Inspection on 12/06/08 for The Oakes

This is the latest available inspection report for this service, carried out on 12th June 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Oakes 10/07/06

The Oakes 12/01/06

The Oakes 14/06/05

The Oakes 21/12/04

The Oakes 12/07/04

The Oakes 12/02/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 The Oakes 55 Railway Approach Laindon Basildon Essex SS15 6JX Lead Inspector Michelle Love Unannounced Inspection 12th June 2008 09:00 The Oakes DS0000018125.V366263.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 The Oakes DS0000018125.V366263.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. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Oakes Address 55 Railway Approach Laindon Basildon Essex SS15 6JX 01268 441096 01268 455103 kingswood@donna-higby.freeserve.co.uk 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) Kingswood Care Services Limited Vacant Post Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To provide care and accommodation to one service user who is 17 years of age and known to the Commission for Social Care Inspection. 5th February 2008 Date of last inspection Brief Description of the Service: The Oakes provides care and accommodation for up to seven young adults with learning disabilities and complex needs such as autism and challenging behaviour. Although the home is registered for seven residents, only six have ever been accommodated. The seventh bedroom is used by staff as a sleeping in room. The Oakes is a large detached house located in a residential area of Laindon. The home is close to local amenities. Laindon shopping centre is within easy reach. The home has two vehicles for transporting residents to activities in the community. The communal accommodation comprises of a large lounge area, a dining/activity area and a kitchen diner. There is a secure garden with seating, patio and shed. There are five single bedrooms, three with en suite facilities. A sixth bedroom has an adjoining dining/leisure area that is used by both staff and residents. Due to the nature of residents needs, items cannot be left easily on display. There was a notice on display advising people of how to access inspection reports for the home. A statement of Purpose, a Service Users Guide and pictorial Service Users Guide were available in the home’s office. The weekly charges at the home range from £1216.88 to £1885.00. These fees reflect the complex needs of residents, and that care is often provided on a one or two staff to one resident ratio. Additional charges to residents include personal requirements, activities and holidays. The Oakes DS0000018125.V366263.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. This was an unannounced key inspection. The visit took place over one day and lasted a total of 6.5 hours, with all key standards inspected. Additionally, the manager’s progress against previous requirements from the last key inspection was also inspected. Prior to this inspection, the registered provider had submitted an Annual Quality Assurance Assessment. This is a self-assessment document detailing what the home does well, what could be done better and what needs improving. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a full tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the site visit, surveys for relatives, staff, care managers and healthcare professionals were forwarded to the home. Where surveys have been returned to us, comments have been incorporated into the main text of the report. The manager, assistant manager, team leader and other members of the staff team assisted the inspector on the day of the inspection. Feedback on the inspection findings were given throughout and summarised at the end of the day with both the manager and team leader. The opportunity for discussion and/or clarification was given. What the service does well: The care home provides residents with a warm and homely environment that is spacious. Individual resident’s rooms are personalised and reflect their personalities. Visitors to the home are made to feel welcome. Food provided to residents is of a high quality and comments from residents relating to meals provided, was positive. There is a varied menu and various alternatives are available if required. A high level of care is provided, to individual residents. The staff team are aware of individual residents complex needs and know how residents prefer to be supported. Rapport between staff and residents’ was observed to be conducted in a respectful and dignified manner. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 6 People at the home are supported to lead an active life, to undertake a variety of activities, which meet their individual needs according to their personal preferences and to use the local community. Robust complaint and safeguarding management and procedures ensure that the needs and welfare of individual residents are paramount. 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. The Oakes DS0000018125.V366263.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 The Oakes DS0000018125.V366263.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. This judgement has been made using available evidence including a visit to this service. A formal assessment process is in place and prospective people can be assured they will have their needs assessed prior to admission. EVIDENCE: The inspector was advised that no new residents have been admitted to the care home since 2006. The previous inspection report, details that the registered provider have previously demonstrated a robust and thorough approach to the admission process. There is a formal pre admission assessment format and procedure in place, so as to ensure that the care team are able to meet the prospective resident’s needs. A blank format was examined and this was observed to be detailed and comprehensive. The inspector was advised that pre admission assessments are conducted by either the manager or the responsible individual, and where appropriate the prospective resident and/or their representative are encouraged to visit the care home and to undertake a period of transition/introduction to the home. The manager advised that the last resident to be admitted to the care home received a transition of over four months. