Care Home: Foxby Hill Nursing Home

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What the care home does well The acting manager provides good information to residents and relatives to help them make informed choices and they are assured that the home can meet their needs through a comprehensive assessment process. Residents benefit from comprehensive care plans and access to a range of healthcare professionals. They enjoy a balanced diet based on their likes, dislikes and choices and benefit from a comfortable and hygienic environment that meets their individual needs. Two carers stated that the home is well run and the acting manager is very supportive and approachable. Comments received from people were that, they liked the home, were happy and the staff `are very nice.` All felt their needs were met and one resident commented that she is `treated normally as a person and staff are mindful of my privacy and dignity`. Another comment was that `I knew some of the residents before I was admitted, it made me feel better`. What has improved since the last inspection? The acting manager stated that those recommendations made in the last visit had been addressed and care plans are continuing to be improved, incorporating the Mental Capacity Act and its outcomes for residents. The general manager has now undertaken an audit of all administration issues and is updating where necessary. The operations manager also commented that training programmes are ongoing for all members of staff working at this establishment. Decoration of the home is ongoing, with plans for a conservatory to be built in the near future. Residents are consulted about the meals, with their likes and dislikes recorded and choices are available. Other changes have been four new rooms built last year, an extension to a dining room and a new quiet front lounge. CARE HOMES FOR OLDER PEOPLE Foxby Hill Nursing Home Foxby Hill Gainsborough Lincs DN21 1PN Lead Inspector Doug Tunmore Unannounced Inspection 30th June 2008 09:50 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 Foxby Hill Nursing Home DS0000002578.V367447.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. Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Foxby Hill Nursing Home Address Foxby Hill Gainsborough Lincs DN21 1PN 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) 01427 611231 juliet.smithevans@tesco.net Mrs Juliet L Smith-Evans Mrs M P Smith Mrs Karen Beverley Johnson Care Home 40 Category(ies) of Dementia (36), Old age, not falling within any registration, with number other category (36), Physical disability (5) of places Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The registered person may provide the following category of service only: Care home with nursing - Code N 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 :Dementia (DE) Old age, not falling within any other category (OP) Physical Disability (PD) The maximum number of service users who can be accommodated under the PD category is 5 To people of the following gender: either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Physical disability (PD) The maximum number of people who can be accommodated under the PD category is 5. The maximum number of service users who can be accommodated is 36 The maximum number of people who can be accomodated within the home is 40. 3. 4. 5. 6. 7. Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 5 Date of last inspection Brief Description of the Service: Foxby Hill is a care home, which provides both personal care and nursing care for a total of 40 people (35 older people over 65 years of age, including 4 residents over the age of 47 years with a physical disability and one resident under the age of 50 years). Foxby Hill is a detached property set in 1 acre of ground and is situated on the outskirts of Gainsborough, close to local facilities. The home has a sunroom and an enclosed garden with raised beds, and a fishpond. There is parking space available. The home’s mission statement states that ‘Foxby Hill Care Home’s philosophy is to provide the highest possible standards of care based on individual needs’. The owners visit on a weekly basis to ensure that both the care standards and training are maintained. The fees at the inspection on the 30/06/2008 ranged from £395:00 to £529:00 per week. Extras are for hairdressing, which range from £3 to £20, chiropody, newspapers and magazines, there is also a fee of £5:52 per hour for staff to accompany people to hospital or GP appointments. The service users guide is available from the acting manager and is kept in the office. All residents have a copy of the service users guide in their rooms. Foxby Hill Nursing Home DS0000002578.V367447.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 two star. This means that people who use this service experience good quality outcomes. One inspector undertook this visit to the home. However, information gained during an annual service review undertaken on the 19/03/08, will be used throughout this report. This formed part of an unannounced key inspection. This visit took into account any previous information held by The Commission for Social Care Inspection (commission) including the homes previous inspection reports and the homes Annual Quality Assurance Assessment form, hereafter in this report referred to as AQAA. No ‘Have Your Say’ surveys were received from the home prior to this inspection. The site inspection consisted of case tracking a sample of four residents records and assessing their care. The inspector joined two residents for lunch and spoke to other residents during the meal. The inspector spent time with two residents, the acting manager, general manager, administrator and the visiting operations manager. No visitors were seen during this visit. A full tour of the home and a review of a sample of the records were also included. What the service does well: What has improved since the last inspection? Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 7 The acting manager stated that those recommendations made in the last visit had been addressed and care plans are continuing to be improved, incorporating the Mental Capacity Act and its outcomes for residents. The general manager has now undertaken an audit of all administration issues and is updating where necessary. The operations manager also commented that training programmes are ongoing for all members of staff working at this establishment. Decoration of the home is ongoing, with plans for a conservatory to be built in the near future. Residents are consulted about the meals, with their likes and dislikes recorded and choices are available. Other changes have been four new rooms built last year, an extension to a dining room and a new quiet front lounge. 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. Foxby Hill Nursing Home DS0000002578.V367447.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 Foxby Hill Nursing Home DS0000002578.V367447.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): Standards 1, 2, 3,4 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive good information about the home, which helps them to make an informed decision about where to live. The clear assessment process assures residents that their needs can be met within the home. EVIDENCE: The providers AQAA states that; ‘the service users guide gives a comprehensive insight into the relevant experience and qualifications of all members of the care team, from the registered provider downwards. Upon admission each new resident/significant other is given a copy of the homes statement of terms and conditions. All residents are assessed (by our own assessment tool) prior to admission’. Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 10 One comment received from a visitor during the annual service review dated 19/03/08 was, ‘we couldn’t have found a better home for our relative’. A review of all information available prior to this inspection and evidence seen at this inspection in residents files and care plans showed that the home does not admit residents without a care assessment being undertaken. Prospective residents are also written to by the home confirming whether they can meet the residents care needs or not. Four people were being case tracked during this visit, two of whom had dementia and two others having a physical disability requiring aids and adaptations. Two spoken with were hazy about their admission. However, one said that he had been admitted from another home and now had a bigger room, which he has filled up with his books and memorabilia. We looked at two files of people who were being case tracked which contained a contract detailing the care that they were to receive. This home does provide intermediate care, on an emergency basis. Foxby Hill Nursing Home DS0000002578.V367447.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): Standards 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from comprehensive care plans, which accurately reflect their assessed needs. The care planning systems do not ensure that resident’s privacy and dignity is maintained. EVIDENCE: The providers AQAA tells us that;‘ all residents within our home have an individual plan of care, which includes individual risk assessments for nutrition, tissue viability, continence, moving and handling falls and the use of bed rails and bumpers. Residents and their significant others are encouraged to take part in the care planning process. All medications for all categories of residents are administered by a Qualified Nurse’. Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 12 Comments made by a relative during the service review was, ‘We are happy with the care. We can’t really fault it. The staff are very good – always cheerful, on top of the job, good sense of humour. We’ve never seen any problems and we go quite often. The staff always inform us of anything; they don’t try to cover anything up. Any changes in condition and they always tell me about it’. One resident stated that they see the GP, community nurse and the chiropodist when they want to and felt that their health and care needs were met at the home. We looked at four care plans and found that specific needs relating to aids and adaptations have been made available to residents to enable them to be mobile and independent in vary degrees. A specific comment made by a resident was ‘Carers are first class, people don’t realise how good they are’. Another resident commented ‘My privacy and dignity is met by carers who are sensitive to my needs, I am treated normally as a person’. We looked at four residents files who were being case tracked and records did not evidence that residents had been involved in determining that their individual intimate care needs were met. Care plans need to be outcome based, focusing on individual resident needs, not task centred on completing given tasks. The acting manager confirmed that care planning is now moving away from task centred care planning. Care plans seen identified issues relating to the Mental Capacity Act 2005 and how this may impact on the decision making process of the acting manager and people who live in this home. Care plans evidenced that monthly reviews were available on each file and Care records included a detailed assessment, social care profile, moving and handling, risk assessment, nutritional, continence assessments and daily records. The home also uses body maps for the mapping of any cuts or abrasions to residents. A sample of care plans also found that residents or their visitors had been involved in the care planning. The pharmacist undertook a visit to this home on the 10/06/08 and the report showed that there were two signatures missing from medication sheets. Due to the pharmacists visit the inspector did not carryout an inspection of medicines. No resident self-medicates in this home at the present time. The operations manager confirmed that only trained nurses administer medication. Foxby Hill Nursing Home DS0000002578.V367447.