Care Home: Orchard House

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What the care home does well The home continues to provide a good service to the service users living at the home. Contact with family and friends are encouraged and service users are able to entertain their visitors in the privacy of their bedroom if they so wish. The registered manager complies with given requirements under the Care Homes Regulations 2001 within the given timescales. Service users spoken to indicated they were happy at the home and liked their activities. All service users at this home enjoy a full active lifestyle. The documentation of individual care plans are easy to read, the assessments gave the reader a full picture of the service users likes and dislikes, communication needs and risk assessments. The home has demonstrated that the care needs of the current service users living at the home are well catered for and met. Observations of care staff interaction with service users indicated that service users are treated with dignity and respect. It was also observed that great care was taken in respect of the service users personal belongings and standard of cleanliness in bedrooms ensured service users lived in a wellmaintained environment. The home has demonstrated its capability to cater for service users from ethnic minority by ensuring staff have the knowledge through training to meet the diverse of service users. Currently, all service users at the home are British and Caucasian. However, the manager told us that the staff mix at the home represent the cosmopolitan nature of the community in which the home is situated. The home has an Equality and Diversity policy, which the staff reassured us they use in their daily work with service users. They also have an equal opportunities policy, which they use in selecting inducting and preparing carers from overseas to work within the British culture. The manager had a good grasp of Equality and Diversity and said she uses it in her daily work with the staff and service users. What has improved since the last inspection? The manager has complied with all the given requirements at the last inspection. What the care home could do better: The manager must ensure that end of life arrangements are in place for all service users.The manager must keep a separate record of homely medication for service users. CARE HOME ADULTS 18-65 Orchard House 31 Hyde End Lane Ryeish Green Reading Berkshire RG7 1EP Lead Inspector Mavis Clahar Unannounced Inspection 31st October 2007 09:30 Orchard House DS0000011365.V353328.R01.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 Orchard House DS0000011365.V353328.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 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. Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Address 31 Hyde End Lane Ryeish Green Reading Berkshire RG7 1EP 0118 988 6029 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) orchard.house@atlas.plus.com Atlas Project Team Ltd Post Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th February 2007 Brief Description of the Service: Atlas Project Team Ltd are the registered provider for Orchard House, and provide care and accommodation for 4 Young Adults aged 18-65, who have a learning disability with associated challenging behaviour. Orchard House is a large detached house within Ryeish Green close to the amenities within the village of Spencers Wood and the town of Reading. The house is owned by Housing Solutions who oversee the maintenance of the home, as reported to them by Atlas Project Team. The home has a large secluded garden with patio and garden furniture, and a large wooden garden swing to be enjoyed by all in the warmer months. The home has the use of its own vehicles’ and public transport is available. Parking spaces are available to the front of the house; off road parking is also available. The fees for this home range from £1826.98 to £2378.28 per week. Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit, which forms part of the key inspection to be undertaken by the Commission for Social Care Inspection, was undertaken by Mrs Mavis Clahar on the 30th October 2007 and lasted for six hours and fifteen minutes, commencing at 09:20 hours and concluding at 15:35 hours. The first part of the inspection was spent talking to two service users and their carers who were present at the home. The other service users were in the process of being got ready for breakfast and their agreed activities. This was followed by discussion with the manager about the changes to the inspection processes under inspecting for better lives CSCI has implemented. An outline of how this visit would be conducted was discussed and agreed. A tour of the home and gardens was conducted. Each service user bedroom is personalised by the service user to suit their likes and taste. Generally the home is clean and tidy. The home has a good size garden, with easy access by the service users. The second part of the visit was spent reviewing service users care notes and sampling carer workers records, which were all up to date. The information contained in this report is gathered mainly from, service users notes and records kept by the home, along with observations of the interactions of the four service users and their carers, discussions with one service user and with care workers present on the day of the visit. No requirement was made on this visit, but two recommendations of good practice were made. Please refer to the recommendation section of this report. The final part of the visit was spent giving feedback to the manager about the findings of the visit. The inspector would like to thank the service users, and staff who spent time speaking with the inspector. What the service does well: The home continues to provide a good service to the service users living at the home. Contact with family and friends are encouraged and service users are able to entertain their visitors in the privacy of their bedroom if they so wish. Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 6 The registered manager complies with given requirements under the Care Homes Regulations 2001 within the given timescales. Service users spoken to indicated they were happy at the home and liked their activities. All service users at this home enjoy a full active lifestyle. The documentation of individual care plans are easy to read, the assessments gave the reader a full picture of the service users likes and dislikes, communication needs and risk assessments. The home has demonstrated that the care needs of the current service users living at the home are well catered for and met. Observations of care staff interaction with service users indicated that service users are treated with dignity and respect. It was also observed that great care was taken in respect of the service users personal belongings and standard of cleanliness in bedrooms ensured service users lived in a wellmaintained environment. The home has demonstrated its capability to cater for service users from ethnic minority by ensuring staff have the knowledge through training to meet the diverse of service users. Currently, all service users at the home are British and Caucasian. However, the manager told us that the staff mix at the home represent the cosmopolitan nature of the community in which the home is situated. The home has an Equality and Diversity policy, which the staff reassured us they use in their daily work with service users. They also have an equal opportunities policy, which they use in selecting inducting and preparing carers from overseas to work within the British culture. The manager had a good grasp of Equality and Diversity and said she uses it in her daily work with the staff and service users. What has improved since the last inspection? What they could do better: The manager must ensure that end of life arrangements are in place for all service users. Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 7 The manager must keep a separate record of homely medication for service users. 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. Orchard House DS0000011365.V353328.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 Orchard House DS0000011365.V353328.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home are not made until a full needs assessment has been undertaken to ensure the home can meet the needs of the service user. The assessment is conducted professionally and sensitively and involves the service user and their family or representative where appropriate, and the psychologist, and the occupational therapist. Where the assessment is undertaken by social services, the home obtains a copy and a copy of the care plans also. EVIDENCE: Review of service users files demonstrated that the home has established a good process of assessing service users needs. This has been enhanced by the joint development of service users care plans with service users. The assessment is based on the Adaptive Behaviour Scale Residential and Community (ABS –RC). The assessment also contains the documented evidence of the psychiatrist, psychologist and occupational therapist. The home uses the Person centred approach to care, and this is documented using the “widget” method, which is a method of communication suitable for persons with learning disabilities. It was noted that no two service users assessment of needs were identical. The manager said the service users and their relatives or representatives are involved in their assessment and so are able to make decision with support about their care and leisure pursuits. The relatives and Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 10 representative signatures on the care plans and also on the records of review meetings for the service user evidenced this Orchard House DS0000011365.V353328.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are involved in the review of their care, and agreed changes are documented in their care plans, thereby ensuring all care workers have access to this new information. The home encourages service users to make decisions about their daily lives, and to take risks as part of their independent lifestyles, with assistance from the key worker when necessary. EVIDENCE: Random review of service users files demonstrated that service users assessed needs are documented in the care plans and the evaluations demonstrated that changing needs are recorded. How much the service users are currently aware of this was hard to ascertain, as due to their learning disability, communication with a stranger in their home was not very easy. Only one service user present during the visit was inclined to say hello and goodbye to Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 12 the inspector, and he did not answer to any questions asked. It is obvious from the information contained in the care plan that the service users were involved in planning their changing needs, and achieving their personal goal. One service user has demonstrated an interest in art, and is being actively supported by the staff team in achieving this goal. Care workers spoken to say the assessment of needs is carried out consistently, and that the service users and their families are very involved. Full review of care needs is carried out on a yearly basis with the service user, the care manager and the relatives and all present are required to sign the agreed care plans. It was apparent that service users made decisions about their lives. Review of each service user’s files during tracking revealed that service users can and have changed their minds about a decision they had made and have decided to do something different on the day. In discussion with the manager, we were told the home’s documentation on service users’ choices is based on Respect, Independence, Community participation and Community presence. In discussion with care workers the inspector was told service users are involved in the care of their home. The inspector observed one service user vacuuming the hall during the visit to the home. Review of the service users’ documents revealed service users are encouraged and supported to take risks to enhance their lifestyles supported by suitable risk assessments in place. Orchard House DS0000011365.V353328.