Care Home: Woodlands Care GRP Ltd

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What the care home does well From speaking with residents and the information residents gave on the comment cards, it was clear that they were happy with the care provided. Staff were described as, "very nice", "friendly", " nothing is to much trouble to them". The home is well managed and staffed by experienced, well-trained and competent staff team. The home is clean and maintained to a high standard. Resident`s rooms were very comfortable, warm and tidy. The home provides a good range of activities to meet individual needs. Visitors are made welcome and can visit at any time. What has improved since the last inspection? The new extension had now been completed. The garden area has been landscaped and has seating areas for residents to sit outside. Improvements were noted to the lounges with regard to seating arrangements and the small kitchen/ breakfast bar in one lounge. Work on the care plans has made them easier for staff to read. Several areas of the home had been decorated; giving the home a brighter and more modern look to the home. New signage with arrows directing people around the home had been put in place, such as garden area and bedrooms, this is to help people orientate around the home. Toilet and bathrooms doors are easily identified. Staff now wear their own clothes instead of uniforms, however some staff said they preferred to wear a uniform. The home has a clear dress code and an inforamal uniform policy. What the care home could do better: The owners and the manager still have plans for improvement and development and these were highlighted on the returned AQAA. CARE HOMES FOR OLDER PEOPLE Woodlands Care GRP Ltd 22 Woodlands Drive Atherton Manchester M46 9HH Lead Inspector Judith Stanley Unannounced Inspection 3rd September 2008 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 Woodlands Care GRP Ltd DS0000067718.V370610.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. Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodlands Care GRP Ltd Address 22 Woodlands Drive Atherton Manchester M46 9HH 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) 01942 875054 F/P 01942 875054 Woodlands Care GRP Ltd Mrs Janet Hope Care Home 36 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (36) of places Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP Dementia over 65 years of age - Code DE (E) (maximum number of places: 16) The maximum number of people who can be accommodated is: 36 Date of last inspection 28th August 2007 Brief Description of the Service: Woodlands offers personal care and support for up to 36 residents, included in those numbers the home can offer care to 16 residents with a dementia related illness. Woodlands is on the Bolton and Atherton border and is set back off the main road up an un-adopted road. Local amenities are a short drive away from the home. The home is a large detached house set in it’s own grounds with wellestablished gardens to the front and the rear of the home. The garden at the rear is private and secure. Limited car parking is available at the front of the home. The home is a two-storey building with bedrooms, bathrooms and toilets on both floors. The home offers 36 single rooms of which 14 have en suite facilities. There are two lounges, one has a small kitchen area and a dining area, and there is also the main dining room. The current scale of fees per week ranges from £358.68 - £450.00. Additional charges are made for private chiropody, hairdressing, personal toiletries, personal newspapers and pet food and pet costs (a resident has brought her cat with her when she moved into the home). Woodlands Care GRP Ltd DS0000067718.V370610.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 the service is 2 star. This means that people who use the service experience good quality outcomes. This inspection was unannounced and included a site visit and took place over a 7 hour period on one day. The inspector looked at a selection of records including some care plans (information about the residents), the activity plans, some staff files and training records and the general maintenance file. The inspector also looked around the home and spoke with two of the owners, the manager, staff and residents. Prior to the inspection the home was sent an Annual Quality Assurance Assessment (AQAA). This is a self-assessment form that is completed by the manager and tells us what the home does well at, and in what areas they can still develop and improve on. Comment cards, asking residents, relatives and staff what they thought about the home and the care provided were sent prior to the inspection. Eight staff, three residents and three relatives returned comment cards. All were satisfied with the care provided. Comments received included the following: “Provide a clean environment, caring service and a good varied menu”. “The new owners have made many improvements. I am confident that more improvements are planned”. “The care is excellent, staff are sensitive to peoples feelings”. What the service does well: From speaking with residents and the information residents gave on the comment cards, it was clear that they were happy with the care provided. Staff were described as, “very nice”, “friendly”, “ nothing is to much trouble to them”. The home is well managed and staffed by experienced, well-trained and competent staff team. The home is clean and maintained to a high standard. Resident’s rooms were very comfortable, warm and tidy. Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 6 The home provides a good range of activities to meet individual needs. Visitors are made welcome and can visit at any time. What has improved since the last inspection? 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. Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 7 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 Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 8 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): 1,2,3 and 4 were assessed. Standard 6 was not assessed, as the home does not provide an intermediate care service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are properly assessed prior to admission so ensuring the home is able to meet any identified needs. EVIDENCE: The home has a detailed statement of purpose and a service user guide. The brochure informs people about the services and facilities available at Woodlands for example about the bedrooms and communal areas, and meal times. A section for residents with a dementia related illness is also included to help residents and to assist their relatives in making a choice about moving into the home. Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 9 We selected three care plans to work with throughout this inspection, this is known as case tracking. Using these selected care plans we checked to see that all residents has a contract/statement of terms and conditions in place regardless of how their care was funded. Up to date contracts were seen in all three files. To ensure that the home can meet the needs of the residents a pre admission assessment is carried out prior to a resident being admitted to the home. The only exception when this may not happen would be in the event of an emergency admission. The assessment is carried out at the most convenient place for the resident either at there own home or at the hospital. The manager or the deputy manager carries out the assessment, this ensures that the residents well being, brief medical history, medication, risk of falls, foot care, oral care, nutritional status, continence, personal care needs etc can be fully met by the staff at the home. For residents with dementia the home also carries out a mini mental assessment to help the staff assess the level of dementia and confusion. The home is registered to offer care for up to sixteen people with a dementia related illness who do not need any nursing care. Residents are not segregated and share all communal space. The garden area at the rear of the home is private and secure to allow residents access to outside. Most staff at the home had undertaken training in caring for people with dementia and in addition staff have access to publications from the Alzheimer’s society to use as reference. Senior staff had attended training on the Mental Capacity Act, which they are cascading to other staff until further training in this area is available. Woodlands Care GRP Ltd DS0000067718.V370610.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): 7,8, 9, 10 and 11 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and care needs were well met with care plans providing guidance and information to staff when delivering care. Residents were treated with dignity and respect and their right to privacy was upheld. EVIDENCE: Three care plans were examined, including the last person to be admitted in to the home. Since the last inspection the format of the care plans had been changed. Care plans were separated in to different sections with clear headings that allowed staff to find and record information more effectively. The care plans were easy work with and contained comprehensive information relating to residents personal, social and health care needs. Each area of care was a separate record for example communication, hearing, bathing and weights etc. Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 11 Other information includes risk assessments for moving and handling, risk of falls, fire risk and a general risk assessment. Daily entries in care notes were completed in all the plans examined and gave a good indication of the care provided and residents well being. Care plans had been reviewed monthly as required and any changes to the plans documented. Supplementary information showed that outside agencies such as doctors, district nurse, chiropodist and the optician are contacted and visit the home as required. During this inspection we tried to check the medication for the three case tracked residents. There had been a problem with the lock on the drugs trolley resulting in the trolley being taken off the premises to be repaired. This resulted in the medication being stored in a small locked cupboard for security reasons and was not easily accessible for the deputy manager and the inspector to check. We managed to find the blister pack and records for one of our case tracked residents and this was found to be in order. It would not have been appropriate at that time of day to have medication out to check any further. A substitute drugs trolley was to be delivered to the home later that day. The deputy manager confirmed that all residents had been given their medication as required. This will be checked in detail at the next inspection. Those residents who are able to comment and feedback in returned resident/relative comment cards, indicated staff respected their privacy and dignity. During the inspection, staff were observed to treat residents with respect and consideration. Residents were observed to be dressed in clean and nicely laundered clothes. Ladies and gents hair was neat and tidy and the gentlemen were clean-shaven. Palliative care (care for those nearing the end of their life) may be provided to allow residents to end their days in familiar surroundings with staff they know and trust, this includes person centred planning and pre planned choices. Staff also provide support and empathy to relatives at this time. Woodlands Care GRP Ltd DS0000067718.V370610.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): 12,13,14 and 15 were assessed Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Resident’s interest and links with visitors are encouraged. The provision of social activities within the home is good and meets the needs and expectations of the residents. Residents enjoyed the meals and the food is nourishing and presented on a way that meets their needs. EVIDENCE: On the day of the inspection, the routines of daily living were observed to be flexible. Residents were seen to getting up in the morning at times that suited them and choosing where to spend their day. A new activity coordinator was on induction at the time of the inspection and was waiting to start full time employment. The manager and deputy manager had worked hard to produce a programme of events that ran throughout each month; this is a good guideline to prompt daily activities. The manager of the home had introduced ‘Butterfly Work’ this is where every resident in the home has some time spent with them everyday. Staff document the time that they Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 13 spent with a resident so that the staff coming on duty at the next shift can check and make sure which residents have had time spent with them and those who had not had not. Other activities include daily living tasks, One resident was seen watering the plants in the garden with member of staff. Regular baking sessions take place, making smoothies with fresh fruit. Some residents