Inspection on 04/08/05 for 4 Piggy Lane

This inspection was carried out on 4th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

4 Piggy Lane 05/10/06

4 Piggy Lane 01/02/06

4 Piggy Lane 06/01/05

4 Piggy Lane 01/10/04

4 Piggy Lane 23/03/04

4 Piggy Lane 18/12/03

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Treloar College

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 4 Piggy Lane 4 Piggy Lane Bicester Oxon OX26 7HT Lead Inspector Nancy Gates Announced 04 August 2005 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 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 Stationary 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. 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 4 Piggy Lane Address 4 Piggy Lane, Bicester, Oxon, OX26 7HT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01869 249533 Oxfordshire Learning Disability NHS Trust Pearl Whiteley Care Home 5 Category(ies) of LD; PD; LD(E); PD(E) registration, with number of places 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The total number of persons that may be accommodated at any one time must not exceed 5 Date of last inspection 06 January 2005 Brief Description of the Service: 4 Piggy Lane is a large purpose built modern bungalow and is part of a complex of houses supporting adults with learning disabilities. The home is situated in the North Oxfordshire town of Bicester and is close to local shops and services. Five adults with complex needs are supported by a large staff team employed by Oxfordshire Learning Disability NHS Trust. Support is provided on a 24 hour basis. 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector was in the home from 10.30am until 4.00pm on a weekday. All five residents were in the home at the time of inspection. There were three staff members on duty exclusive of the manager. At handover six staff were available to support the people who reside at the home. All staff and service users were welcoming, allowing for the atmosphere of the home to be warming and relaxed. The inspector looked around all of the building, including service users’ bedrooms upon their invitation. A number of records were inspected including the personal records of service users. Two of the five service users and two staff members were spoken with. No visitors were available to speak to the inspector at the home, although a telephone conversation with one service user’s relative took place. What the service does well: What has improved since the last inspection? Regular unannounced visits are now being made to the home by a representative of the housing and support provider with a copy of the visit report provided to the Commission for Social Care Inspection. 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 6 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. 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The standards in this section were not inspected on this occasion. EVIDENCE: 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 and 9 Individual Essential Lifestyle Plans and personal information for service users is written and maintained at a good standard. The plans clearly centre around service users’ preferences and wishes and are inclusive of the contribution of individual’s families. Reviews are conducted on a regular basis allowing for the support provided being consistent, safe and relating to residents’ changing needs and wishes. EVIDENCE: The Essential Lifestyle Plans (ELPs) of two service users were viewed by the inspector with the individual’s permission. The documents provide clear information as to how each person likes to be supported. It was clear that the individuals, their families and friends contributed throughout the whole process of writing the plan. The plans also relate to the person’s communication support needs, clearly identifying and guiding staff in the interpretation of sound and gesture. The plans give opportunity for personal likes and wishes to be prioritised in order of individual personal preference, for example one plan stated “I must have a good supply of glossy books. I prefer large catalogue-type books – catalogues with pictures - and pens provided to draw on the catalogues”. 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 10 Another plan stated, “I must sit in a bright space that is not too cold. When I am at home I like to be sat in my Kirton Comfort chair”. The inspector observed that both of these plans were being followed in practice by all staff members. The ELPs included assessment of risk and actions to minimise risk. Service users clearly have opportunity to consider activities and lifestyle choices within a risk guidance framework that ensures their safety, whilst undertaking activities of their choice. 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, 16 and 17. Service users are supported to make lifestyle choices which recognise individuality, and are enabled to take risks within these choices. A healthy, balanced and varied diet is provided to all service users. A knowledgeable staff team supports specialist dietary needs, although 1:1 interaction and hygiene standards are not fully maintained at all times. EVIDENCE: Essential Lifestyle Plans are also used as a document to describe preferences, likes, dislikes and favourite lifestyle activities. The often complex needs of all service users can be seen to hinder choice, but the staff and manager have made a strong commitment to ensuring that service users are able to fulfil their wishes as far as practically possible, and at times being supported/given the opportunity to take risks. The inspector observed one person being escorted to town to have a haircut. The impromptu decision to have a haircut was taken by the service user and the staff were happy to escort him to the hairdressers. On return the service user explained that they had been for coffee and bought bread for lunch. This 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 12 demonstrated respect and commitment to ensuring that service user’ wishes are acted upon and supported. Discussion with a service user’s family member provided a clear picture of a welcoming and relaxed home. They described how family members are included in decisions and are always kept informed of any changes or events in the home. Staff were described as respectful and helpful, always appearing to want the best for the service users. The inspector was invited to join the service users and staff for lunch. Service users were provided with a choice of two types of sandwich. One service user had a pasta dish as an alternative. Observation by the inspector raised a concern that positive interaction with this service user was not taking place as staff were engaged in conversation with each other rather than providing one-to-one interaction with the individual. Observation of menus showed that a healthy, balanced and varied diet was being provided to the service users. 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Service users’ personal and healthcare needs are appropriately supported except for one example as described in the evidence section. Needs and wishes are respected. Changes in health status are recognised and acted upon appropriately. Access to additional support from healthcare professionals is consistent and meets service users’ health needs. Medication is stored securely and administration is accurate, ensuring service users’ safety. EVIDENCE: Essential Lifestyle Plans again describe personal support needs. The information provides clear guidance as to how to support the often complex needs of the individuals at the home. Emotional needs are also recognised, including the thoughts and wishes of the service users and their families. This view is supported by the discussion with one service user’s family member who stated that the staff were “Competent and have a great deal of knowledge”. 