Care Home: Rushes House

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What the care home does well The manager is qualified and has many years` experience in care. A professional assessment of need is obtained prior to people going into the home. The manager operates an open and inclusive atmosphere and good interactions were noticed between people throughout the day.One person said, `I can always talk to the manager, she is very approachable, she will always sort things out.` There were examples of good care planning, reviews and risk assessments with the home looking at individual needs of people. There was evidence that people were encouraged to be independent. One person said `All people are encouraged to take pride in their appearance.` One relative said, `She receives a lot of attention which she needs and I have nothing but praise for the staff, they keep my wife nice and clean.` People in the home and their relatives were positive about the changes made by the owner manager. People in the home praised staff saying, `The care and support I receive is very good.` Relatives were particularly happy about medical needs being met, saying `Staff always make sure my wife is well cared for, ensuring she eats meals and drinks plenty of fluids, also that her medical needs are taken care of.` Routines were flexible and people-orientated. One person said, `The good lady who manages the house leaves me to my freedom.` People were complimentary regarding the food served, saying `Food is very good, you don`t go short of anything,` and `The meals are like a five star hotel.` Staff training is given a high profile, leaving them confident in their role. Staff felt supported and informed of any changes. One said, `The manager does a lot for people and us. It is great to work for her.` And `We are a good staff team and we all work together.` The manager recognised the need to address equality and diversity with people`s religious needs and choices being respected. What has improved since the last inspection? Requirements made on the previous inspection had been addressed and there had been an improvement in daily recordings of care delivery and people`s interests and hobbies. There has been substantial improvement in the environment, for example, redecoration, replacement lighting, all doors and some new furniture in the lounges. The kitchen has been relocated to the basement area in order to provide additional dining space, with this aspect of the refurbishment still ongoing at the time of the inspection. There has also been a new central heating boiler and washing machines.Comments from people in the home included, `they get 10 out of 10 and a gold star for improvements and `there have been big improvements all round.` What the care home could do better: Improvements in the recording of medication need to be made. For example, when variable doses of medication are required, the dose administered must be recorded. There were shortfalls in staff recruitment procedures and failure to obtain Criminal Record Bureau checks prior to staff commencing employment, which may pose a risk to people in the home and detracts from the otherwise good services and facilities. CARE HOMES FOR OLDER PEOPLE Rushes House 2 St Martins Road Marple Stockport Cheshire SK6 7BY Lead Inspector Sandra Buckley Unannounced Inspection 19th December 2007 09:30 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 Rushes House DS0000065091.V354039.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. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rushes House Address 2 St Martins Road Marple Stockport Cheshire SK6 7BY 0161 427 7332 0161 456 9985 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 Mary B Rushe Mrs Mary B Rushe Care Home 17 Category(ies) of Dementia - over 65 years of age (14), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (17) Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 17 services users to include: *up to 17 service users in the category of OP (Old age not falling within any other category); *up to 14 service users in the category of DE(E) (Dementia over 65 years of age); *up to 10 service users in the category of MD(E) (Mental disorder excluding learning disability or dementia over 65 years of age). As from the date of registration, there must be no further admissions of Younger Adults (persons under 65 years of age). Six named service users in the category MD (Mental disorder excluding learning disability or dementia). 8th August 2006 2. 3. Date of last inspection Brief Description of the Service: Rushes House is currently undergoing major refurbishment in all areas. Its unusual layout and internal shapes place restrictions on how far the home can be altered, however substantial work is underway to create dining space and provide improved disabled bathing/ showering facilities on the ground floor. Accommodation is on four floors with a lift serving each area. The home offers both single and double bedroom accommodation and the home is currently non-smoking. A dining room offers two additional lounge chairs. The home is in a pleasant area in the village of Marple. It is close to local shops, parkland and canals. Fees charged range form £365 to £425. