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Care Home: Trafalgar House

  • 9 Sutherland Avenue Bexhill-on-sea East Sussex TN39 3LT
  • Tel: 01424222911
  • Fax: 01424736013

Trafalgar House is one of many homes owned by Care Management Group (CMG), which is registered to provide support and accommodation for up to seven adults with mild to moderate learning disabilities. Residents at this establishment also present with some challenging behaviour and mental health needs. The home is located in Bexhill-on-Sea and has good access to local amenities and public transport. There is a small car parking area to the rear of the property, which is primarily for the home`s people carrier, although on street parking is permitted for staff and visitors. The home is a detached three-storey property with a small garden to the rear of the property. It consists of six single bedrooms and one self-contained flat on the third floor, two bathrooms / shower facilities, a spacious lounge and separate kitchen and dining area. In addition there is office accommodation for the manager and staff. The layout and facilities within the home would not be suitable for those with reduced mobility or wheelchair users. Prospective residents and their relatives are provided with written information regarding the services and facilities provided at the home prior to admission. The home`s most recent inspection report is available on request. The home`s fees as of 19th October 2006 range between £1300 - £1900 per person per week dependent on needs.

  • Latitude: 50.840000152588
    Longitude: 0.45699998736382
  • Manager: Shaun Lee Haffenden
  • Price p/w: £1300
  • UK
  • Total Capacity: 8
  • Type: Care home only
  • Provider: Care Management Group Ltd (trading as CMG Homes Ltd)
  • Ownership: Private
  • Care Home ID: 16928
Residents Needs:
Learning disability

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Trafalgar House.

CARE HOME ADULTS 18-65 Trafalgar House 9 Sutherland Avenue Bexhill-on-sea East Sussex TN39 3LT Lead Inspector Joe Harris Key Unannounced Inspection 13th December 2007 10:00 Trafalgar House DS0000021273.V346928.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 Trafalgar House DS0000021273.V346928.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. Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trafalgar House Address 9 Sutherland Avenue Bexhill-on-sea East Sussex TN39 3LT 01424 222911 01424 736013 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) www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Shaun Lee Haffenden Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning Disabilities - Code LD The maximum number of service users who can be accommodated is 7 2. Date of last inspection 24th October 2006 Brief Description of the Service: Trafalgar House is one of many homes owned by Care Management Group (CMG), which is registered to provide support and accommodation for up to seven adults with mild to moderate learning disabilities. Residents at this establishment also present with some challenging behaviour and mental health needs. The home is located in Bexhill-on-Sea and has good access to local amenities and public transport. There is a small car parking area to the rear of the property, which is primarily for the home’s people carrier, although on street parking is permitted for staff and visitors. The home is a detached three-storey property with a small garden to the rear of the property. It consists of six single bedrooms and one self-contained flat on the third floor, two bathrooms / shower facilities, a spacious lounge and separate kitchen and dining area. In addition there is office accommodation for the manager and staff. The layout and facilities within the home would not be suitable for those with reduced mobility or wheelchair users. Prospective residents and their relatives are provided with written information regarding the services and facilities provided at the home prior to admission. The home’s most recent inspection report is available on request. The home’s fees as of 19th October 2006 range between £1300 - £1900 per person per week dependent on needs. Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection process culminated in a site visit to the home on 13th December 2007. The site visit commenced at approximately 10am and concluded at 4.30pm, lasting for around 6.5 hours. During the course of the visit a tour of the premises was undertaken and discussions were held with the registered manager, staff members and service users. A range of documentation was examined relating to the residents, staff, medication, health and safety and the day-to-day running of the home. What the service does well: What has improved since the last inspection? The home has addressed the vast majority of requirements and recommendations from the previous inspection. The Registered Manager has made efforts to address issues around staff training, but has found there to be a lack of availability of courses provided by the organisation. Efforts have been made to improve medication processes in the home in line with advice from the previous inspection. The risk management process has been thoroughly reviewed and updated, which has resulted in an almost overly cautious approach to risk management. Individual behaviour management guidelines have been developed and the individual service user plans in general have become more person-centred. Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 6 The complaints process has been improved and staff continue to work towards NVQ targets. The home now complies with advice from the fire safety department having installed self-closing mechanisms to all fire doors. The Common Induction Standards have been introduced into the home and all new staff now work through this process. 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. Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 7 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 Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 8 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 and 4. Quality in this outcome area is good. The needs of all prospective service users are assessed prior to moving in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has recently developed improved the pre-admission and transitional process with the focus on person-centred planning. All initial referrals are received through a central referral team within the organisation and then allocated to potential services. On receipt of the referral the home receives key information about the individual including care management plans, risk assessments and background history where appropriate. The manager and a senior staff member arrange a visit to see the prospective service user in their current accommodation. Further visits are then arranged by other staff members to introduce themselves and assess different aspects of the individual’s day such as morning routines, accessing the community and independent living skills. The timeframe for this process is flexible depending on needs and wishes. The prospective resident is then offered the opportunity to visit the home on an increasing scale from short day visits to overnight and weekend stays as appropriate. The home maintains good records in relation to the assessment process. Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 9 Emergency admissions are accepted and in these circumstances the home ensures that all required and pertinent information is received prior to admission. Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 10 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 and 9. Quality in this outcome area is good. Service users assessed needs and perceived risks are identified and residents are able to make decisions affecting their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three individual plans of care were examined during the site visit all of which had been developed providing clear guidance to ensure assessed needs can be met consistently. The range of information on each individual includes a pen portrait, behaviour management guidance, support plans with clear guidance and risk assessments. Advice was given on a number of minor issues with regard to support plans. Plans are reviewed on a regular basis or as needs change and residents are encouraged to be involved in the planning process as far as possible. Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 11 Residents are supported to make decisions affecting their lives within the context of their assessed needs. None of the service users manage their own finances and the organisation is financial appointee for a small number of residents. Service users benefits are paid into an account that is not linked to the running of the business and on receipt is transferred to the home and placed in individual resident accounts. All other service user’s finances are managed by someone independent of the home. The home has promoted the use of advocates in the past and information is available to access such resources. The home has recently updated all individual risk assessments, which have been completed thoroughly and provide clear guidance. A wide range of risk assessments have been developed some addressing minimal risks. The registered manager was advised to introduce a preliminary risk assessment process to identify the likelihood of a perceived risk enabling them to be focussed on outcomes and responsible risk taking. Service users are involved in the risks management process and the assessments are reviewed regularly. Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 12 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 and 17. Quality in this outcome area is good. Service users are able to participate in a good range of activities and are able to access the local community. Visitors are welcomed into the home. Service users are provided with healthy and balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home ensures that service users have the opportunity to engage in a wide range of activities depending on individual needs and preferences. It was reported that the local area does not have a large amount of community learning disability resources, but a number of service users attend college courses and the local gateway club. Other facilities are found further a field, but the staff continue to try and identify new opportunities in the local area. An aromatherapist visits the home twice a week and an art therapist visits weekly. In addition there are a number of leisure facilities in the home Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 13 including a pool table, computer, a game station and a football goal in the back garden. Residents are encouraged to suggest new activities on a regular basis and have weekly timetables for regular events. Staff take residents swimming, bowling, to the cinema, theatres and into the town and to places of interest. The registered manager stated that the aim is to enable everyone to go out on their own terms everyday. Visitors are apparently welcomed into the home, although there were no opportunities to speak to any visitors on the day of the site visit. The registered manager reported that the staff in the home liaise closely with relatives ensuring that they are kept informed of any changes. There is adequate space throughout the home to ensure that service users and their visitors can meet in private if they wish to do so. The ethos of the home centres around individual choice in all aspects of daily life unless there is an assessed need that impacts on the ability to choose. Residents are able to choose when they get up and go to bed and are consulted and encouraged to decide what activities they would like to each day. The home provides a healthy and balanced diet for all residents taking into account cultural, religious and special diets as required. Service users are included fully in planning and preparing meals with staff support. Menu records show evidence that choices are available and meals are varied. There is a wellequipped domestic style kitchen that is suitable for the needs of the home. Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 14 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 and 20. Quality in this outcome area is good. Service users receive personal support as they prefer and their healthcare and medication needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff are sensitive to the needs of the service users and provide assistance with personal support in a respectful and thoughtful manner. Support plans set out in good detail the preferences of individuals and the nature of support that they may require, whether this be merely encouragement or more structured assistance. It was evident through observation that staff have developed good relationships with residents and promote positive interaction. The home monitors and supports residents to ensure that their healthcare needs are met. Records are maintained of all appointments and consultations detailing outcomes and actions satisfactorily. All service users are registered with a local GP and receive support from community learning disability teams. The staff ensure that residents receive input from dentists, opticians and Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 15 chiropodists, etc as and when required. The changing healthcare needs of service users are monitored and reflected in the plans of care. The home has well-established medication systems in place and has met the requirements made at the last inspection in this respect. The Boots MDS system is in use and the home/organisation have developed policies and procedures relating to all aspects of medication administration, storage and record keeping. A controlled drugs cupboard had recently been fitted and medication is kept securely. Medication administration records were well maintained and up to date. Staff undergo a competency assessment prior to administering medication and the majority of staff have undertaken Boots MDS medication training. It is recommended that all staff complete further training in medication administration. Refer to recommendation 1. Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 16 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 and 23. Quality in this outcome area is good. Service users views and concerns are listened to and acted upon and are protected from forms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear, comprehensive and accessible complaints procedure addressing all necessary issues. The home aims to address any concerns or complaints in an informal manner in the first instance, but should this be unsatisfactory then there are formal processes clearly set out. A copy of the complaints procedure is displayed in the home and accessible. A record of complaints is maintained. There have been no complaints since the last inspection. The home has clear policies and procedures in place aimed at protecting service users from potential abuse and maltreatment. Systems are in place to record and document any incidence of abuse should it occur and procedures for reporting such incidents are also in place. There is an awareness and understanding of legislation and responsibilities regarding the Protection Of Vulnerable Adults. Staff are provided with guidance and training relating to adult protection and demonstrated good levels of awareness. Additional training is booked for those staff who have not yet attended this course. Policies and procedures regarding service users finances are clear and adhered to. Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 17 1 Adult Protection alert was raised by the Registered Manager relating to an alleged incident of aggression by a staff member to a service user. This matter was investigated by the home under the Adult protection process. The service user retracted the allegation and no evidence of abuse was found. Trafalgar House DS0000021273.V346928.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 and 30. Quality in this outcome area is good. The environment is suitable for the individual and collective needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Trafalgar House is a comfortable, bright and open environment well suited to meet the needs of the service users. The home is located on a residential street conveniently located in the town of Bexhill-on-Sea. There is ample street parking available outside the home and in the local vicinity. The home is set out over three floors. The second floor is a semi-independent flat and the first floor comprises largely of single bedrooms and toilet and bathing facilities. There is a small quiet room that staff hope to refurbish. The communal space on the ground floor is made up of good-sized rooms including a lounge, games room, dining room, kitchen and laundry. There are also two offices Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 19 conveniently located. There is an attractive garden to the rear with a shelter for smokers. The patio area is in need of replacement and it was reported that a budget has been set for this work to be carried out, which will be completed once the weather improves. The carpet in one of the offices also requires replacing as it represents a health and safety hazard, it was reported that this has also been agreed with the organisation. Refer to recommendation 2. Residents spoken to said that the home is comfortable and a good place to live. The residents of the home recently all contributed to the purchase of a new television and the manager stated that they have further items on the wish list that they hope to buy in the future. The laundry facilities in the home are adequate for the needs of the service. Residents are encouraged and supported to manage their own washing as far as possible. There is access to the laundry from the outside as well as through the kitchen in case of any infection control issues. The home has suitable policies and procedures in place regarding infection control and all hazardous substances are stored appropriately. It was reported that the home meets with fire safety and environmental health legislation. Tests have been carried out on the water fittings and supply. Trafalgar House DS0000021273.V346928.