Care Home: The Pines

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What the care home does well People who may consider moving into the home are provided with helpful information to help them decide if the home will be suitable for them. Good assessment procedures ensure people`s needs are understood and can be met. They can be confident care will be provided in line with their individual wishes and preferences. They can be sure their personal information will remain confidential.People who live in the home are encouraged to be as independent as possible. They enjoy opportunities to take part in a range of activities inside and outside the home and at the day care centre. People can be confident their personal and healthcare needs will be met in a way that respects their individual wishes and preferences and upholds their privacy and dignity. They are protected through safe systems for handling medication. There have been no complaints about the service since the last inspection. People are listened to and are encouraged to offer comment or complaint. They are protected from abuse. People benefit from the spacious and welldesigned accommodation; everyone has their own room. People who live in the home benefit from the support of the committed, well trained and competent staff team. The staff and manager understand their needs and actively promote their best interests. The home is managed in the best interests of the people who live there. Effective quality assurance systems promote year on year improvement in the service. What has improved since the last inspection? People are protected through good risk management systems. Each person`s activities and daily routines are risk assessed and clear guidance is provided for staff on how to minimise risk. Risk assessments are included in care plans and are reviewed regularly. People can be confident staff are competent to care for them and have been trained in the following areas: Protection of vulnerable adults, first aid, disability awareness and medication administration. What the care home could do better: Each person`s care plan should include clear information on the most helpful way for staff to communicate with him or her. All staff, including agency staff should receive training to enable them to communicate effectively with people who live in the home. All staff, including agency staff should receive regular supervision where their training needs should be identified. Consideration should be given to making all areas of the garden more accessible to people who live in the home. Easy chairs should be provided in bedrooms unless individual assessments indicate this would not advantage the occupant. The registered provider must appoint a new manager who meets the criteria for registration and inform the Commission of the outcome. CARE HOME ADULTS 18-65 Pines (The) (Redhill) 2 College Crescent Redhill Surrey RH1 2HP Lead Inspector Ruth Burnham Unannounced Inspection 22 January 2008 10:00 nd Pines (The) (Redhill) DS0000013748.V357750.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 Pines (The) (Redhill) DS0000013748.V357750.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. Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pines (The) (Redhill) Address 2 College Crescent Redhill Surrey RH1 2HP 01737 277716 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) Surrey and Borders Partnership NHS Trust Mrs Khatijah Joosub Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th November 2006 Brief Description of the Service: The Pines is a care home, which opened in 1997 and is run by Surrey Borders Partnership NHS Trust. The service provides care and accommodation for six younger adults of both sexes with a learning disability. The premises are owned and maintained by the metropolitan housing association. The home is a detached purpose built bungalow and consists of 6 single bedrooms, a comfortable sitting room, dining room, and adequate toilet and bathing facilities. The internal decorations and furniture are in a satisfactory condition. There is a patio and garden to the rear of the property and parking space at the front of the property. Cost of Care: £84,091.00 per year. Pines (The) (Redhill) DS0000013748.V357750.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 2 star. This means the people who use this service experience good quality outcomes. The Commission has since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the Service was an unannounced “Key Inspection”. The Inspector arrived at the Service at 10.00 and was in the Service for six hours. It was a thorough look at how well the Service is doing. It took into account detailed information provided by the Service’s owner or manager and any information that CSCI has received about the Service since the last inspection. There are three Required Developments at the end of this Report. There are currently six people living in the home, they have all lived there for many years. All six residents were in the home on the day of the site visit. None of the residents are able to communicate through speech, we used an observational tool called a Short Observational Framework for Inspection (SOFI) to help us make a judgement about people’s quality of life. During the visit 4 people were observed for 2 hours using SOFI, 3 members of staff and the manager were spoken to. The deputy manager has been seconded temporarily to the post of manager until a permanent manager is recruited. Feedback was given to the manager following the inspection. A full tour of the premises was undertaken. Three care plans were inspected. Responses to surveys sent out to people by the Commission before the visit were not received in time to be included in this report. Two relatives were contacted by phone; they were very satisfied with the care their relatives receive. The manager also completed an Annual Quality Assurance Audit (AQAA) for the Commission, this was used as part of the inspection. The inspector would like to thank the residents, the assistant manager and staff members for their time, assistance and hospitality during the inspection. What the service does well: People who may consider moving into the home are provided with helpful information to help them decide if the home will be suitable for them. Good assessment procedures ensure people’s needs are understood and can be met. They can be confident care will be provided in line with their individual wishes and preferences. They can be sure their personal information will remain confidential. Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 6 People who live in the home are encouraged to be as independent as possible. They enjoy opportunities to take part in a range of activities inside and outside the home and at the day care centre. People can be confident their personal and healthcare needs will be met in a way that respects their individual wishes and preferences and upholds their privacy and dignity. They are protected through safe systems for handling medication. There have been no complaints about the service since the last inspection. People are listened to and are encouraged to offer comment or complaint. They are protected from abuse. People benefit from the spacious and welldesigned accommodation; everyone has their own room. People who live in the home benefit from the support of the committed, well trained and competent staff team. The staff and manager understand their needs and actively promote their best interests. The home is managed in the best interests of the people who live there. Effective quality assurance systems promote year on year improvement in the service. What has improved since the last inspection? What they could do better: Each person’s care plan should include clear information on the most helpful way for staff to communicate with him or her. All staff, including agency staff should receive training to enable them to communicate effectively with people who live in the home. All staff, including agency staff should receive regular supervision where their training needs should be identified. Consideration should be given to making all areas of the garden more accessible to people who live in the home. Easy chairs should be provided in bedrooms unless individual assessments indicate this would not advantage the occupant. The registered provider must appoint a new manager who meets the criteria for registration and inform the Commission of the outcome. Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Pines (The) (Redhill) DS0000013748.V357750.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 Pines (The) (Redhill) DS0000013748.V357750.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): 1–3&5 People who use the service experience good outcomes in this area. The home has produced helpful information to help people who may consider moving into the home in the future and their representatives decide if the home will be suitable for them. Good assessment procedures ensure their needs will be understood and can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are six people living in the home who have been there for many years. There have been no new admissions to the home. Helpful information about what life is like in the home is available for anyone who may consider moving to the home in the future to enable him or her to make a decision. This information is contained in the statement of purpose and service user guide, which are reviewed regularly; the service user guide contains pictorial as well as written information. The deputy manager is updating the home’s brochure to include more pictures. No one has moved into the home for a long time so assessment procedures were not examined in detail; however assessments seen in current residents’ files were impressive and contained detailed information about people’s needs. These assessments are reviewed regularly. Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 10 Everyone who lives in the home is provided with a statement of terms and conditions to enable them and their representatives to understand their rights and responsibilities. These documents were seen on individual files. Pines (The) (Redhill) DS0000013748.V357750.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 – 10 People who use the service experience good outcomes in this area. People can be confident their needs are understood and care will be provided in line with their individual needs, wishes and preferences. People can be confident their personal information will remain confidential. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person who lives in the home has an individual plan of care. These are developed with the involvement of residents, relatives, key workers, care managers and relevant healthcare professionals. Care planning takes account of individual needs and choices. Care plans are reviewed regularly with more formal reviews taking place annually or as needs change. People can be confident their needs will continue to be met. Good examples were seen where specialist services have been involved in setting up revised plans of care and advising staff how to adapt the service to meet peoples’ changing needs. The Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 12 care plan folders include details of personal care needs and individual preferences; risk-assessments, activities, diet, health care needs and some files include religious needs. A short version of the care plan was seen in people’s rooms. Some discussion took place about providing more information to staff about how best to communicate with people who live in the home, currently information mainly focuses on how the resident communicates rather than providing clear guidance to staff on the best way to for them to communicate with each resident. People’s communication needs are complex, varied and challenging to inexperienced visitors and new staff to the home. None of the residents can communicate with speech; however staff seen on the day of the inspection clearly know the residents very well and understand how each person prefers to communicate. Everyone who was observed during the inspection was engaged in some activity during the visit. On the whole staff were seen to communicate well with people throughout the day; support is offered and provided discreetly in a way that promotes privacy and dignity. All interaction observed was respectful, good humoured and kind. People’s right to make decisions about how they wish to live their lives are respected. People are supported to make decisions in a number of ways. Each resident has an allocated key worker who is trained to offer one to one support. They know the resident well and understand his or her needs. There are good risk management processes in place to protect people from harm. Each person has individual risk assessments for all activities and routines of daily life. People can be confident their personal information remains confidential. Personal information is stored securely and is available solely to authorised and appropriate people. Pines (The) (Redhill) DS0000013748.V357750.