Care Home: Emm Lane Care Home

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What the care home does well The comments made by everyone connected with the home support our observations that the home is well managed and run in the best interests of the people who live there. The people who live at the home all made generally positive comments about the care and support people receive. One person said their social worker helped them when they moved in. All except one person said they know how to make a complaint if they need to. They said they would either speak to the manager or discuss their concerns with their family or the staff. People said the staff listen to them and act on what they say. Everyone said they can always do what they want to. One person said `I like all the staff`.The care and support plans reflect each individual`s preferences and needs. People are involved in making decisions about the way the home they live in is run, and the management and staff make sure their views are central to any decisions. It was clear during the inspection that the staff know and understand each person and do everything they can to support people`s individual needs. People`s right to make individual choices is respected and supported. People`s cultural and spiritual needs are understood and met. People know how to make a complaint or raise a concern if they are not satisfied with any aspect of the service. The recruitment procedures are thorough, making sure that the staff who are appointed are safe and suitable to work with the people who live at the home. The staff are well qualified and are encouraged to keep up their professional development by taking training to keep their skills and knowledge up to date. What has improved since the last inspection? All except one of the requirements made at the last inspection have been met. There are sufficient staff on duty to support people and meet their needs. Efforts have been made to try and make sure that there are staff available to support people to follow their interests. The care plans are person-centred and are being regularly reviewed, to make sure they reflect each individual`s wishes. The broken locks on some of the toilet and bathroom doors have been repaired. Some bathrooms and toilets have been refurbished and the kitchen has been refitted and redecorated. The few unnecessary odours have been eliminated. Window restrictors have been fitted, where necessary, to make sure people are safe. What the care home could do better: The home`s staff should continue their efforts to provide people with as wide a range of leisure and social opportunities as possible. The home`s management must make sure that all significant occurrences are reported to us, as required by Regulation 37 of the Care Standards Act 2000. CARE HOME ADULTS 18-65 Emm Lane Care Home 72 Emm Lane Heaton Bradford West Yorkshire BD9 4JH Lead Inspector Liz Cuddington Key Unannounced Inspection 13th August 2008 11:00 Emm Lane Care Home DS0000001139.V370064.R02.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 Emm Lane Care Home DS0000001139.V370064.R02.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. Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Emm Lane Care Home Address 72 Emm Lane Heaton Bradford West Yorkshire BD9 4JH 01274 541444 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 Kim Helen Jomeen Mrs Kim Helen Jomeen Care Home 14 Category(ies) of Learning disability (2), Mental disorder, registration, with number excluding learning disability or dementia (12), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (12) Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th August 2007 Brief Description of the Service: Emm Lane is situated near Lister Park, approximately 3 miles from Bradford city centre. The area is well served by public transport to Shipley and Bradford. The house is a semi-detached period property, providing care and accommodation for adults who are recovering from a mental illness. The accommodation is situated on three floors, with two twin and ten single bedrooms. There are two lounges and a dining/kitchen. There is a walk in shower on the ground floor but the home is not really suitable for wheelchair users. The present fees for the home are set at the Social Services/Bradford District Health Care Trust rates. People pay their own personal expenses. Emm Lane Care Home DS0000001139.V370064.R02.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 this service experience good quality outcomes. The purpose of this inspection was to assess the quality of the care and support received by the people who live at Emm Lane. The visit to the home was carried out over one day by one inspector. Since the last inspection in August 2007, no complaints or concerns have been made to us about the home. The methods used to gather information included conversations with the people living at the home and the staff, looking at care plans and examining other records. Many of the people who live at the home returned questionnaires to us and we also received the home’s self-assessment questionnaire before the inspection visit. These questionnaires provide valuable information to help us form a judgement about the quality of the care and support the home provides. We would like to thank the people who live at Emm Lane and the staff, for their welcome and hospitality and for taking the time to talk and share their views during the visit. What the service does well: The comments made by everyone connected with the home support our observations that the home is well managed and run in the best interests of the people who live there. The people who live at the home all made generally positive comments about the care and support people receive. One person said their social worker helped them when they moved in. All except one person said they know how to make a complaint if they need to. They said they would either speak to the manager or discuss their concerns with their family or the staff. People said the staff listen to them and act on what they say. Everyone said they can always do what they want to. One person said ‘I like all the staff’. Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 6 The care and support plans reflect each individual’s preferences and needs. People are involved in making decisions about the way the home they live in is run, and the management and staff make sure their views are central to any decisions. It was clear during the inspection that the staff know and understand each person and do everything they can to support people’s individual needs. People’s right to make individual choices is respected and supported. People’s cultural and spiritual needs are understood and met. People know how to make a complaint or raise a concern if they are not satisfied with any aspect of the service. The recruitment procedures are thorough, making sure that the staff who are appointed are safe and suitable to work with the people who live at the home. The staff are well qualified and are encouraged to keep up their professional development by taking training to keep their skills and knowledge up to date. What has improved since the last inspection? What they could do better: The home’s staff should continue their efforts to provide people with as wide a range of leisure and social opportunities as possible. The home’s management must make sure that all significant occurrences are reported to us, as required by Regulation 37 of the Care Standards Act 2000. Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 7 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. Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Before people move in the staff carry out a thorough pre-admission assessment and introduction procedure, to make sure they would be able to meet the individual’s needs. EVIDENCE: People are given information about the home before deciding to move in, and they also receive a contract stating the type of room the person will have. Where possible the home encourages people to visit and talk to the people who already live at the home. The home invites them to come and spend time at the home, before reaching a decision. This means that the home can get to know the person’s needs and also the individual has the information they need to help them make such an important decision. If this is not possible, a senior member of staff will visit people to carry out an assessment and make sure the home can meet their needs before offering a place. Emm Lane Care Home DS0000001139.V370064.R02.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, 8 & 9 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To maintain their autonomy and independence, staff support people to make choices and decisions about all aspects of their daily lives. People are involved in planning how their care and support is to be provided. EVIDENCE: Three individual care and support plans were looked at. The plans reflect the individual’s preferences and needs and demonstrate the person’s involvement in making all the decisions that affect them. They show that people and, where the person wishes, their relatives and social care professionals are involved in developing and reviewing their plans. Someone who is independent of the home chairs the care plan review meetings. The notes taken at the meetings were very clear and covered all the Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 11 areas relevant to the individual. They reflect improvements in people’s health and well-being. People are involved in making decisions about the way the home they live in is run, and the manager and staff make sure their views are central to any decisions. The people who commented confirmed that the service supports them to live the life they choose and agreed that the service meets their different needs. Observation, and conversations with the staff, confirmed that the staff know and understand the needs of each person. The staff promote people’s independence and everyone is treated as an individual. Each care plan includes a ‘pen picture’ of the individual giving the staff background information to help them understand the person, their support needs and their preferences. There are risk assessments in place where necessary and the plans are reviewed regularly, to make sure they are up to date and still reflect the person’s needs. When someone’s needs change significantly, this is shown in the detailed review. During the visit, all the staff were seen to treat people with respect and maintain their dignity. People said that they receive the care they need and are supported to maintain their independence for as long as they are able. All the written information is securely stored and confidential information about people is only shared with those who need to know. Emm Lane Care Home DS0000001139.V370064.R02.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, 14, 15, 16 & 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to follow activities of their choice, to make sure each person’s needs and expectations are being met. People are offered a good choice of meals, and other foods, to make sure their dietary needs and preferences are met. EVIDENCE: The care plans include information about each person’s choice of recreational and leisure pursuits and their goals. The activities people follow depend upon what they want to do. People are involved in making decisions about the way the home they live in is run, and the manager and staff make sure their views are central to any decisions. Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 13 People said they are supported to lead their lives in the way they choose. The staff are aware of people’s preferences and the home is run in the best interests of the people who live there. Individual choices about spiritual and cultural matters are reflected in the plans and the staff all know and understand each person’s needs and preferences. Some people like to help with the household tasks and enjoy cooking and shopping. People also enjoy walks in the local park, going out to musical shows at local theatres, visiting the pub, museums and the cinema. At home there is a choice of games such as cards, dominoes and quizzes. People are supported to take up paid or voluntary employment if they choose. Emm Lane Care Home DS0000001139.V370064.R02.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 & 20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s personal and healthcare needs are met. People are protected by the home’s medication systems. Medications are stored safely and are generally administered accurately. To maintain their privacy and dignity, the staff treat people with respect, care and consideration at all times. EVIDENCE: Each plan is individual and reflects the person’s choices for all aspects of their life. The way people prefer their care and support to be provided is clearly detailed. The people we spoke with said that the home and the staff meet people’s needs. Detailed records of appointments with healthcare professionals are kept and a recognised health check assessment is completed for each person. The home Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 15 monitors people’s health and works with the healthcare services to make sure people receive the care and treatment they need. The plans make sure that people’s health and personal care needs are being met in the way the person prefers. The plans cover each area of the individual’s care needs. They all contain enough information to guide staff in how to care for and support each person. People said that they always receive the medical and healthcare support they need. The home seeks advice about people’s health from healthcare professionals, and the care plans show that the staff act upon the advice they are given. People’s preferences are detailed in the plans, so that staff know exactly how each person likes their support to be provided and understand the routines they like to follow. People are supported to be as independent as possible in their daily lives and any adaptations or specialist equipment they need are made available. There are risk assessments in place and the plans are reviewed regularly, to make sure they are up to date and still reflect the person’s needs. When someone’s needs change significantly, this is shown in a detailed review. The medicines are kept safe and secure and the Medicines Administration Record (MAR) charts are securely stored. Most of the medicines are supplied by the pharmacy in a monitored dosage system, but some is kept in the original packaging. The MAR charts, which must show clearly the quantities of medicines received and in stock for each person, were examined. The medicines supplied in the monitored dosage system appeared to be administered and recorded accurately. There were signatures to confirm that staff had administered the medicine, although some signatures were missing. In order to keep an accurate record of the medicines that are supplied in their original packaging, a ‘brought forward’ system should be put in place. This would show the quantity of any medicines that are carried forward from one four-week MAR chart to the next, in addition to any new supply of the medicine. Medicines must be administered directly from the packaging supplied by the pharmacy. The practice of the home’s staff dispensing someone’s medicines into their own monitored dosage system is potentially unsafe as errors could occur. During the visit, all the staff were seen to treat people with respect and maintain their dignity. People said that they receive the care and support they Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 16 need, they are supported to maintain their independence and their wishes are respected. Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at the home, and their relatives, are aware of how to raise a concern or make a complaint if they are dissatisfied with the service. Staff have received suitable training and understand the adult protection policies and procedures, which makes sure that people staying at the home are safe. EVIDENCE: The staff training records showed that they have all taken adult protection training. They have also had training in how to manage challenging behaviour. Conversations with the staff showed that they understand their responsibilities towards people with regard to protecting them from any risk of abuse or poor practice. Staff are made aware of the home’s ‘whistle blowing’ policies and procedures, to be used if they suspect abuse or see examples of poor practice. People we spoke with said they feel safe and know how to make a complaint or raise a concern if they need to. The staff we spoke with said they understand the complaints and adult protection procedures. Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 18 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, 28 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, clean, comfortable and well-maintained environment. EVIDENCE: The home is clean and generally well maintained and there is an ongoing refurbishment programme. Everyone said the home is always kept fresh and clean. The rooms are comfortably furnished and have a welcoming feel. Protective gloves and aprons are available for staff to use when necessary. The washing machines have a sluice wash programme, as part of the home’s infection control measures. The home’s owners have a programme of maintenance and re-decoration for the home. The kitchen has been refurbished since the last inspection visit and Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 19 is a clean, safe and comfortable place for staff to prepare meals and for people to sit and enjoy their meals. There are sufficient, accessible toilets and bathrooms on both floors of the house. Some of these have recently been refurbished and are fresh and attractive. The broken locks on the toilet and bathroom doors have all been repaired. The gardens are tidy and have seating for people to use in the better weather, as well as a sheltered outdoor area for people to use all year round. Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 20 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 & 36 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are employed to meet people’s needs. People are protected by thorough recruitment procedures, which ensure that staff are suitable to work with people who live at the home. Suitable training is provided to make sure staff have the skills and knowledge they require in order to meet people’s needs. EVIDENCE: The staff rotas confirmed our observations that there are enough staff on duty to meet the needs of the people who live in the house. The staff confirmed that the number of staff on duty is adjusted to reflect people’s needs. There are three staff on duty during the day, two after 5pm and two waking night staff. Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 21 All staff complete an application form and provide two written references. Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks are obtained and no new staff begin work until these checks have been completed satisfactorily. Recruitment of staff who have come from overseas is through a specialist agency. We were told that immigration office staff have visited the home and checked the records and they were satisfied that everything is in order. The staff recruited from overseas, are qualified as nurses in their own country; one has experience in mental health nursing. They are currently working as senior care assistants as they have not done the adaptation training, which would allow them to be registered as nurses in the UK. The home said that the remaining care staff have all achieved a National Vocational Qualification (NVQ). New staff complete a recognised induction training programme and all staff have completed their mandatory health and safety training. They have also had medication administration training and attended specialist training covering dementia care and challenging behaviour. People who commented said they thought the staff were well trained and competent. Staff training certificates are kept in their personal files. The records, and the staff, confirmed that all the staff are having regular one to one supervision meetings with their line manager. This supports staff to plan their personal and professional development and gives them the opportunity to discuss any areas of concern in a confidential setting. Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and well managed and is run in the best interests of the people who live there. EVIDENCE: The manager has the experience and skills to run the home in the best interests of the people who live there. To maintain confidentiality, people’s personal information is stored in an office that is locked when it is not being used. Where the home helps people to keep their money safe, accurate records are kept of all transactions. All monies are securely stored. Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 23 The comments made by people and staff support our observations that the home is well managed and run in the best interests of the people who live there. Observations during the inspection visit, and comments from other people, confirm that everyone’s views are valued and taken into account. People’s views are sought through meetings and informal discussions with the people who live at the home, their relatives and any health and social care professionals who are involved. Quality assurance questionnaires were last sent out to people in March 2008. The information was used to help the owners improve the service they offer. The policies and procedures are kept up to date to make sure they provide relevant information to guide staff on how to act in every situation. All the regular health and safety checks for the home are carried out in a timely manner. Staff have basic health and safety training. All these measures make sure that the health, safety and welfare of the people at the home is promoted and safeguarded. We were assured that information about any notifiable incidents is being forwarded to us. However, our records do not confirm this. The home’s management must make sure that all significant occurrences are reported to us, as required by Regulation 37 of the Care Standards Act 2000. Emm Lane Care Home DS0000001139.V370064.R02.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 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 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 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 Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA42 Regulation 37 Requirement Any incidents or accidents in the home, which affect the well being of the people living at the home must be notified to us. This will make sure that any issues are being managed in the best interests of the people living there. Last timescale not met: 01/11/07 Timescale for action 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Emm Lane Care Home DS0000001139.V370064.R02.S.doc Version 5.2 Page 27 - 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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