Care Home: Furzehill Road (9)

What the care home does well "Supports me to help me move to live on my own" and "It is nice, I enjoy living here" were what two people living in Furzehill Road either told us themselves or told people helping them complete the surveys we sent to them. People who work at Furzehill Road told us that "We have a good manager" and "we work well together as a team". Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Everyone that we spoke to or heard from in some way or other during this inspection process was very positive about Furzehill Road and told us that they thought it provided good care for the people who live there. Whilst we were visiting the home, it was calm, pleasant and relaxed and everyone seemed to be getting on with each other very well. We found that the manager and the other people who help her run the home and look after the people who live there had doe the paperwork they have to do and the records we looked at were correct and up to date. What has improved since the last inspection? The home`s manager was registered by the then Commission for Social Care Inspection in October 2008. This had been something we asked to be done in our last report on Furzehill Road. This means that we think that she is a `fit` person to be in charge of a home like Furzehill Road. There has been some improvement to the building, and whilst we were in the home, decorators were painting parts of the home to make it a nicer place to live and work in. The kitchen has been changed around in a way that the people who live in the home wanted. What the care home could do better: Some people said the home would be even better if they had more staff and if more of those staff were men. Because some of the staff are quite new, they have to get used to how things work at Furzehill Road. They are being helped to do this by the manager and those staff who have worked in the home longer, and as they become more familiar with everything, this will make the home even better for the people who live there. The manager told us in the AQAA that there are to be more changes to the building, including improvement to the `music room` to make it a place where people living in the home can `chill out` and relax. Key inspection report CARE HOME ADULTS 18-65 Furzehill Road (9) 9 Furzehill Road Borehamwood Hertfordshire WD6 2DG Lead Inspector Jeffrey Orange Key Unannounced Inspection 4th June 2009 08:55 Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Furzehill Road (9) Address 9 Furzehill Road Borehamwood Hertfordshire WD6 2DG 0208 953 8401 F/P 0208 953 8401 h3073@mencap.org.uk www.mencap.org.uk Royal Mencap Society 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 Jennifer Margaret Bunn Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th June 2007 Brief Description of the Service: 9 Furzehill Road is a two storey semi-detached house operated by the voluntary organization Mencap as a six-bed care home for adults with learning disabilities. It is located in Borehamwood, just off the High Street. All the people who live there have their own bedrooms and the home has a variety of communal spaces, decorated and furnished in domestic styles. All the town facilities are nearby. There is a bus stop outside the home and a railway station within walking distance. The home is staffed twenty-four hours a day and aims to support the service users to lead the lifestyles they choose in a safe environment. Information about the service provided at 9 Furzehill Road, including the most recent inspection report can be obtained on request from the manager. Each person living at 9 Furzehill Road has a tenancy agreement that sets out his or her individual contribution towards the rent, which is part of a block contract with Hertfordshire County Council. Their individual contributions range from £69.90 - £108.10 per week. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use the service experience excellent quality outcomes. We last visited Furzehill Road in June 2007 when we found that people living there were cared for well. Since then we have carried out an Annual Service Review (ASR) where we look at all the information we hold regarding a service to assess if our inspection plan needs amending. In the case of this service the inspection plan was maintained. We started this inspection visit early in the morning and stayed long enough to speak to some of the people who live in the home before they went out for the day, including two people who were going to a special ‘Our voice’ meeting. ‘Our Voice’ is an area group of people who access Mencap’s services. One of the people from Furzehill told us that they were going to be in charge of looking after the money for the group. Whilst we were at the home we also spoke to the manager before she left to go with people to the ‘Our Voice’ meeting and we were able to talk to some of the staff team on duty. We looked at some important paper records about the way that the home is run and organised. This included details about how people staying at Furzehill Road are helped with any medicines they may need to keep healthy and to the care plans that they will have helped put together. People have sent us surveys telling us what they think about staying at Furzehill Road, we have also had some surveys from people who work at Furzehill Road and from relatives of people living in Furzehill Road. All of these have been very helpful and have given us a lot of important information. The manager sent us a long document called an Annual Quality Assurance Assessment (AQAA). This is s self-assessment document that says how well people living in Furzehill Road are being looked after and how things might be able to be made better. It also includes some interesting facts and figures for us to look at. What the service does well: “Supports me to help me move to live on my own” and “It is nice, I enjoy living here” were what two people living in Furzehill Road either told us themselves or told people helping them complete the surveys we sent to them. People who work at Furzehill Road told us that “We have a good manager” and “we work well together as a team”. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 6 Everyone that we spoke to or heard from in some way or other during this inspection process was very positive about Furzehill Road and told us that they thought it provided good care for the people who live there. Whilst we were visiting the home, it was calm, pleasant and relaxed and everyone seemed to be getting on with each other very well. We found that the manager and the other people who help her run the home and look after the people who live there had doe the paperwork they have to do and the records we looked at were correct and up to date. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 7 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Furzehill Road (9) DS0000019392.V376066.R01.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 Furzehill Road (9) DS0000019392.V376066.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12345 People using 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. Anyone considering Furzehill Road as a home for themselves or someone they are responsible for can be confident that before they are admitted there will be a thorough assessment of their individual needs to make sure that these can be met appropriately. EVIDENCE: When we looked at the assessment process for anyone being considered for a place in Furzehill Road, we found that it was thorough and comprehensive and that significant time and effort goes into the process to ensure, as far as is possible that it is successful. The process includes a series of visits to the home to enable everyone concerned to be familiar with the environment and to meet the people who already live there, together with the staff who will support them if they move in. We were told in the AQAA that this process includes the person concerned, those people who are important to them and any other health and social care professionals involved in their support. