provided verbally” and “Good reputation and local”. The manager said that all people living at the home had been given copies of the combined Statement of Purpose and Service User Guide. There was a copy of this document, together with the most recent inspection report in the DS0000036246.V332785.R01.S.doc Version 5.2 Page 9 entrance hall. The separation of the Statement of Purpose from the Service User Guide was discussed. It was also recommended that as a sign of good practice, the Service User Guide be given to prospective residents. People living at the home were assessed prior to admission to the home and copies of the assessments were seen on their files. They contained a good range of information of their individual needs and wishes. DS0000036246.V332785.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were treated with respect, and their day-to-day care needs were generally reflected in their care plans but could be enhanced. Health needs were met and medication procedures were generally sufficient to ensure that people were protected. EVIDENCE: People considered that care and health needs were met. Comments were, “The staff respond to her own individual needs”, “Individual needs are always considered and seen to”, “From the limited view I get when visiting patients their needs appear to be met”, “Look after you well and at the same time make you feel at home”, “Senior care staff do listen and act upon advice given”, “The client I am involved with in the home, their care needs are met by the care service” and “Basic care of their residents and they do try their best to achieve a good standard of care.” DS0000036246.V332785.R01.S.doc Version 5.2 Page 11 The files for four people who live at the home were checked. These contained a good range of information. Visits by health professionals were recorded and provided information of the reasons and outcomes of their visits. Risk assessments had been carried out according to need and were updated regularly. Nutritional assessments were carried out and people were weighed at least once a month and more regularly according to need. The Malnutrition Universal Screening Tool was discussed; the manager said that she was aware of it and was familiarising herself with the process for use before implementing it. The care plans provided information of how care needs were to be met. Daily recording could improve by specifying which of the physical care needs had been met instead of using the all-encompassing phrase “All hygiene needs met”. There was good information of how health needs were met and some information of emotional well-being. There was information of visits but this social information could be extended to include other forms of social stimulation and motivation. The manager said that information of people who had participated in activities was kept in a separate book. A method of including this information in the daily records was discussed. The use of a person centred approach was discussed with the manager. Accidents were recorded and 72 monitoring charts were implemented following accidents. The manager also carried out monthly analyses of accidents to establish patterns and frequency of accidents. Health professionals were consulted and meetings held to determine the best course of action for any person considered at high risk of falls. During the site visit, such a meeting was being held to discuss a person who had frequent falls. Relatives said that they were always kept informed of people’s welfare including hospital visits and accidents. “If in any doubt carers are quick to get help from doctor or ambulance”, and “When mum was in hospital there was excellent communication between the care home and ourselves. We are always informed in case of illness or doctors’ visits” Care plans were reviewed at least once per month and a relative said that she was consulted about her parent’s care plan. Medication was stored safely. The manager said that stock control was carried out monthly. She also carried out random medication checks weekly as part of the quality assurance system and discussed any discrepancies with the member of staff responsible. A recent staff meeting had been held to discuss medication and minutes of this meeting were available. The home used a monitored dose system (MDS) for the bulk of the medication prescribed. The medication in the monitored dose system (MDS) for three people was checked against the Medication Administration Records (MAR) sheets and these tallied. Loose medication (i.e. not in the MDS) was also checked. In one instance there was a gap in the records where a member of DS0000036246.V332785.R01.S.doc Version 5.2 Page 12 staff had not signed to show that a tablet had been given and in two instances, codes that were not the accepted codes were used. The manager was informed of these discrepancies. The home used a numbering system for identifying members of staff instead of using staff signatures on the Medication Administration Records. The list of staff with their corresponding numbers was at the front of the MAR charts. The manager said that numbers were much clearer than signatures and prevented confusion. The MAR charts for some people contained their photograph and allergies whilst others did not. The manager was advised to extend this system to include all people living in the home. Controlled drugs were suitably stored and the controlled drugs register was completed correctly with two signatures. The majority of people in the unit were awake, alert and calm. Interactions, both verbal and non-verbal, were good and showed that people living in the home were treated with respect. Health professionals and relatives confirmed this. Their comments were, “My impression is that there is a high level of respect between staff and residents. Issues of a confidential nature are dealt with in a way which respects the feelings of the individual”, “They always knock before entering your room”, and “During my frequent visits at various times during the day, nothing has indicated otherwise. Clients have always been given privacy and dignity.” DS0000036246.V332785.