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection with included an unannounced visit to the home. A random inspection had been carried out prior to this key inspection on 20th February 2007 to check compliance with the requirements made on the previous inspection. This visit found the manager had made big improvements and addressed the requirements. The inspection looked at all the key standards and included a review of all available information received by the Commission for Social Care (CSCI) about the services provided at the home. During the site visit information was taken from various sources which including observing care practices and talking to people in the home. The manager, relatives and some members of the staff team were also interviewed. A tour of the home was undertaken and a sample of care, employment and health and safety records were seen. Comments from questionnaires returned from residents and their relatives are also included in this report. The CSCI requires the home to complete an annual quality assurance assessment (AQAA) in order to demonstrate the level of care provided. Comparisons are made with this document at the time of inspection, which, in this instance, found that outcomes for people in the home matched that reflected by the home, especially in relation to daily life. The manager also demonstrated how the home could be developed to the benefit of people living there. This inspection found that groundwork had already been done to meet their objectives. What the service does well: The manager is qualified and has many years’ experience in care. A professional assessment of need is obtained prior to people going into the home. The manager operates an open and inclusive atmosphere and good interactions were noticed between people throughout the day. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 6 One person said, ‘I can always talk to the manager, she is very approachable, she will always sort things out.’ There were examples of good care planning, reviews and risk assessments with the home looking at individual needs of people. There was evidence that people were encouraged to be independent. One person said ‘All people are encouraged to take pride in their appearance.’ One relative said, ‘She receives a lot of attention which she needs and I have nothing but praise for the staff, they keep my wife nice and clean.’ People in the home and their relatives were positive about the changes made by the owner manager. People in the home praised staff saying, ‘The care and support I receive is very good.’ Relatives were particularly happy about medical needs being met, saying ‘Staff always make sure my wife is well cared for, ensuring she eats meals and drinks plenty of fluids, also that her medical needs are taken care of.’ Routines were flexible and people-orientated. One person said, ‘The good lady who manages the house leaves me to my freedom.’ People were complimentary regarding the food served, saying ‘Food is very good, you don’t go short of anything,’ and ‘The meals are like a five star hotel.’ Staff training is given a high profile, leaving them confident in their role. Staff felt supported and informed of any changes. One said, ‘The manager does a lot for people and us. It is great to work for her.’ And ‘We are a good staff team and we all work together.’ The manager recognised the need to address equality and diversity with people’s religious needs and choices being respected. What has improved since the last inspection? Requirements made on the previous inspection had been addressed and there had been an improvement in daily recordings of care delivery and people’s interests and hobbies. There has been substantial improvement in the environment, for example, redecoration, replacement lighting, all doors and some new furniture in the lounges. The kitchen has been relocated to the basement area in order to provide additional dining space, with this aspect of the refurbishment still ongoing at the time of the inspection. There has also been a new central heating boiler and washing machines. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 7 Comments from people in the home included, ‘they get 10 out of 10 and a gold star for improvements and ‘there have been big improvements all round.’ 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. Rushes House DS0000065091.V354039.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 Rushes House DS0000065091.V354039.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): Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Professionals appropriately assess people’s needs before entering the home, ensuring their needs can be met. EVIDENCE: Three people’s files were examined; two of which were new admissions to the home, the third had been in the home for nearly a year. All were found to have an assessment of need from professionals trained to do so. An information folder is accessible to people in the home and their relatives. This provides details on what the home can offer. One person said ‘I was given a residents’ information pack before I came in.’ Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Good care planning and staff practices resulted in positive outcomes for people. EVIDENCE: Three people’s case files were examined and found that care planning was in line with their assessment of need. The manager also completes the home’s admission sheet and social history. Health care visits were recorded, one person said: ‘I go out for health care visits, I went to the opticians yesterday.’ Daily notes had improved significantly from the previous inspection, with key workers taking a bigger part in completion. Records identified daily living, care delivery and social interest. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 11 In one instance, it was recorded that one person had been out with staff to pick up their prescription. Any allergies had been recorded in care planning and brought to staff’s attention. People were weighed on a regular basis and staff had identified that one person had lost weight and nutritional screening was put in place. The care plan stated that calorie-laden food was required. Risk assessments were in place for people who were prone to falls and care planning was reviewed on a regular basis. The manager provided instructions for staff on how to deal with aggression and challenging behaviour, which were reflected in care planning and were linked to people’s individual needs. Some relatives’ comments were ‘She receives a lot of attention which she needs’, ‘The manager always keeps me informed of any changes’ and ‘I have nothing but praise for the staff, they keep my wife nice and clean.’ Another said, ‘All residents are smart and encouraged to take pride in their appearance.’ All the people in the home had nothing but praise for the manager and staff. They said, ‘I always get help when I need it’, ‘The care and support I receive is very good.’ Other relatives commented that the home has been improving all the time under the new manager. One person said, ‘People’s care is the most important service to date which Rushes House do very well.’ Another said, ‘Staff always make sure my wife is well cared for, ensuring she eats her meals and drinks plenty of fluids, also that her medical needs are taken care of.’ The manager accesses training through Stockport Social Services training in partnership. There was evidence that staff had received training in moving and handling with inexperienced staff shadowing senior staff until they were deemed competent. Training dates had been arranged for 2008 to ensure new staff had appropriate skills. Examination of medication procedures found some irregularities, for example, variable doses of medication did not state how many had been given and possibilities of allergic reactions to penicillin had not been transferred from care planning onto medication sheets. There were also gaps in recording when medication had been administered. We noted that people were clean and tidy and positive interactions were made throughout the day between staff and people. Also between the people living in the home, promoting a lively atmosphere. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 12 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, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Good care planning and staff practices resulted in positive outcomes for people. . EVIDENCE: People were complimentary about their lifestyles in the home. There was evidence in care planning that people’s individual interests and hobbies were addressed, as far as possible. People had access to daily newspapers, with some choosing to have their own delivered. One person said ‘I have a Daily Express delivered and one of the other ladies has a Mirror and we swap afterwards.’ Another person said, ‘I like to stay in my room and paint, I do not like television.’ ‘I have meals in my room because I prefer to be alone. The good lady who manages the home leaves me to have my freedom.’ Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 13 People stated on questionnaires that the local church comes in and give communion or a blessing. Staff routines were very much led by people’s individual choice. One person said, ‘Nobody wakes you up you can get up when you like.’ And ‘Everyone gets on well together here.’ Several friendships had developed in the home. Two people went out daily shopping or dining out. One said, ‘We used to go out every day for lunch but since the new cook, meals have improved and we now stay in at least twice a week.’ Another person said, ‘People are very kind here, it’s just like being at home.’ It was identified on the home’s AQAA that one person was from a different religious background. The manager had explored this to see how their needs could be met. This person did not wish to practice their faith, which was recorded in care planning. We spoke to the cook who said it was all home-made food and soup. Staff go round and ask people what they want every morning. We dined with five people and the dinner was steak pie and potatoes and semolina pudding. One person said, ‘Food is always good here and the hairdresser comes every two weeks.’ And ‘Meals are much better with the new cook.’ Other comments included, ‘Food is very good, you don’t go short of anything’ and ‘the meals are like a 5-star hotel.’ The dining experience was a pleasant, social occasion. Unfortunately, at present, several people have to dine in the lounge using an over-bed table. However, half the refurbishment of the home was to re-position the kitchen in the basement and make the present kitchen area into an additional dining space. At the time of this inspection, work was partly completed and the manager was awaiting builders to complete refurbishment. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 14 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. An open inclusive atmosphere provides an opportunity for people to express their views. Staff training provides protection for vulnerable adults. EVIDENCE: A book is in place to record any concerns or complaints. Neither the manager nor the CSCI had received any complaints since the last inspection. The information provided to people on the admission contains a copy of the complaints procedure. The AQAA stated, “the complaints procedure is brought to the attention of any prospective resident and their family and that their attention is brought to the complaints book if required.” People in the home were complimentary about the manager’s open and inclusive atmosphere. Comments from people included: ‘I can always talk to the manager, she is very nice and approachable, she will always sort things out’ and ‘If I was not happy I would see the main woman, but I never have any complaints.’ Also, ‘the manager keeps on top of things, if I had any concerns I would see her right away, she is very approachable.’ Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 15 Staff receive training in the protection of vulnerable adults and, at interview, had a good knowledge of how abuse may present and their role in prevention. There was evidence in staff meeting minutes on 20th October 2007 that the protection of vulnerable adults training was compulsory in the home. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with a good standard of accommodation that is clean and well maintained. Personalisation of people’s rooms provides a homely environment. EVIDENCE: The owner-manager has made substantial improvements to the environment, which is still ongoing. New carpets had been provided and redecoration has taken place in bedrooms and communal areas. Lighting and fixtures and fittings have also been replaced. At present the home appears cramped and lacking in dining space, especially with over-bed side tables being used in the lounge for dining. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 17 The manager plans to address this through the recent relocation of the kitchen into the basement. The kitchen area is planned to become the new dining room that will provide additional space in the near future. Bathing and toileting areas have been upgraded and all bedroom doors replaced providing a fresh airy space. Future plans are to join two rooms together and allow for a shower room for people with a disability. Other refurbishment machines. includes new central heating boiler and washing People in the home and their relatives were very pleased with the improvements and the effort made by the manager and staff to provide a better standard of living. Comments included: ‘There are big improvements all round’, ‘My bedroom has all new furniture’, ‘There have been big changes for the better’. One person said, ‘They get 10 out of 10 and a gold star for improvements.’ People have personalised their rooms giving a homely appearance. The home was clean and tidy and free from odours. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and training were sufficient to meet the needs of people in the home. The lack of appropriate recruitment procedures impinges on the otherwise good care practices. EVIDENCE: Staffing levels in the home were maintained to an appropriate level which met people’s needs. On this visit there were 17 people accommodated in the home and three care staff, the manager and ancillary staff were on duty. The home had a relaxed peaceful atmosphere, staff did not rush people and interactions were pleasant. Staff spoken to were complimentary about working in the home and said they felt trained and supported to deliver a good service. Comments from staff included, ‘We are a good staff team and we all work together’, ‘the manager never misses any detail’ and ‘We get regular handovers and the manager keeps us up to date. Also, ‘The manager does a lot for people and us, it is great to work for her.’ There was evidence that staff received induction, training and supervision. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 19 Comments from relatives included ‘All carers at Rushes House always speak to people nicely.’ ‘The staff are very capable and friendly.’ People in the home said, ‘Staff do listen to me and staff are always available when I need them.’ All staff spoken to could list numerous training events they had attended which included the protection of vulnerable adults, moving and handling, dementia care and the administration of medication. At interview, staff knew the needs and care planning issues of people in their care. Examination of recruitment procedures found shortfalls in obtaining Criminal Record Bureau checks previous to employment which detracts from the otherwise good care practices. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Rushes House is a well managed home which is run for the benefit of people living there. Staff training in health and safety ensures the protection of people in the home. EVIDENCE: The manager is a qualified nurse (RGN) with a wide experience of caring for people with both conditions relating to old age and mental health issues. She has also completed the registered manager’s award. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 21 They operate an open, inclusive atmosphere and although formal meetings in the home do not take place on a regular basis, people confirmed that informal meetings take place and the manager chats with them every day. Comments from questionnaires and people in the home included, ‘I was very happy before but since the new manager took over it is 100 better.’ ‘The manager keeps on top of things, if I had any concerns I would see her right away, she is very approachable.’ One person said, ‘10 out of 10 and a gold star for improvement’. And another said, ‘The present owner-manager has renovated from top to bottom.’ Throughout the inspection both people in the home and staff felt supported by the manager. The home had developed an annual quality assurance system to gain the views of people in the home and professionals. Staff had received training in health and safety and fire awareness that was ongoing. Staff meetings were held regularly. The last agenda included compulsory protection of vulnerable adults training; nutritional issues and hygiene standards were discussed. Electrical and gas equipment had been tested for safety. An environmental health visit took place on 18th December 2007, with their comments stating that big improvements had been noted. Financial records were maintained well and many people in the home were responsible for their own finances. The manger stated in the AQAA that their plans for future development in the home are to “continue to expand diversity into every aspect of daily living offering a wide range of choices. Setting up group and individual therapies to suit all needs.” Observations made on the day found that progress was being made in meeting these objectives. Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 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 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement When people are prescribed medication in variable doses, an entry must be made on medication sheets on what dose has been administered. Medication must be signed for at the point of administration and any gaps in recording explored to ensure people’s health and safety in the home. Criminal Record Bureau checks must be obtained for employees prior to commencing duty in the home for the protection of vulnerable adults. Timescale for action 31/01/08 2 OP29 19 31/01/08 Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rushes House DS0000065091.V354039.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU 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 Rushes House DS0000065091.V354039.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!