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 14 One service user requires the use of a feeding tube to maintain a good nutritional status. Observation of one staff member’s interaction demonstrated a sound knowledge of how to support the individual in the use of the feeding system. Support provided by a different staff member raised concerns as to the maintenance of hygiene, as the inspector was unable to observe this staff member washing their hands before contact with the individual. It was also noted that gloves were not used. Whilst the protocol and guidance within the home did not stipulate the use of gloves, good practice would suggest that the highest level of hygiene should be maintained to ensure the continued health and well being of the individual. Interaction with the service user whilst the health care tasks were being performed by the second member of staff was, at times, non inclusive. Communication was not undertaken with the individual as the tasks were taking place. The manager stated to the inspector that the staff member was reasonably new and was developing skills of communicating with the individual. The health and welfare of service users is a recognised priority for the staff group. The inspector observed the immediate and appropriate response of the manager to contact an individual’s GP on hearing a change in health status, subsequently resulting in the prevention of a serious infection. The attending GP and a district nurse who visited during the inspection described that the home provide a high standard of care, “They’re excellent, especially the manager who is on the ball. She will contact the surgery, the district nurses and the GP’s immediately she notices a problem”. Demonstration of this commitment was also evident in the care and support of a service user during a recent hospital admission. The manager organised additional staff to be present at the hospital to ensure that the individual’s needs could be met, also ensuring that the discharge and subsequent care would be as consistent as possible. The medication administration system of a well-known chemist is used at the home. Medication is received within blister packs. The packs are labelled, relating to an individual, the medication required and the times of administration. Medication was observed to be stored appropriately in a locked cabinet and at the correct temperature. Computer generated Medication Administration Records (MAR) are provided for all medication received at the home. No omissions within the documentation were seen. Copies of the completed MARs are retained at the home for future reference if required. 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The standards in this section were not inspected on this occasion. EVIDENCE: 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27, 28, 29 and 30 A clean and comfortable environment is provided with service users’ bedrooms reflecting individuality. The design and layout of the home is inclusive of numerous adaptations that meet service users’ assessed needs. Staff need to be more aware of safety issues relating to the safe storage of cigarettes and lighters. EVIDENCE: The home is part of a purpose-built complex close to local facilities. Another care home, a supported living service and office accommodation are situated in this complex. The home is a large bungalow, therefore all areas are wheelchair accessible. Numerous adaptations, specifically relating to service user need, have been installed and are regularly maintained. Service users’ bedrooms reflect individual tastes, containing personal effects that ensure that individuality is recognised. 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 17 The bathrooms contain appropriate equipment to support service users’ physical needs. A toilet has been specifically identified for use by one individual relating to assessed needs. The home was bright, clean and tidy. The inspector observed a packet of cigarettes and a lighter on a shelf in the lounge. The manager explained that a member of staff had left them from the previous shift and that staff should be fully aware of the implications of leaving lighters unattended. The manager assured the inspector that the staff member would be reminded of the health and safety implications involved. 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 35, and 36. Staff on duty were attentive and respectful, promoting communication and independence in relation to need. Training provided to staff ensures that they are competent and qualified to meet service users’ needs. Supervision is provided on a regular basis. Staff recruitment records were not available for inspection, therefore the protection of service users could not be guaranteed. EVIDENCE: The inspector had the opportunity to speak with two members of staff to explore their knowledge of supporting the service users in the home. Both staff members demonstrated a sound knowledge of the complex needs of the service users. A diverse training programme offered by the Oxfordshire Learning Disability NHS Trust underpins their knowledge base. Training is also provided by the district nursing team, specifically relating to the complex health needs of a number of service users. Competency is assessed and recorded within training records. 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 19 Staff confirmed that formal supervision is conducted on a regular basis, with guidance and support available from the manager at all times. The staff demonstrated throughout the inspection a commitment to ensuring that service users’ wishes are respected and acted upon. The inspector’s request to observe staffing records was unable to be granted due to all staff records being held at the OLDT human resources department in central Oxford. The manager was unable to demonstrate that recruitment checks for the protection of service users had been undertaken, although stated that the HR department provides verbal confirmation of the receipt of references and a satisfactory Criminal Records Bureau check. The inspector acknowledges that the HR department is willing for records to be viewed at their department but this clearly does not meet the requirements of the Care Home’s Regulations. A checklist, signed by the registered manager, must be held within a staff file in the home, which confirms that all required documents not kept in the home are present on file at the proprietor’s area or regional office and are available for inspection at any time. 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The standards in this section were not inspected on this occasion. EVIDENCE: 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 4 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 x 1 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 4 Piggy Lane Score 2 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 22 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 34 Regulation 19(1)(b), (c) Requirement The registered manager must keep in the care home and available at all times for the inspection information under Regulation 17 of the Care Home regulations 2001 and The Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004 Substituted Schedule 2. The Commission is prepared to accept the following in respect of the Substituted Schedule 2 and Schedule 4, Paragraph 6 information: A checklist signed by the registered manager must be attached to each staff file in the home, which confirms that every required document not kept in the home is present on file at the proprietor’s area or regional office and is available for inspection at any time. Timescale for action 30.09.05 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 18 Good Practice Recommendations All personal care tasks undertaken should be through direct interaction with servcie users. Staff should ensure that hygiene is maintained when supporting individuals health needs. The personal possessions of staff members should be stored safely. 2. 42 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Burgner House, Cascade Way Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: 0845 015 0120 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 4 Piggy Lane H57-H08 S13123 4 Piggy Lane V231567 040805 Stage 4.doc Version 1.40 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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