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): 11 – 17 People who use the service experience excellent outcomes in this area. People who live in the home are encouraged to be as independent as possible. They enjoy opportunities to take part in a range of educational, social and leisure activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People are supported to be as independent as possible. They are actively encouraged to make their own choices and to live their lives as they wish, so far as they are able. Records seen indicate that religious and cultural needs are known and respected. The SOFI observation focussed on 4 people and took place in the lounge and dining room over a 2 hour period. During this time people were seen to be engaged in a variety of activities such as throwing and catching soft balls, listening to music, interacting with favourite objects, enjoying , drinks and lunch, relaxing and interacting with each other and with staff. During the day Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 14 some residents went out with staff, others enjoyed one to one sessions in their own rooms with staff or with a visiting aroma therapist. Pictorial information is used to help people choose activities, outings and holidays. Everyone has the opportunity to go on a holiday of his or her choice. Regular trips are also organised to places of interest. Each person has their own activity plan detailing activities they enjoy, these include swimming, shopping, aromatherapy, reflexology, attending a daycentre and visits from ‘us on a bus’. Staff support people to use local services such as hairdressers, pubs and local restaurants. People are supported to maintain contact with family and friends, visitors are welcome in the home at all reasonable times. Peoples’ privacy is respected; discussion with and observation of staff throughout the day show staff are committed to promoting the interests of people who live in the home. Interaction observed during the visit was warm, supportive and respectful. The majority of staff who were spoken to during the visit know the residents well and understand their needs. People have their nutritional needs assessed and menus are planned in consultation with a dietician. A number of people require help at mealtimes, this was provided with discretion and dignity. Pines (The) (Redhill) DS0000013748.V357750.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 – 21 People who use the service experience good outcomes in this area. People who live in the home can be confident their personal and healthcare needs will be met in a way that respects their individual wishes and preferences and upholds their privacy and dignity. They are protected through safe systems for handling medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are provided with care in a way that respects their individual wishes and preferences and upholds their privacy and dignity. Routines are flexible and relevant, care plans and observation during the visit show people are able to choose how to live their lives and their choices are respected. People are supported with their healthcare needs. Each person has an individual health action plan; this document helps staff monitor and promote peoples’ health. Records show regular visits are arranged to the local G.P. and Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 16 everyone has a regular health check. People are supported to access other healthcare professionals where necessary, including the dentist, optician, chiropodist and physiotherapist. Where people have specialist healthcare needs, the home liaises with relevant healthcare professionals to ensure they receive the best possible care. People are protected from harm through the safe handling of medication. Medication is stored securely and records are well maintained and up to date. Pines (The) (Redhill) DS0000013748.V357750.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 People who use the service experience good outcomes in this area. People who live in the home are listened to and are encouraged to offer comment or complaint. They are protected from abuse This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are unable to comment or complain verbally however staff know and understand how people communicate and recognise when they are unhappy. Records seen and observation during the visit show are very aware of how people are feeling. Staff are quick to take action is taken to ensure any unhappiness is addressed. There have been no complaints. There is a clear complaints procedure; this is available in pictorial form. Two relatives, who were contacted as part of the inspection confirmed they knew who to complain to should they be dissatisfied, both said they had no reason to complain and are very happy with the care their relatives receive. People who live in the home can be confident they are protected from abuse. All staff have completed training on the protection of vulnerable adults. All staff are checked through the Criminal Records Bureau before they begin working in the home. Where staff handle peoples money clear records are kept of all transactions. Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 – 30 People who use the service experience good outcomes in this area. The quality of life for people who live in the home is enhanced by the spacious, homely, clean, accessible and well equipped accommodation. Additional furniture in some bedrooms may be needed to ensure the comfort of residents and they would benefit from a more accessible garden. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home benefit from the spaciousness and cleanliness of the premises. The home is generally well furnished and everyone has his or her own room. All accommodation is on the ground floor. Communal areas of the home include a lounge and a dining room. The kitchen and office are well equipped. People benefit from access to the garden where there is a small patio, other areas of the garden are sloping which is not ideal for people who have difficulty walking. The premises are warm, homely and comfortable, internal spaces have been designed for ease of access for people with mobility Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 19 difficulties, bathrooms and toilets are easily accessible and adapted for use by people who have physical disabilities. There is a well-equipped laundry. People are encouraged to personalise their bedrooms and those seen were homely. Some discussion took place about the suitability of chairs provided in bedrooms, not all bedrooms have easy chairs suitable for relaxing should people choose to spend time in their rooms, care plans do not show any individual assessment of bedroom furnishings. People are supported to choose the colour schemes in their rooms to suit their preferences. The home has been purpose built and equipped to meet the needs of all the people who live there, regardless of age or ability. Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 – 36 People who use the service experience adequate outcomes in this area. People who live in the home benefit from the support of the committed, and competent staff team who understand their needs and actively promote their best interests. Agency staff are not adequately supervised or trained to communicate effectively with people who live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home benefit from the support of the stable and welltrained staff team, the majority of staff clearly have a good understanding of peoples’ needs. Interaction observed throughout the inspection was warm and respectful and staff work hard to engage people who are less able, to promote their well being. Conversations with staff during the visit showed a high level of commitment to promoting the best interests of people who live in the home. There are enough staff available to meet peoples’ needs. On the day of the site visit three support staff and the deputy manager were on duty. Relative who were spoken to praised the staff for the quality of care they provide. Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 21 People who live in the home are protected through robust recruitment procedures, which include checks through the Criminal Records Bureau and taking up 2 written references prior to appointment. Staff files are up to date and contain all the relevant documents as detailed in Schedule 2 of The Care Homes Regulations 2001. No new permanent staff have been recruited since the last inspection, agency staff are used to cover vacancies. There was one member of agency staff on duty during the visit who has been working in the home for a year, it was clear that this member of staff had less confidence when working with residents and less understanding of how to communicate with them effectively. This was discussed with the deputy manager who explained that agency staff are used more for tasks other than the direct care of residents. The manager agreed that all staff, including agency staff, should be fully trained to communicate effectively with the people who live in the home. People who live in the home can be confident permanent staff are wellsupervised and competent to carry out their duties. Agency staff, up to now have not had formal supervision however the manager said this is now being arranged. A number of staff have completed NVQ Level 2. There are however less than 50 of staff qualified to this level. All permanent staff undertake additional training relevant to understanding the specific needs of the people they care for. Refresher courses are arranged regularly for all mandatory training. Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 – 43 People who use the service experience good outcomes in this area. The home is managed in the best interests of the people who live there. Effective quality assurance systems promote year on year improvement in the service. People are protected through effective systems, which promote their health and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home benefit from the experience and commitment of the manager to promoting their best interests. While there is still no registered manager at the home the deputy manager has been seconded to cover the manager post until a permanent manager is recruited. It was a requirement from the last inspection that a manager should be registered by the end of Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 23 January 2007. The manager post has now been advertised. Current management arrangements do not appear to have had any detrimental effect on people who live in the home. Records seen during the visit were up to date and well maintained. The manager completed the Annual Quality Assurance Audit (AQAA) for the Commission as part of the inspection. This document shows how people are benefiting from the effective quality assurance system in operation in the home. The AQAA identifies where improvements have been made since the last inspection and how further improvements are planned. People can be confident the home is managed in their best interests. Information included in the AQAA also shows how people are protected and how their health and safety is promoted through good fire safety systems and regular safety checks on all equipment and installations. Staff have access to a full range of policies and procedures to enable them to care for people in a way which promotes their privacy and dignity, enables them to lead fulfilled lives and recognises their individuality. People are protected from harm through safe working practices. There are clear policies and procedures in place and all staff receive training in basic food hygiene, first aid, moving and handling, health and safety, fire safety and infection control. Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 x 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 2 25 3 26 2 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 4 13 4 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 3 3 3 3 3 x Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES 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 YA26 Regulation 16(2)( c ) Requirement The registered person shall having regard to the size of the care home and the number and needs of service users— provide in rooms occupied by service users adequate furniture, bedding and other furnishings, including curtains and floor coverings, and equipment suitable to the needs of service users and screens where necessary. In that easy chairs should be provided in bedrooms unless individual assessments indicate this would not advantage the occupant. 2. YA32 8(a)(b)(2) The registered provider must appoint a manager who will satisfy the criteria for registration with the Commission. 31/03/08 Timescale for action 31/03/08 Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 26 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. Refer to Standard YA6 Good Practice Recommendations Each person’s care plan should include clear information on the most helpful way for staff to communicate with him or her. Consideration should be given to making all areas of the garden more accessible to people who live in the home. All staff, including agency staff should receive training to enable them to communicate effectively with people who live in the home. All staff, including agency staff should receive regular supervision where their training needs should be identified. 2. 3. YA24 YA33 4 YA35 Pines (The) (Redhill) DS0000013748.V357750.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Office 4630 Kingsgate 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 Pines (The) (Redhill) DS0000013748.V357750.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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