arts and craft work was displayed around the home. Other activities taking place included, quizzes, nail care, flower arranging, reminiscence and gentle exercises etc. Some residents had been out to the library where they can browse and select books and enjoy and cup of tea. The library has allowed the home to purchase some of the large print books at a reasonable rate. There is a good selection of books and talking books around the home. For those residents who wish to sit quietly away from the main hub of the home there is a comfortable seating area on the first floor. The new kitchen area in one lounges and breakfast bar had proved to be a great success; it has encouraged residents to sit together and enjoy a cup of tea or coffee and spend time together chatting. The manager has ordered a lap top computer to encourage residents to learn new skills and with the help of staff could e mail relatives living abroad and have the opportunity to shop on line which could be beneficial to those residents who want to buy new clothes but find shopping difficult. The home has an open visiting policy. There are no restrictions on the time people visit, evidence of which is highlighted in the visitor’s book. Entries showed residents friends and relatives visiting at different times during the day and the evening. The only time restrictions would be imposed is when requested by residents or if staff felt the residents were being compromised in any way. Residents who were able to comment expressed satisfaction with the care provided and organisation of life within the home. It should be noted a number of residents have memory and communication difficulties so were unable to confirm they were able to exercise choice. Nevertheless observation of care practices indicated residents could make a choice for example when rising and retiring, where they spent their day and times when they preferred to bathe, either morning or evening. Those resident who request a morning bath are offered breakfast in bed so that they don’t have to get dressed then undressed again. To assist residents with choices mainly at breakfast time a range of hot and cold dishes are available, the manager has introduced that all the cereals available are set out on a table, if boiled eggs and toast is offered the cook prepares a sample of this and puts it on the table, residents can then go and look to see what is available and select what they want. The menus had recently been amended and are planned on a two weekly cycle. The manager has introduced a range of finger foods and has replaced the afternoon biscuits with a healthy option such as fresh fruit or homemade Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 14 scones. There is fresh fruit available on the dresser for residents to help themselves. Wine, sherry or a beverage of resident’s choice is available. At lunch and dinner there are two sittings, this allows staff to spend more time assisting those residents who require help and encouragement with their meals. A group of residents sit together at the breakfast bar for some of their meals, as is their choice. Lunch is the main meal of the day and residents were offered, beef stew and dumplings, creamed potatoes and seasonal vegetables, followed by chocolate sponge and custard or fruit. There is always an option available such as soup, sandwiches and salads. It was noted that the dining tables were nicely set with appropriate cutlery and crockery, condiments and brightly coloured napkins. An early evening meal is served, again a selection of hot and cold dishes are available. Hot and cold drinks and snacks are available throughout the day and on request. Residents are offered a choice of suppers and drink of their choice, including a hot milky drink before they retire. Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 15 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): 16 and 18 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an effective complaints system in place to ensure that complaints and concerns are suitably dealt with and appropriate action taken. EVIDENCE: The home has a complaints policy and procedure in place. The complaints file was inspected and there has been two complaints made since the last inspection, these were not related to care issues and had no impact on the residents. All concerns or complaints were logged and the outcomes documented. There had been one safeguarding referral made since the last inspection. This was suitably dealt by the appropriate agencies. All staff at the home had undertaken training in the protection of vulnerable adults to ensure that residents are protected from abuse in any of its forms. Woodlands Care GRP Ltd DS0000067718.V370610.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): 19, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A recent programme of redecoration and refurbishment has resulted in improvements, providing residents with a clean, pleasant and comfortable environment. EVIDENCE: At the last inspection the home was undergoing major building work; this has now been completed. The extension to the home offers all single en suite rooms, which have been tastefully furnished with colour coordinated carpets, bedding and curtains. One of the rooms has been fitted out with a small kitchen area with a fridge and microwave and facilities for making refreshments. This room can be used for people of respite or short stay or for people who can still carry out some daily living tasks for themselves. Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 17 From a tour of the home it was evident that several areas had been painted and refurbished. The new style of décor has given the home a lighter, brighter and modern appearance. In one of the lounges the furniture has been rearranged and a breakfast bar added with a small kitchen area. Residents were seen enjoying sitting together and having a meal in this area. This lounge has large wall mounted TV screen so that residents can have a good view of their choice of programmes or DVDs. The hairdressing salon had been relocated and now combines other relaxation treatments and therapies for residents to enjoy. For those residents who want some time alone from the main part of the home comfortable seating and reading materials are available on the first floor. The bathrooms were inspected and were found to be domestic in style and offered a relaxed atmosphere for residents when bathing. The home has a new spa bath, which the manager confirmed residents enjoyed, what