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, and 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Personal choice and control were promoted. Meals were good quality with variety and choice. The lifestyle within the home did not always match people’s expectations and preferences. EVIDENCE: There was a programme of activities displayed on the ground floor but no programme on the first floor i.e. the unit for people with dementia. No activities were seen throughout the day and all the people seen were sat in front of televisions throughout the home, but very few were actually watching anything. The manager said that they had an activity co-ordinator who arranged activities and outings for all people living at the home but on this particular day she was working as a carer, therefore no activities were taking place. The need to provide stimulation, particularly for people with dementia was discussed. Visitors said that they were always made welcome and visited regularly. Comments were “The staff have always been polite and courteous to my visits. DS0000036246.V332785.R01.S.doc Version 5.2 Page 14 I have always witnessed the same manner to any other visitor be it clients’ family/friends or any other professional person”, “Good in this respect” and “We live locally and visit on a regular basis. If we are away and we telephone, the staff will pass on messages”. Information on people’s preferences and wishes were recorded in their plans of care. Relatives and health professionals considered that people living in the home made their own choices. Comments were “Reflecting on the client I am involved with in the care home the staff are quite flexible to her wishes e.g. midday bed rest, choice of foods/drinks, activities” and “Mum has never said that she has felt under pressure to do anything she didn’t want to do. She is also given opportunities to make decisions about what she will do and when on a day by day basis, e.g. what time to get up/when to have a shower or have breakfast/what to eat at meal times/what to wear/where to go on trips etc.”. Some people were observed having late breakfasts. unhurried and the people were relaxed. The meals were There were no menus displayed to inform people of the meals on offer. A member of staff said that people were informed of the meals on offer just before they were served. Because mealtimes tend to be the highlights of the day, a menu board would give people who still had the ability to read, the time and opportunity to decide which meal to choose and to look forward to. Snacks and sandwiches were served at lunchtime and the main meal of the day was served late afternoon. A relative said that the meals were fine and that her parent had regained weight since moving into the home and another comment was “Care home provides good food - mum enjoys her food very much”. At least one of the care plans contained information of meals eaten and food monitoring. Specialist diets were catered for. The atmosphere in both dining rooms was pleasant. DS0000036246.V332785.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using this service were protected from abuse. They and their relatives and friends were confident that their complaints would be dealt with appropriately. EVIDENCE: The home had their complaints procedure displayed in the entrance hall and it was also included in the Statement of Purpose/Service User Guide. The CSCI local address needed adding, and the manager agreed to do this. People knew how to complain and were confident that any complaint would be dealt with appropriately. Comments were “…when I have raised concerns for my client the staff have acted accordingly to my requests with full co-operation.” The home had an adult protection policy and procedure. The manager said that all staff including ancillary staff had undertaken adult protection training. Since the last inspection, there had been one adult protection issue that involved this home and another home. Adult protection multi-disciplinary team meetings were held and recommendations were made. There were no outstanding complaints. DS0000036246.V332785.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home was pleasant, hygienic, well maintained and safe. EVIDENCE: The home succeeded in creating a very good first impression for any new visitor. It was pleasant and clean with a calming atmosphere and there were no offensive odours. Bedrooms have en-suite showers and lavatories. Furnishings and furniture were in good condition. Bedrooms were well decorated, clean, and had been personalised. Bathroom and toilets were clean. All rooms were well decorated and well lit. Aids and adaptations were in place. The gardens were neat and tidy. However, communal areas on the first floor would benefit DS0000036246.V332785.R01.S.doc Version 5.2 Page 17 from pictures and means of orientation and stimulation for people with dementia. This was discussed with the manager. A relative commented, “The atmosphere is very welcoming and open. The care home is reasonably secure – excellent front door security and signing in/out procedures. The care home is very clean, well decorated and tidy. Residents’ rooms are extremely pleasant and encourage residents to have their own belongings”. Another relative spoke about how pleased she was that the home had provided the type of seating that her mother was used to, thus meeting her mother’s needs. DS0000036246.V332785.