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 9 Additional information is also sought from healthcare professionals and individual care managers so as to inform the pre admission assessment process. Staff surveys returned to us, recorded staff as being given sufficient information about the needs of the prospective resident. One staff survey stated, “Any information that needs recording gets recorded straight away and anyone who it will effect is verbally informed as well”. The Oakes DS0000018125.V366263.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, 8 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents can be sure they have an individual plan of care in place and that this is reflective of their individual care needs and that these will be met. EVIDENCE: There is a formal, comprehensive and detailed care planning system in place to identify, the care needs of individual residents and to specify how these are to be met by care staff. It is positive to note that shortfalls identified at the previous inspection have been addressed and of two care files examined, these were observed to be thorough and descriptive, evidencing the individual’s care needs in respect of their health and welfare and how these were to be proactively managed by the staff team. For example, one file made reference to the person displaying aggressive and inappropriate behaviours on occasions. The care file clearly recorded the specific nature of the above inappropriate behaviours and identified strategic guidelines for staff as to how best to support the individual The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 11 person in moments of `crisis`. There was evidence that the staff team/management team of the home had collaborated and sought advice from other professional agencies and were working jointly to ensure the person’s health and welfare were actively promoted. There was evidence that where changes occurred in relation to the person’s care needs, the care plan and other associated documentation were reviewed and updated. The only exception to this is detailed within the `Personal and Healthcare Support` section of the report. One staff survey forwarded to us recorded, “All information is within residents’ files, which are easy to access for all staff and anything that needs to be known regarding any specific resident is transferred verbally”. Another staff survey recorded, “care plans could be updated more often”. The latter was not evidenced on the day of inspection and of those, care files examined these had been updated and reviewed. One survey forwarded to us from a care manager recorded, “The service aims to deliver a service that meets the persons individual needs, and live as ordinary a life as possible, to help maintain the person’s quality of life. To promote person centred planning for individual persons and to achieve a person’s potential”. Risk assessments were devised for all areas of assessed risk and clearly identified the risk, the person/s affected and risk reduction measures devised and implemented. As identified at the previous inspection to the home, the staff team are proactive in minimising risks to residents and staff are aware of high risk areas within the home environment e.g. laundry room and kitchen. The Annual Quality Assurance Assessment details under the heading of `how we have improved in the last 12 months`, “All care files are reviewed and up to date”. Both the manager and assistant manager advised the inspector that care files for individual residents, are being further reviewed and updated to ensure that they are person centred. Care files examined showed that residents receive an annual review and this includes all interested parties e.g. the resident, family members, staff from the home, independent advocate and healthcare professionals. During the site visit, staff were heard and observed to wherever possible offer residents choice, to encourage residents to make decisions about their lives and to encourage participation where appropriate with household chores. Staff interaction with residents was observed to be respectful and appropriate and residents were noted to have a good rapport with both the manager and individual staff on duty. We recognise that as a result of individual resident’s complex needs, not all residents are able to verbally communicate, however The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 12 residents were observed to be relaxed with staff and two residents spoken with, advised the inspector that they liked living at The Oakes and liked staff. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the opportunity to have an active lifestyle and to have their social care needs met. EVIDENCE: Each person has an activity monitoring form in place within their care file, detailing activities undertaken and specific details of their personal activity programme that reflect their personal choices, likes and dislikes. The Annual Quality Assurance Assessment under the heading of `what we do well` stated, “Residents are encouraged to live as independently as possible, using a person centred approach, despite their level of disability and inappropriate behaviours”. It also documents, “Service users are encouraged to participate in all community activities to prevent exclusion and promote inclusion within the community”. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 14 Despite barriers relating to their being a lack of formal day care provision for people with learning disabilities/challenging behaviours, evidence indicated that residents have the opportunity to participate in both in house activities and activities within the local community e.g. swimming, horse riding, circuit training etc. Where appropriate people are supported to attend adult education classes e.g. cookery. The manager advised that when there are college breaks, an additional programme is devised in house so as to ensure that people still receive a varied programme of activities. Within the home environment there is an activity room available for residents use and there was sufficient equipment and materials available. As a result of residents’ complex care needs they are supervised/supported closely to ensure their safety and wellbeing. Residents have access to two vehicles so as to enable them to