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): Standards 12,12,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a varied and appropriate activity programme, which enables them to maintain an active social life. They are able to choose from a range of foods within a balanced diet. EVIDENCE: The providers AQAA evidences that ‘the appointment of our Activities Coordinator has greatly improved our residents choice in relation to leisure and social activities. Residents are given choice as to the menu they wish and where they would prefer to eat. If a resident chooses to have their main meal in an evening this can easily be accommodated’. Specific comments received from relatives at the time of the service review were; ‘the residents get a pretty good variety of food, good choice. At the main mealtime there’s 4-5 different things to choose from. The staff discussed with us about (the resident’s) diet. They had her (resident) assessed and are Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 14 monitoring her condition, which is good’. The inspector joined two residents for lunch and found their food to be hot, well presented and nutritious. The meal was taken in a relaxed atmosphere with residents not being hurried by carers through their meal. Residents made favourable comments about the food, ‘The food is good’ and ‘I enjoy my meals and there is quite a choice’. Other comments made at the service review were; ‘We were told that there is an activity organiser who works Mondays, Tuesdays and Wednesdays and that the residents get quite a lot more activities now’. Another comment made was, ‘We were told that occasionally not all residents are asked if the activities provided suit their wishes and needs but most are satisfied with what is provided’. On the day of the visit a pianist was entertaining the people in the large lounge; a number joined in with carers in a singsong. One younger resident informed the inspector that he uses dial a ride to go into town to watch films at a club. Unfortunately he wasn’t picked up at the end of one evening and drove back to the home in his motorised wheelchair. This resident confirmed that he occasionally has visitors who are made welcome at the home. Observations made during this visit were that residents have large areas in which to wander safely which are currently being developed. They can view the woodland around the home especially the rabbits, which are a favourite of people in the home. Foxby Hill Nursing Home DS0000002578.V367447.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): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures for addressing and monitoring complaints and concerns are in place to protect residents who are vulnerable. Adult protection issues are taken seriously and the manager would seek advice if she had concerns. EVIDENCE: The providers AQAA tells us that ‘We have a comprehensive complaints and whistle blowing procedure, which outlines the process undertaken in case of a complaint. This is included in the service users guide, a copy of which is in every client’s room. All our staff are made aware of the abuse policy and relating issues on a rolling programme of in-house sessions. We have rewritten our protection of vulnerable adults policy within the last twelve months to reflect all the changes which have occurred’. The annual service review found that; two concerns had been raised since the last inspection visit. They have been investigated, any issues addressed and the relevant people informed of the outcome. Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 16 The acting manager and provider have worked with the County Council Authorities to resolve a Safeguarding Adults issue within recent months. The commission has been kept informed of developments. We looked at the complaints folder and found that there have been five complaints in 2008. Evidenced was seen that they had been addressed in the prescribed time scale of 28 days. One relative contacted as part of the service review said that ‘As soon as we had a concern, the manager sorted it out straight away’. They said that ‘Staff are always helpful’. Two relatives said they have never had any concerns or complaints, ‘We are very satisfied with the way she is looked after’. Both residents seen expressed the view that they were safe at this home and felt protected by staff. The training profile evidenced that safeguarding vulnerable adults training had been undertaken by carers and further training is planned for 2008. Two carers confirmed what action they would take if they were aware of abuse of residents and they were knowledgeable about the different types of abuse that could occur in a care home. Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 17 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): Standard 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in clean, well-decorated, homely and safe accommodation. EVIDENCE: The providers AQAA states that, ‘the home is constantly being upgraded as part of a rolling programme of maintenance and renewal. The home has had a refurbishment resulting in increased communal space, four new en-suite bedrooms, a wet room and new purpose built disabled toilet, a kitchenette for use by visitors, increased access to the courtyard, new administration office, reception, front lounge and car park. We have a maintenance person employed at thirty-five hours per week’. Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 18 We received a specific comment from a relative as part of the service review; ‘They always trying to upgrade the environment. The owners don’t scrimp. If it’s needed, they get it. We’d give them full marks’. The providers AQAA tells us that, ‘the home is kept clean, hygienic and free from odours by a team of a housekeeper, one assistant and three domestic assistants who are managed by a general manager. The housekeeper and all staff have had COSHH training’. A tour of the home by the inspector found it to be clean and smelt fresh. This was also confirmed from a previous inspection in 2006. Evidence was also seen on the day of the visit of continuous maintenance taking place. Residents said they liked their bedrooms and spoke of how satisfied they were with the cleanliness of the home. Individual bedrooms were comfortably furnished with personal possessions, individual adaptations and specialist equipment provided to aid the person’s independence. Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 19 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): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the provider’s recruitment procedures. Residents benefit from a knowledgeable staff team who are well trained. EVIDENCE: The providers AQAA tells us that, ‘we aim at all times to provide above minimum staffing levels to ensure our residents are in receipt of the high level of care we aim to deliver. At all times there is at least one trained nurse, one care leader (on days) and the appropriate number of care staff and at least twenty four hours per week. Currently our NVQ achievement level is 33 and those working towards NVQ (National Vocational Qualifications in caring for the elderly) is 29 ’. A staff member told us at the time of the service review that, ‘The care side is really good. There’s a good staff team and we work well together. There’s a heavy workload, but I have no gripe with the providers. There is a key worker system in place; each team is headed by a care leader and there are 8-9 Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 20 residents for each team. We have more time to do things with individual residents in the afternoon. The nurses write the care plans. But although carers do not write in them, they are fully aware of the care plans’. A resident stated that she likes this home very much, she further commented that due to her condition when she rings the call buzzer ‘the staff always come quickly, they’re very good’. Two carers felt that there were not always the numbers of staff required due to sickness and holidays. They confirmed that they have undertaken NVQ training level 2 and moving and handling, dementia training, safeguarding vulnerable adults training, fire training and health and safety. The providers training profile evidenced that training is ongoing for all staff at this establishment. Staff also received a supported induction. Care workers are given a copy of the General Social Care Council’s Codes of Practice, which sets out their responsibilities as care workers looking after vulnerable adults Staff records examined also showed each person had an application form, references, criminal records bureau check and contract. Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 21 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): Standards 31,32, 33, 35, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Accurate accounts are kept of resident’s monies. People’s valuables are not protected due to inadequate recording. The home is well managed meeting the needs of residents whose health, safety and welfare are protected. EVIDENCE: The Providers AQAA states that ‘All residents in the home have a lockable Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 22 facility in their room. For things of value, they are encouraged to leave them either in the homes safe or in their own bank. There is a comprehensive infection control policy in place and all staff are aware of the need to ensure good infection control in the workplace. All equipment required to carry out good infection control is provided i.e. gloves, aprons and masks if the situation dictates’. The acting manager stated that she would send her application to be registered by CSCI within four days of this inspection. She is a registered nurse and has considerable nursing experience and has been a bank nurse for twenty-two years with elderly people. Comments made at the time of the service review by a relative was, ‘The manager – I can talk to her. She’s very cheerful, very good at her job. Always around, helping. There’s a nice atmosphere amongst the staff.” The minutes of the last residents meeting were held in July 2007 and showed that residents are encouraged to voice their views and are actively involved in issues relating to the running of the home. The acting manager commented that more regular residents/relatives meetings are to be undertaken. The home assists some residents with managing their personal allowances and a record is made of all transactions with receipts kept. The administrator evidenced that an accurate record of resident’s monies is kept and receipts were available to show monies spent by residents. We looked at people’s files, which did not evidence that all residents had an individual record of their valuables when admitted. Some had no watches or rings recorded. The homes custom and practice is to record and describe all items and should include those residents who do not have certain valuables. The acting manager stated that an immediate audit would be undertaken and all items belongings to residents would be recorded. The providers AQAA showed that; gas safety inspections have been carried out, electrical wiring checks, fire precautions checks, and portable electrical equipment checks. The manager stated that risk assessments are available relating to the home environment. Staff had been trained in Health & Safety, Fire procedures, etc. Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Foxby Hill Nursing Home DS0000002578.V367447.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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