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): 12 13 15 16 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a strong commitment to enabling service users to develop their skills, including social, emotional, educational, cultural communication and independent living skills. Service users are encouraged and supported to identify their goals, and aspirations and work to achieve them. Service users are able to make choices in accordance with their abilities and are provided with balanced diet in pleasant surroundings and in an unhurried way. EVIDENCE: The observed interactions between care workers and service user was relaxed and friendly creating a warm and friendly homely feeling. Service users are encouraged to live a full life and to partake in age related activities such as going to the pub, having meals out attending college of further education, sports, shopping and going to the cinema. Their religious beliefs are acknowledged and encouraged. Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 14 Review of service users records and in discussion with care workers it was documented that Service users are encouraged to make friends outside of the home and to keep in touch with their friends and families as they wish. Service users are enabled to entertain their guest in the privacy of their bedroom if they so wish. The manager told us the home is run on the basis that it is a family home where each member is allocated tasks within their capabilities and sometimes tasks are allocated that will stretch the service user, who is always supported and enabled by their key worker and service users achievements are always acknowledged. Completed risk assessments were observed for service users where it is assessed as necessary to the development of the service user. The care workers aided by the service users provide catering service for all at the home. The inspector did not sample the mid-day meal but the service users indicated it was delicious, and the amount was right. It was also observed that staff and service users ate their meal together at the dining table. The inspector noted a good amount of dry, frozen and fresh food in the home. Service users are allowed to make drinks as they wish with assistance from their key worker. The manager told us that at their weekly menuplanning meeting they discuss the advantages of healthy diet. They discuss the meals for the week with each service user encouraged to make at least one choice of main or evening meal. Orchard House DS0000011365.V353328.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Carers understand the principles of giving personal care and support and are responsive to varied and individual requirements of the service users. They recognise that the delivery of personal care is highly flexible, consistent and reliable ensuring that service users receive personal care and support in the way they prefer; and that their emotional and health needs are met. None of the service users at this home are assessed as capable to selfadminister their medication. Staff trained to do so administers medication, thereby service users are being protected by the home’s policies and procedures on administration of medication. EVIDENCE: Discussions with Manager and care workers and review of care plans indicated each service user received the agreed personal care and support as directed in the care plans. Physical and emotional needs identified in the care plans are also met. The care plans are reviewed on a regular basis, visits to the doctor dentist, and dietician are carried out on a as required basis. Daily care notes Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 16 are documented dated and signed by the key worker or other care worker as necessary. Review of randomly selected service user files revealed that no service user at the home is risk assessed as capable to self-administer their medication. A review of the medication records demonstrated that medication is being administered within the home’s policy and guidelines of administration of medicines. A recommendation of good practice was made to record all homely medicines on a chart separate to the MAR sheet. It was noted that some service user’s end of life arrangements was not documented. A recommendation of good practice was made on this standard for the manager to ensure this omission was rectified as soon as possible. Orchard House DS0000011365.V353328.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home operates in a manner that supports service users to air their views and concerns, which are acted upon before they can become complaints. Robust safeguarding policies are in place to protect the service users from abuse neglect and self-harm. EVIDENCE: CSCI Oxford office has not received any complaints about this home since the last inspection, and the Annual Quality Assurance Assessment (AQAA) revealed no complaints made to the home since the last inspection. Included in the service users information pack kept in the home’s office (service users would destroy them) is the homes’ complaints policy and service users’ guide, developed in pictorial and widget symbol format. The manager told us that issues raised by service users are dealt with instantly before they can become complaints. Random sample of care workers files and in discussion with care workers it was evidenced that care workers are being trained to recognise and report any act or suspicion of abuse to service users. The manager supported this by the production of the staff training record. The manager was able to produce up to date copies of Protection of Vulnerable Adults Scheme dated May 2006, Multi Agency Policy and Procedures for the Protection of Vulnerable Adults from Abuse. Care workers were knowledgeable about whistle blowing and Safeguarding Adults procedures within the home. Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 18 Orchard House DS0000011365.V353328.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical layout of the home enables service users to live in a safe, wellmaintained and comfortable environment, which encourages independence. EVIDENCE: The home has a well-maintained environment, and service users are encouraged and enabled to personalise their bedrooms. The home presents as a safe place to live with bedrooms that meet the National Minimum Standards for Younger People. The management has a good infection control policy: they seek advice from external specialists, e.g. infection control, and encourage their own staff to work to the home’s policy and procedures to reduce the risks of infection. It was noted in care workers file that they attend regular training sessions on Health and Safety issues. Care workers spoken to were knowledgeable about suitable storage and disposal of waste. Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 20 The home presents as comfortable with large garden and orchard which are easily accessible to service users. The AQAA stated that improvements are being made to the garden and this was evident on the day of the inspection. Orchard House DS0000011365.V353328.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32 34 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care workers in the home are trained, skilled and in sufficient numbers to support the service users who live at the home, and to support the smooth running of the home. The homes’ recruitment policy and the training given to care workers ensure suitably selected and qualified staff meets service users needs. EVIDENCE: Review of service users care plans indicated their named key worker supports service users. Review of care workers training files indicated the manager encourages and enables carers to undertake external qualifications beyond the basic requirements to enable staff to assist the service users achieve the agreed care and social needs identified. In discussion with care workers, and supported by the manager and a review of the current and proposed training matrix, it was revealed that staff training is high on the agenda for the home. Review of the staff rota indicated that adequate numbers/skill mix of care workers are on duty over any twenty-four hour period to meet the needs of the service users. One carer plus another on call manager cover night duty. In Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 22 discussion with care workers it was verified that the home provided training and regular updates for them. The home has a good recruitment policy and procedure, based on their equal opportunities policy that has the needs of the service users at its core, which is adhered to. Care workers were very pleased to inform us of their strength in caring for service users at this home based on each service user’s assessed equality and diversity needs. It was noted that all members of staff were recorded as having had an application to the Criminal Record Bureau (CRB). Review of staff files demonstrated Schedule 2 of the Care Homes Regulations 2001 (Amended) was being observed by the home. Orchard House DS0000011365.V353328.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems to ensure service users views are obtained and acted upon. The manager ensures that care workers follow the policies and procedures to maintain the health, safety and welfare of the service users. EVIDENCE: The home now has a manager who is in the process of being registered with Commission for Social Care Inspectorate, who is a registered nurse with many years experience in caring for and managing care needs of people with a learning disability. The manager is in possession of the Managers Award Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 24 (RMA). There is a strong ethos of being open and transparent in all aspects of the running of the home. The manager is service user focused and leads and supports a strong staff team who have been recruited and trained to a high standard. It was difficult to measure how confident service users were that their views underpin all self-monitoring, review and development by the home due to their learning Disabilities. We were told that official meetings with service users were not held, however, the manager informed us that service users and care workers opinions were listened to and acted upon. Service users are encouraged and supported to make choices even when these choices might involve some degree of risks, for which appropriate risk assessments are completed. Each service user is registered with the local GP practice, which they access as required. Chiropody service and dental service is also accessed as required. Service users have access to the wider primary health care services and the manager said she is aware of whom to contact if the need arises. The manager ensures that at all times the health, welfare and safety of the service user and care staff are promoted and protected by having suitable numbers of trained care workers on duty at all times to meet the assessed needs of the service users. Orchard House DS0000011365.V353328.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 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 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 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 X 3 X X 3 X Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 26 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. 1. 2. Refer to Standard YA20 YA21 Good Practice Recommendations A separate record of homely medicines must be kept apart from the MAR sheet to reduce the inference that care workers are prescribing medication for service users. All service users must have their end of life wishes documented in their care plans. Orchard House DS0000011365.V353328.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Orchard House DS0000011365.V353328.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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