have good community access. The manager advised that he is very careful when compiling the staff rosters, to ensure that there is at least one driver available on each shift. One staff survey forwarded to us recorded, “the service provides a fun and wide variety of activities for the residents and also in giving them choices of what to eat and drink”. Another staff survey recorded, “It allows service users to make their own choices even for those people who are non-verbal. It also encourages service users to participate in different activities and allows them to express themselves”. Residents are offered at least 1 week’s holiday per year and also have the opportunity for day trips e.g. records for one person recorded they recently enjoyed a trip to London. Visiting at the home is very open and residents are actively encouraged and enabled to maintain contact with family members and friends. There is a rolling 4 week menu (summer and winter). Both the cook and the manager advised the inspector that residents and their families have been consulted so as to ensure that the menus are varied and include individual’s personal preferences. Records showed that residents are offered choices and alternatives to the menu are always available. One resident spoken with advised the inspector that they liked the food provided at the home. The manager was advised that consideration should be given to devising a pictorial menu, so as to enable residents to make an informed choice. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive appropriate support so as to ensure their healthcare needs are met. EVIDENCE: Records showed that residents have access to a range of healthcare professionals as and when required e.g. GP, Consultant Psychiatrist, Behaviour Therapist, Nurse Specialist etc. Records showed that residents’ health is monitored and clearly documented, detailing the rationale for the visit, appropriate actions and outcomes. Additionally, records showed that individual resident’s are, supported by staff to attend appointments and other healthcare checks. One survey forwarded to us from a healthcare professional advised that in their opinion, the healthcare needs of individual residents are met by the staff team at the home and the service are able to respond to the different needs of individual resident’s. Additionally they reported, “I had limited experience of working with the service but they responded well to the client I was supporting”. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 16 Individual care plans record specifically how people have their personal support provided. Routines within the home were observed to be flexible and according to individual resident’s needs. It was positive to note that shortfalls identified at the last inspection in relation to medication practices and procedures had been addressed however one issue was highlighted during the site visit, which needs to be dealt with so as to ensure residents safety and wellbeing. As part of the inspection process, practices and procedures for the safe handling of medication were examined. The majority of medication is managed through a monitored dosage system (blister pack). Storage systems within the home were observed to be safe and secure and room temperatures where medication is stored were now being monitored regularly. During the inspection, the team leader was observed to mix together three liquid medications, which were to be administered to a resident in a drink. Both the manager and the team leader advised the inspector that advice/agreement to administer medication in this way had been formally agreed, however no documentation could be located and the person’s care plan/risk assessment made no reference to the above. Both the manager and team leader were advised that confirmation of any decision must be documented within the individual’s care plan and there should be open discussion and agreements with the multidisciplinary team and the person’s relatives/advocate. The decision, action taken and the names of all parties concerned should be documented and reviewed at regular intervals. As a result of the above observation, further advice was sought from a specialist pharmacist inspector and written correspondence has been forwarded to the home manager. The manager was also advised as part of good practice procedures that keys for the medication cupboard should not be attached to the main set of keys and should be kept separate. The manager was advised to refer to the guidance as detailed within the Royal Pharmaceutical Society document `The Handling of Medicines in Social Care`. The training matrix evidenced all staff as administering medication to residents as having received medication training, however following discussions with the manager it was apparent that he is the only person who has undertaken the `advanced` training course. It is recommended that all staff who administer medication receive the `advanced training. We recognise that staff receive bi monthly competency assessments and this is recognised as good practice. It was positive to note that the majority of staff had received training relating to the administration of rectal diazepam, however it was discussed with the The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 17 manager of the home that as part of good practices procedures, the training certificates should state that staff are competent to undertake this task. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 18 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. This judgement has been made using available evidence including a visit to this service. Residents and others can be confident that any concerns or complaints raised will be listened to and appropriate actions taken. The management of safeguarding within The Oakes ensures that residents are protected from abuse. EVIDENCE: The home has a corporate complaints policy and procedure in place and a pictorial format for residents understanding. There was evidence to indicate that relatives of residents are aware of how to raise concerns with the management of the home, should the need arise. Staff surveys forwarded to us recorded that staff know what to do if a resident, relative or other interested party should need to raise concerns. One care manager survey recorded, “In the past this has not been met, however since the arrival of the new manager there have been massive changes made to ensure a `zero tolerance` for abuse issues raised”. On inspection of the complaint log, one complaint has been received at the home since the last inspection. Records showed appropriate action was, undertaken by the registered provider. Records also showed complimentary comments from one relative and this stated that they were happy with the current staff team and the improvements made at the care home. Appropriate policies and procedures relating to safeguarding were readily available and included the latest safeguarding guidance dated April 08 from the The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 19 Local Authorities. Staff spoken with demonstrated an understanding and awareness of safeguarding procedures. The staff, training matrix recorded all but one member of staff as having up to date safeguarding training. As previously stated, care files examined for individual residents identified their needs relating to challenging/inappropriate behaviours and there was clear guidance for staff as to how to proactively manage and support residents. The majority of staff had received training in conflict management, behaviour management and `SCAPE`, Safe Care and Protection in Essex since the last inspection. The manager advised that the home’s service manager is a SCAPE instructor, and cascades this training to staff. The Annual Quality Assurance Assessment under the heading of `what we do well` states, “All staff have received training in safeguarding adults. This has been `in house` and training provided by Essex County Council. Training materials are available `in house`. A policy is in place which includes whistle blowing”. The document also states, “Where physical intervention is used, robust plans and risk assessments are in place. Staff, receive training in behaviour management and physical intervention”. All of the above was evident on the day of the site visit. It is hoped that within the next 12 months, the safeguarding policy and procedure will be further developed and include a new physical intervention policy. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 20 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 This judgement has been made using available evidence including a visit to this service. The Oakes provides a comfortable, safe and homely environment for residents, which meets their needs. EVIDENCE: A full tour of the premises was undertaken as part of this key inspection with the manager and team leader. On inspection of resident’s bedrooms, all were seen to be personalised and individualised and reflected their personalities and interests. The home is decorated to a high standard and maintained regularly as a result of some individual’s display of inappropriate behaviours towards the environment. Since the last inspection, one room has been altered and equipment purchased, and is now being used as a sensory room. The manager advised that this has proved very popular with both residents and staff. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 21 The garden to the rear of the property is well maintained and secure and it was positive to note that this is accessed by residents on a regular basis. There is a large patio area with seating available and residents are able to use the outdoor trampoline and pool in good weather. The home environment was noted to be clean and odour free throughout the day. The laundry facilities were observed to be well organised. No health and safety issues were highlighted at this inspection. The manager advised the inspector that there is a maintenance person, however they cover all of the provider’s homes in the area (5). The management team of the home complete a weekly maintenance report and this is forwarded to the maintenance person/head office. The Annual Quality Assurance Assessment details under the heading of `what we do well`, “There is a planned maintenance programme for the home and repairs are completed in order of priority”. It also details there are regular health and safety meetings conducted. The purpose of the meetings, are to share practice and information, highlight areas of difficulty and limitations and to develop resources and policy. A fire plan and fire risk assessment for the home was readily available. Records for monthly fire checks and fire drills evidence these are conducted regularly. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 22 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, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from an effective staff team, however further development is required in relation to recruitment practices and procedures and ensuring that staff receive appropriate training to meet residents needs. EVIDENCE: The manager advised that staffing levels at the care home remain at 5 staff between 07.00 a.m. to 15.00 p.m., 2 staff between 09.00 a.m. to 14.00 p.m., 6 staff between 14.00 p.m. and 22.00 p.m. (includes 1 person designated as cook) and 1 waking night staff and 1 sleeping in person between 22.00 p.m. and 07.00 a.m. each day (Monday to Friday). The manager advised staffing levels during the day are reduced at weekends to 4 staff members between 07.00 a.m. and 22.00 p.m. as one resident goes home for the weekend. The manager advised that his hours are supernumerary Monday to Friday, however there are occasions whereby he will undertake additional shifts of an evening/weekend. The inspector was also advised that the deputy manager receives supernumerary days for administration two days per month. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 23 On inspection of four weeks staff rosters following the site visit, these evidence that staffing levels as detailed above have been maintained so as to ensure residents safety and wellbeing. We are aware that 3 residents at the home are funded on a 1-1 or 2-1 staff to resident ratio as a result of their complex care needs. The manager advised that the use of agency staff has reduced significantly since the last inspection and this was confirmed by staff, spoken with. At the time of the inspection there were no staff vacancies. There is a low turnover of staff and within the last 12 months only one member of staff has left the home’s employment. The staff team reflect the cultural and gender composition of people currently living at the care home. Relative surveys forwarded to us recorded, “ Agency staff are not used so much, the permanent staff are amazing” and “ They are very caring especially the established carers and managers”. The manager was advised to ensure that the full names of staff (agency staff) are recorded within the staff roster and a key explaining the codes used on the staff roster should be devised. A random sample of 4 staff files were examined including those for newly recruited staff. The majority of records as required by regulation were available, however some shortfalls were identified. Gaps were noted in relation to no written reference from the most recent employer for two people, full employment history not available for one person, no information available relating to one person’s immigration status, no health declaration for one person and no copy of a job description for one person. Staff profiles were evident for agency staff used at the home over a 4 week period, detailing that the external agency had undertaken all recruitment checks in line with regulatory requirements. It was positive to note that an in house and Skills for Care Induction was evident within each of the staff files examined. It was disappointing that there was no evidence of an induction having been undertaken for agency staff utilised at the care home. The manager was advised to ensure that a simplified induction is undertaken for agency staff and includes an information sheet detailing individual resident’s care needs. Staff surveys forwarded to us recorded that people were happy with their induction and felt that it covered everything they needed in order to do their job effectively. The staff training matrix evidences, 4 members of staff have attained NVQ Level 2, 2 staff members have attained NVQ Level 3 and currently 2 members of staff are undertaking NVQ Level 2 and 2 staff members are undertaking NVQ Level 3. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 24 Records of staff training were readily available and these verify that since the last key inspection some staff have received training relating to health and safety, food hygiene, epilepsy, communication, manual handling, infection control and fire safety. This is recognised as an improvement since the last key inspection, however care must be taken to ensure that newly employed staff who have no previous care work experience, receive more in depth training. This refers specifically to one person whose file indicated that the majority of their training had been delivered by watching a video/completing a questionnaire. This is seen as inadequate and potentially places both residents and the staff member at risk. The manager was advised to ensure that all staff receive, appropriate training associated with the needs of people who have a learning disability. The Annual Quality Assurance Assessment details under the heading of `what we do well`, “Skill scans are used to identify skill gaps for individual staff members and completed at the interview stage”. The document further states that these records are held at head office. This is disappointing, as this would have provided further evidence as part of the inspection process, as to the organisations training methodology and/or rationale for key decisions relating to the homes training schedule. The Annual Quality Assurance Assessment details under the heading of `Our plans for improvement in the next 12 months`, “Development of new training and development policy and development of home training plan and skill mix”. On inspection of the staff supervision tracker, this showed that staff, are receiving regular formal supervision and 7 members of staff have received their annual appraisal. Records of formal staff supervision sessions were documented and readily available. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 25 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, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at the home, benefit from a well run home. EVIDENCE: The manager has been employed at The Oakes since September 2007, but been employed with Kingswood Care Services Ltd since 2002. The manager has vast work experience within the care industry, working with children and adults who have a learning disability and who present a variety of challenges. The manager has achieved the Registered Manager’s Award, NVQ Level 4 in Care, NVQ Level 3 in Care and the A1 Assessor’s Award. Additionally the manager advised he has undertaken training relating to health and safety, food hygiene, first aid, epilepsy, communication, safeguarding, manual handling etc. Currently the manager is undertaking training relating to the Mental The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 26 Capacity Act with Essex County Council and in September 2008 is due to commence an 18 week management course (distance learning). The Annual Quality Assurance Assessment details under the heading of `what we do well`, “The manager receives training to keep himself up to date and this is supported by monthly manager’s meetings at head office where practice is shared. The manager has created a culture of learning and improvement within the home, and is open and transparent”. The manager advised that his ethos for the home is to be “captain of a happy ship”, to ensure that previous identified shortfalls are addressed, that residents’ independence is continually promoted and that the home provides a high quality service for its residents. The manager further stated that staff moral within the home has improved and although there is some negativity amongst some staff members, this is not stopping progress being achieved. Additionally staff, are working cohesively and as a team and the outcome is that residents’ challenging/inappropriate behaviours has decreased dramatically. The latter was evident from inspection of MAR records (usage of PRN/as and when required medication), from correspondence received from healthcare professionals (consultant psychiatrist) and from evidence of behaviour monitoring charts. Staff spoken with, were complimentary regarding the management of the home and there was evidence of good staff rapport. One staff