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs were in the main met by staff levels. People were supported and protected by the homes recruitment procedures. Specific training would enhance staff’s skills and competence. EVIDENCE: There were many comments about the staff. These ranged from staff attitude, to staff availability and also staff skills. Comments about staff attitude were positive, “Satisfied with the staff. They are quite supportive” and “Yes, they (staff) listen to what you say and act on the comments you say”. Comments about staffing levels and staff availability were mixed. One comment was that, “They are always on hand” whilst others considered that “Sometimes staffing levels and time for individual patient recommended care are limited due to a shortage in staff and time” and “ I am sometimes a little concerned about staffing levels.” When asked how the home could improve, DS0000036246.V332785.R01.S.doc Version 5.2 Page 19 the comments were generally about the staff, “Increase of staff levels”, “Sometimes …staffing levels are stretched” and “More staff” At the time of this site visit there were three staff working on the dementia unit during the morning but only two staff for the afternoon. This shortfall imposed limits, because of health and safety, on the personal care that could be provided e.g. bathing. This meant that people could not always have a bath when they chose. This was discussed with the manager and it was recommended that an increase in staffing be considered especially when the unit was also caring for day clients. Comments about staff skills and training were mixed, but most considered that although new employees and junior staff did not have experience and knowledge, they were supported by senior and more experience staff. Comments were, “Depending on who is working on a particular shift. My parents are very well looked after”, “I have experienced staff not having basic knowledge needed to meet health care needs but senior care staff have been at hand to direct those staff members”, “Overall I feel the staff do have the skills to carry out social and health care needs”, “In my experience staff have asked for advice when they have met a problem”, “No problems at all with main carers and long term staff who also undertake training opportunities. Those newly appointed staff who sometimes do lack skills and experience appear to have support from more senior staff and certainly have a good role model in the Centre Manager. Training opportunities appear to be available”, “ I feel greater training for junior staff on dealing with clients who have a dementing illness”, and “To have training on managing people with behavioural problems associated with dementia. However staff could shadow CMHNs and discuss issues on dealing with clients with a dementing illness”. (CMHN = Community Mental Health Nurses) The manager said that the majority of staff had now achieved or were in the process of achieving National Vocational Qualifications in Care at Level 2 and Level 3. Staff undertook regular training to improve their skills but had only received a few hours training in dementia care. To enable greater insight and empathy for people with dementia, staff providing this care need to undertake more training in dementia. One of the people had a sensory disability. The manager admitted that staff had not received any sensory awareness training. This needs to be provided to ensure that staff have the skills to meet this person’s needs. The recruitment files for four members of staff were checked. the relevant checks and information. All contained DS0000036246.V332785.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home was run and managed in the best interests of people living at the home. Their health, safety and welfare were promoted and their financial interests were safeguarded. EVIDENCE: The registered manager was qualified and experienced. She provided leadership and was considered a good role model. She was up to date with current practice and proactive in her management approach. DS0000036246.V332785.R01.S.doc Version 5.2 Page 21 The home had a good quality assurance system that included environmental and health and safety checks, audits of systems, meetings and questionnaires. Reports of visits by the responsible individual were also available and demonstrated company awareness of actions needed. This home is very good at informing the CSCI of issues relating to people’s well-being. Money held on behalf of people who lived at the home was stored safely. Records were kept and a sample of these was checked against the money and these tallied. Receipts were available for purchases made on behalf of people living at the home and these were numbered for ease of reference. Audits were carried out. Mandatory health and safety training was ongoing and information of each member of staff’s level of training was recorded. Certificates were available to verify that systems and equipment within the home had been serviced and maintained within the required timescales. DS0000036246.V332785.R01.S.doc Version 5.2 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 DS0000036246.V332785.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 12 Timescale for action Provide more specific information 08/11/07 in the daily records of the physical care needs that have been met. Daily records need to include 08/11/07 information of how people’s social needs are met through group or individual pursuits. This provides stimulation and motivation and a more person centred approach. Staff need training to have a 03/01/08 greater understanding of people with: • Dementia • Sensory disabilities to ensure that the individual needs of people living at the home can be met. Requirement 2. OP7 16 3 OP30 12 DS0000036246.V332785.R01.S.doc Version 5.2 Page 24 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 3 4 5 6 7 8 Refer to Standard OP1 OP1 OP9 OP12 OP15 OP16 OP19 OP27 Good Practice Recommendations Consider separating the statement of purpose from the service user guide to ensure that the reader has the relevant information for each document. Issuing a copy of the service users guide to prospective clients or their relatives would ensure that they had information about the home The provision of people’s photos and information of allergies should be extended to all people living in the home to reduce the risk of error in administration. Activities suited to people with dementia should be provided to promote motivation. Provide menu boards to inform people of the meals and choices available. Amend the complaints procedure to include the local address of the Commission for Social Care Inspection. Provide pictures and visual stimulation and means of orientation to time and place to assist people with dementia Consider increasing staffing levels at certain times of the day to meet the needs of people living in the home particularly on the dementia unit. DS0000036246.V332785.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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. 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