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 10 We saw that Mencap has a families’ charter that clearly sets out the way the home works with families to achieve the best possible care outcomes for the person concerned, putting their health, safety, well-being and interests first and foremost in the process of moving into the service. Each person living in the home has an individual agreement covering their tenancy and the care they are to receive. When we looked at individual files, we saw evidence of efforts to fully involve people living in the home in their care and reviews of it, and there was good evidence that changes in their care needs are identified and appropriate action taken to make sure they are still being met. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6789 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Furzehill Road can be assured that they will be encouraged and supported to control their lives to the greatest possible extent. This will be done within an individual framework of risk assessment that ensures they can do so safely, whilst also recognising the need for them to be able to take reasonable risks. EVIDENCE: When we asked people who live in the home if they made decisions about what they do each day, the majority said that they usually did and one person said that they always did. When we asked if the care staff and managers listened to them and acted on what they said, all but one person said they always did, one person said they usually did. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 12 When we looked at the care plans of people who live in Furzehill Road, they included good evidence that they are involved in the planning and review of their care and that they are consulted widely about the routines and organisation of the home. For example they kitchen layout and menus have all been changed in line with views expressed by people living in the home and there have also been changes made to their support plans. Care plans and other documentation seen were found to include evidence that risks have been assessed and addressed, with a view to supporting people to take reasonable risks in their lives not to limit their lives unreasonably. Where people currently living in the home may be capable of more independent living and want to pursue this option, this is encouraged and facilitated in a process that involves the person themselves, their family and other significant people in their lives as appropriate and by health and social care professionals who support them. We spoke to one person living in the home who is hoping to move to a more independent setting in the future and they indicated that they were being supported by the staff to help them achieve this. Mencap have identified a need to look into the ways that they seek feedback from people within this and other services, the intention is that the new process will be more flexible and accessible and will enable people who rely principally on non-verbal communication to make their views and feelings very clear. People who live in Furzehill Road are already involved in the recruitment process for new care staff, which enables them to make their views known and to influence the decision as to who will work in the home and support them. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 13 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): This is what people staying in this care home experience: 12 13 15 16 17 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Furzehill Road can be confident that they will be helped to maintain contacts, routines and activities in the home and wider community in line with their personal choices, interests and preferences. EVIDENCE: When we asked people who live in Furzehill Road what the home does well, they all included activities, particularly in the community as being very positive for them. “Going to the pub” “Day to day activities that I like” were some typical comments recorded on behalf of people living in the home. Whilst we were at Furzehill Road we were able to speak to two people living in the home who were about to go to ‘Our Voice’ which is a regional service user Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 14 group, that enables people living in different Mencap support services to meet and take part in a range of activities. When we checked with the home the next day, we found that this had been very successful and that one person from Furzehill was taking a major part in the group as ‘treasurer’. When we looked at care plans and other associated documentation, we found details of a whole range of activities and groups, outings and social events that different people supported in Furzehill Road take part in. There was also evidence that where it was in line with the wishes of people living in the home, families and friends were welcome to be part of their lives and the home seeks to strengthen family connections that are important to the people living in Furzehill Road. We saw evidence of a programme for development and individualisation of activities, each person living in the home has a development plan, with specific goals set by the people themselves, which are then worked towards with the support and help of care staff. People living in the home are encouraged to develop daily living skills and to follow particular interests that they may have. For example several people enjoy cooking and are supported to participate and plan as much as they are able to. Some people living in the home belong to a gym and others go to various clubs. In the home, as well as ‘rest days’ when people are supported and encouraged to ‘catch up’ on their domestic tasks, there are sessions with a massage therapist and reflexologist that is a benefit to those who enjoy the experience. In their AQAA the home state that “We appreciate different tastes and interests and plan activities with the people we support accordingly. We do not operate a one size fits all policy!” What we have seen and heard during this inspection supports that assertion. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 People using 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 receiving care in Furzehill Road can be confident that they will be supported to access the health care services they require to maintain their health and well-being and that where the home helps them with their medicines it will be done safely. EVIDENCE: When we looked at care plans for people who live in Furzehill Road, we found that they included health action plans and that these are kept up to date with monthly reviews being carried out; the health support plan includes details of individuals’ health needs. This should mean that the health needs of people living in Furzehill Road are identified, kept under review and met. There is a medication ‘pen picture’ for each person living in Furzehill Road which is kept up to date and there is a robust system of monitoring and Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 16 checking of medication records. We found that only care staff with Mencap medication training are permitted to administer medication for people living in Furzehill Road. This should ensure that medication can be administered safely and that if any errors are made, they will be identified very quickly and appropriate action taken to protect the person concerned. When we checked the medication records for the home we found that hey were accurate and well-completed. When we asked people who live in the home if care staff treat them well everybody said either that they always did or usually did. Furzehill Road (9) DS0000019392.V376066.