survey recorded, “Every day the manager asks how I am getting on and gives me tips with working with the residents”. The manager reported that he feels supported by the organisation and attends regular monthly meetings. Another staff survey recorded, “There is good communication between staff and you are advised of any changes”. It also recorded, “I think it is a nice relaxed environment to work in and the staff are very welcoming. There are good staffing levels so you don’t feel that too much is put on you”. One staff survey recorded, “Since the new management has been put in place there have been many improvements and I feel that the staff are receiving very good support which has had a knock on effect on the service users. I think we as a service, manage behaviours well and with the added support of outside services such as psychiatrists and social workers, have managed to remain consistent in our approach to managing service users behaviours”. Relatives surveys forwarded to us recorded, “I like the atmosphere, the staff are friendly and are approachable. The home always looks clean and there is always plenty of food to eat” and “As far as I am aware the residents are well looked after, as regards to their hygiene and their meals. I have no problems at all, they are taken care of and I am quite happy when I visit” and “ I would like to say that over the last year [name of resident] has been more settled and as a relative if [name of resident] is happy, then so am I”. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 27 The manager is not yet formally registered with us. An application must be forwarded to us in due course so that the manager’s registration can be processed and completed. It is evident from this inspection that there has been significant progress to meeting previous identified shortfalls. The Annual Quality Assurance Assessment details under the heading of `how we have improved in the last 12 months`, “the main areas of improvement are, recruitment of staff, improved systems of record keeping, improved staff training and supervision, improved medication practice and monitoring, inclusive communication, development of the garden, redecoration, development of room for sensory activities, annual quality assurance audit and improved health and safety checks”. Areas, which continue to require further development relate to recruitment procedures and some aspects of staff training. All sections of the Annual Quality Assurance Assessment were completed. The manager and staff team demonstrate a level of self-awareness and recognises the areas that it still needs to improve upon. There was evidence of a Quality Assurance Audit in place and this was completed by the manager and the responsible individual during JanuaryFebruary 2008. The audit included the views of residents’ relatives, independent advocates and health and social care professionals. Additionally the responsible individual undertakes monthly Regulation 26 visits. There was evidence to indicate that regular staff meetings are undertaken and resident meetings are conducted monthly. The manager advised that there is an `open door` policy so as to discuss issues with relatives and other interested parties. A health and safety policy was observed within the home. Accident records were inspected and records were well maintained and included all necessary information. A random sample of safety and maintenance certificates showed that these had been serviced, and remain in date until their next examination. The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 28 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 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 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 2 X 3 3 3 X X 3 X The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 29 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 YA20 Regulation 13 (2) 12(1)(a) Requirement Ensure that where medications are combined and administered in food or in drink, appropriate consultation and advice has been sought and agreed by a pharmacist, so as to ensure that the properties of medication remain unchanged and remain effective for the individual person. Ensure that the care file clearly demonstrates that advice and agreement to administer medication in this way has been formally agreed. Ensure that robust recruitment procedures are adopted at all times for the safety and wellbeing of residents. Ensure that staff, receive appropriate training to the work they perform. This refers specifically to those conditions associated with the needs of people with a learning disability. This will ensure that staff, have the competence, confidence and ability to meet resident’s care needs. DS0000018125.V366263.R01.S.doc Timescale for action 24/06/08 2. YA34 19 23/06/08 3. YA35 18(1)(c) and (i) 01/09/08 The Oakes Version 5.2 Page 30 4. YA35 18(1)(c) and (i) Ensure that agency staff working at the care home receive an induction, that is appropriate to their role. This will ensure that staff have the competence, ability and confidence to meet individual resident’s care needs. 23/06/08 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. Refer to Standard YA17 YA20 Good Practice Recommendations Consider devising a pictorial menu so as to enable residents to make an informed choice. Consider as part of good practice procedures and in line with guidance highlighted by the Royal Pharmaceutical Society for the Handling of Medicines in Social Care, the keys for medication being separate to the main bunch of keys used at the care home. Staff who have received training relating to rectal diazepam should be deemed competent by the person who has trained them. 50 of care staff should be trained to NVQ level two or above. Staff who have no previous care work experience, should receive more in depth training that is not solely based on video teaching methodology. Consider devising resident information sheets for agency staff so that they have a basic understanding of individual people’s care needs and associated risk areas. 3. 4. 5. 6. YA20 YA32 YA35 YA35 The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 The Oakes DS0000018125.V366263.R01.S.doc Version 5.2 Page 32 - 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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