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): 32, 33, 34 and 35. Quality in this outcome area is good. Service users are supported by a competent staff team in suitable numbers. Recruitment practices protect the welfare of residents. Staff training needs to continue to be updated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is working towards achieving 50 of the staff team with NVQ level 2 or above. 4 staff have already obtained this qualification and a further 7 staff are in the process of completing their NVQ. 2 staff have been enrolled to commence the course in January. In discussion with staff it was evident that there are committed team members with a sound understanding and knowledge base of the clients that they are working with. Service users said that the staff are helpful and supportive. One resident said, “the staff are great, we all get on really well”. There are sufficient numbers of staff on duty at all times. There is a minimum of 2 staff on for limited periods of the day with three staff on for the majority of the time to enable residents to go out and receive appropriate support. At Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 21 night time there are 2 waking staff and sleep-in team member. The rota is maintained and up to date. The home ensures that the recruitment of new staff is completed safely and consistently. A number of staff personnel files were examined for recently employed carers. These contained all the required information including CRB and POVA checks, completed application forms, proof of identity and two written references. Employment histories were completed in suitable detail covering all gaps and reasons for leaving previous employment. The home has it’s own specific induction processes in place and the Common Induction Standards have been introduced over recent months to compliment this and provide a foundation in the principles of care. An up-to-date training matrix has been developed, but this demonstrated a number of shortfalls in training issues. The organisation provides an impressive range of training courses and lists of available training are circulated to the home on a monthly basis. However, there has been limited accessibility to these courses for staff and therefore mandatory training needs require updating. The organisation has provided the Commission for Social Care Inspection with a training plan detailing the dates of future training. This demonstrates that all staff will have up to date mandatory training and other service specific courses within the first 3 months of 2008. Refer to requirement 1. Trafalgar House DS0000021273.V346928.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, 39 and 42. Quality in this outcome area is good. The home is well run and in the best interests of the service users. The health, safety and welfare of the residents is protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager has been in post for approximately 2 years and has achieved the necessary management qualifications. In discussion he demonstrated a very good understanding of the needs of the service, it’s limitations and strengths. He also has clear ideas regarding the on-going development of the home and a commitment to putting the needs of the residents first. He is ably supported by the deputy manager who has a wealth Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 23 of experience in the care sector. Staff and service users in the home spoke positively about the management of the home. Largely it was reported that the organisation provides good support and there is a clear line management structure in place, however concerns were noted regarding the availability and accessibility of training within the organisation, which is an area that needs to be addressed. There are well designed quality assurance processes in place including a monthly audit by a quality assurance assessor who provides a clear action plan for work in the home. There are regular staff and resident meetings and feedback is actively encouraged by the registered manager. Annual satisfaction surveys are completed by all involved in the home and these results are collated into an organisational quality report. It is recommended that the results of the surveys for each individual home are broken down to identify any potential issues with each service. Refer to recommendation 3. All health and safety records and documentation is kept up to date and fire logs, accident records and service safety certificates were examined and are well-maintained. Safe systems of work are instituted and environmental risk assessments completed and up dated. Some staff have received all required mandatory training, although this is an area for further development by the home and organisation to ensure that all staff have up to date foundation training and other service specific instruction such as de-escalation and management of aggression training amongst other topics. The organisation has provided the Commission for Social Care Inspection with a training plan demonstrating that all staff will receive the required training in the first quarter of 2008. Refer to requirement 1. Trafalgar House DS0000021273.V346928.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 X 2 3 3 X 4 3 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 3 34 3 35 2 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 Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 25 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. 1. Standard YA35 Regulation 18(1) Requirement To ensure that the staff training programme is implemented in the home providing instruction in all mandatory training and service specific topics. Timescale for action 01/04/08 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. 3. Refer to Standard YA20 YA24 YA39 Good Practice Recommendations To ensure all staff administering medication continue to develop medication awareness and training. To ensure that planned maintenance work is carried out in a timely fashion. To develop a service specific annual quality report showing the strengths and limitations of individual homes. Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Trafalgar House DS0000021273.V346928.R01.S.doc Version 5.2 Page 27 - 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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