is for some a new experience. Several of the bedrooms were looked at, these were seen to be warm, clean and tidy. Residents had personalised their bedrooms with their own possessions brought with them from home. To help residents who may be confused the home has clear signage indicating the way to bedrooms, the toilet and the garden area etc. The outside area of the home is well maintained; the exterior of the home had been painted. The garden area had been landscaped and had appropriate seating for residents to sit outside; the garden area is safe and secure. At the front of the home extra parking spaces had been made available. The footings for a new conservatory at the rear of the home are in place and work is to commence within the near future. On the day of the visit the home was clean and odour control was very good. The laundry had moved to the attic and is well away from food storage and food preparation areas as does not intrude on the residents. Staff were seen wearing different protective clothing for different tasks. Woodlands Care GRP Ltd DS0000067718.V370610.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): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory ensuring consistency of care for people living in the home. The residents were cared for by staff that were safety recruited, suitably experienced and trained to meet the residents care needs. EVIDENCE: On the day of the visit staffing levels were sufficient to meet the needs of the residents. A written rota is maintained and showed which staff are on duty and at what time. The home does not use agency staff and if needed the homes own staff will cover extra shifts. Domestic and catering staff are employed and help support the care workers. Two members of staff cover a waking a night shift, these levels are constantly reviewed and extra cover would be brought in if necessary. Several of the staff had worked at the home for a number of years, this provides consistent and reliable care for residents by people they know and can trust. In the main staff spoken with liked the changes made within the home, however after discussion with the manager and deputy manager it was apparent that some staff preferred the old way of working. Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 19 The atmosphere in the home was very relaxed and friendly. Interactions between staff and residents were frequent, warm and natural. During the visit staff were observed to respond speedily to requests for assistance made by the residents. The files of three staff employed looked at showed all the necessary recruitment checks had been undertaken. All contained: a written application form, 2 references, Criminal Records Bureau check (CRB) and verification of identification. An individual training record of training is kept with the staff file. A record of supervision and annual appraisals was available for inspection. All new staff completes an induction course on commencing work. A new member of staff was in induction on the day of the visit. The home meets the standard of having at least 50 of care staff qualified to NVQ level 2 in care. All staff had completed mandatory training as required, including moving and handling, fire awareness, protection of vulnerable adults, food hygiene, first aid etc. Further training included dementia awareness and Mental Capacity Act. Staff attend in house and external training as required. Woodlands Care GRP Ltd DS0000067718.V370610.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): 31,33, 35 and 38 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is experienced, well qualified and competent ensuring the home runs in the best interests of the residents. Regular maintenance and fire safety checks were carried out, promoting the health and safety of both residents and staff. EVIDENCE: The manager has extensive experience in caring for the elderly and has obtained the NVQ level 4 and the Registered Managers Award. There is a clear line of accountability in the home which residents and staff are aware of. The manager is well supported by the homes deputy manager who is well qualified Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 21 and experienced and can run the home in the absence of the manager, a role that she undertook recently when the manager was off sick. During the inspection, it was observed that residents and staff had no hesitation in approaching the manager and deputy manager if they had anything they wish to discuss. Record keeping was good and staff had access to all the paperwork they might need during their shift. There is a good system of continuous self-monitoring with in the home, which includes satisfaction questionnaires, regular audit of rooms, falls, medication, meals and care plans. There are regular visits from the owners of the home who can be contacted at any time if the need arises. One of the owners visits the home on a monthly basis as required and completes a written report of their findings. The manager holds regular meetings with staff and residents. All staff is expected to read and sign that they have read meeting notes and correspondence. The home has a satisfactory accounting system in place. The deputy manager could determine exactly how much money the home was holding for each resident. The home looks after small amounts of resident’s personal allowances. Detailed records are held of all transactions. All monies held for safekeeping are kept individually. Health and safety policies and procedures were in place. The staff team have completed health and safety training. Any accident, injuries or incidents that affect the health and well being of residents and staff are reported and recorded and the CSCI are informed as required. Information on the returned AQAA provided the CSCI with a list of maintenance and associated records. A number were checked on the site visit, including the lift, electrics, gas, fire systems and portable appliance testing. Certificates of validation were available for inspection. Woodlands Care GRP Ltd DS0000067718.V370610.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 3 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 3 x 3 3 Woodlands Care GRP Ltd DS0000067718.V370610.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road 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 Woodlands Care GRP Ltd DS0000067718.V370610.R01.S.doc Version 5.2 Page 25 - 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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