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 People using 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 who live in Furzehill Road can be confident that they are well protected from actual or potential abuse by staff training and by the way that policies and procedures intended to protect them are enforced and put into practice. EVIDENCE: All of those people that we contacted during this inspection indicated that they feel safe and well-protected in Furzehill Road and that they are aware of how to raise any concerns or complaints that they might have. Where they may be unable to express any concerns verbally, there are mechanisms in place to record non-verbal indicators that may suggest the person concerned is not happy or at ease. When we looked at the complaints policy we found that it was easy to understand, was readily accessible and available in different formats, for example in a pictorial version to help people living in the home to understand the process. When we looked at the systems and records in place to help support people living in Furzehill Road with their finances we found that they were robust and Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 18 kept under review with regular checks. Those records that we spot checked were accurate. Care staff that we spoke to told us that they have received training in the protection of vulnerable adults from abuse. In their AQAA the home told us that there have not been any formal complaints received in the past 12 months. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 30 People using 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 living in Furzehill Road can be confident that the home will provide a physical environment for them that is essentially clean, hygienic, safe and comfortable. EVIDENCE: Everyone who returned a survey to us told us that the home is always fresh and clean. Whilst we were in the home there were decorators working there improving the appearance of the living area and when we talked to the manager she told us about plans to reconfigure the music room to make it more useful for people in the home who want somewhere to ‘chill out’. The homes’ AQAA Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 20 informed us that the kitchen area had been rearranged in line with the wish of people living in the home. On the day we visited the home it was reasonably clean and tidy, given that there was some decorating being completed. We were told that it is intended to improve the garden in order to make it more attractive and to enable one person who lives in the home to pursue their interest in gardening. When we looked around the home the overall impression was of a homely environment, with appropriate individualisation of people’s own rooms and plenty of communal areas for them to join together for meals and conversation if they chose to do so. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32 34 35 36 People using 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 living in Furzehill Road can be confident that they will receive care from a well-trained and supported staff team with the skills required to meet their needs. They can also be confident that they are protected by the way that staff are recruited to work in the home. EVIDENCE: All of the people who live in the home who returned surveys to us indicated that care staff either always or usually treat them well and listen to and act on what they say. When we observed the interaction between care staff and people living in the home, we saw that it was appropriate, respectful and appeared supportive rather than directive. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 22 All of the staff who returned surveys to us confirmed that the necessary checks to protect people living in the home were carried out before they started work. This was confirmed from the records seen. When we spoke to staff and received surveys from them, they confirmed that they were supported through supervision and training. They paid particular tribute to the home’s manager and several of them said “we work as a team”. When we looked at records of staff training, supervision schedules, staff meetings they all supported these positive comments and demonstrate that people living in Furzehill Road benefit from a well-supported and enthusiastic staff team, who have the skills required to provide a high standard of care for them. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37 38 39 40 41 42 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Furzehill Road is a well managed home and people who live there can be confident that their needs, wishes and views are both understood and taken fully into account when decisions about the running of the home, its routines, facilities and operation are being taken. EVIDENCE: In the relevant key areas of the surveys completed by or on behalf of people who live in Furzehill Road a very high level of satisfaction with the manager and the way the home is run was recorded. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 24 When we spoke to or received comments from care staff in surveys, they were at pains to praise the way the manager managed the home and helped them work together as a team and to achieve the high standard of care they do for people living in the home. “I believe the manager should be particularly praised for her professionalism towards both residents and staff”. “A very good manager” “The manager actively listens to all support workers and the individuals we support”. When we spoke to the home’s manager she was able to demonstrate an excellent understanding of the care needs of all the people living in Furzehill Road and also had a good understanding of current care issues and best practice both locally and nationally. Since the previous inspection the manager has been registered successfully by the commission, this is important as it is the way we assess and determine a person’s fitness to manage a registered care service. The standard of record keeping found within the service during this inspection was never less than good and provided the information and record of individuals care needs and how they were being met and also a significant focus on planning ahead and development of skills and abilities where that was possible. The home’s AQAA provides information about Mencap’s continuous improvement framework and how this is supported by a robust process of quality assurance, involving people who live in the home, those responsible for them as well as care staff and associated health and social care professionals. We found evidence that the home has a well defined process for gathering feedback from service users and stakeholders, with compliance monitoring in place, monthly monitoring meetings carried out by Mencap on the service as well as other formal periodic reviews. It was clear, during the inspection, that the manager is accessible and proactive and that the management ethos of the home is one of transparency and openness. The AQAA was well completed, and was a realistic document, so that what we saw during the inspection, and what we told by people associated with the home, including people living there and the care staff that support them confirmed, supported and corroborated the information provided in the AQAA and did not contradict them. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 4 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 4 3 3 3 4 X Version 5.2 Page 26 Furzehill Road (9) DS0000019392.V376066.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 27 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Furzehill Road (9) DS0000019392.V376066.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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