CARE HOME ADULTS 18-65
8 Piggy Lane Bicester Oxfordshire OX26 7HT Lead Inspector
Nancy Gates Announced Inspection 13th December 2005 09:30 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 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 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 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. 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 8 Piggy Lane Address Bicester Oxfordshire OX26 7HT 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) 01869 249533 Oxfordshire Learning Disability NHS Trust Ms Jacqueline Berry Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5), Physical disability (5), of places Physical disability over 65 years of age (5) 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 5 11th January 2005 Date of last inspection Brief Description of the Service: 8 Piggy Lane is a modern bungalow that is part of a purpose built complex situated close to local amenities in Bicester, North Oxfordshire. The home is registered for five people with learning and physical disabilities. A staff team employed by the Oxfordshire Learning Disability NHS Trust (OLDT) provides 24-hour support. 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 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. Four service users were in the home at the time of inspection. There were four staff members on duty inclusive of the registered manager and deputy manager. At handover six staff were available to support the people who use reside at the home. All staff and service users were welcoming, allowing for the atmosphere of the home to be relaxed. The inspector looked around all of the building, including service users’ bedrooms. A number of records were inspected including the personal records of service users. One of the five service users and two staff members were spoken with. Two visitors were available to speak to the inspector at the home. What the service does well: What has improved since the last inspection?
The requirements and recommendations made at the previous inspection have been actioned. The home has been redecorated in areas, which has allowed for improvement, but repair to walls where radiators have been removed is still needed. 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.
8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 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. 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 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 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 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 the following standard(s): No new admissions have been made to the home. The standards in this section have not been assessed on this occasion. EVIDENCE: 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 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 the following standard(s): 6, 7, & 9 Individual Essential Lifestyle Plans and personal information is written and maintained at a good standard. The plans clearly centre on preferences and wishes and are inclusive of the contribution of a number of people involved in the individual’s life. Reviews are conducted on a regular basis allowing for the support provided to be consistent, safe and relating to residents’ changing needs and wishes. EVIDENCE: The Essential Lifestyle Plans (ELPs) of all the people who live at the home were viewed by the inspector with their permission. The documents provide clear information as to how each person likes to be supported and it was clear that the individuals, their families and friends contributed throughout the whole process of writing the plan. The plans also relate to a person’s communication support needs, clearly identifying and guiding staff in the interpretation of sound and gesture. 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 Page 10 Clear description and recognition of who people are as individuals contributes to establishing trusting and supportive relationships. A section of each person’s plan provides details of how others perceive individuals - words used include ‘smiling eyes, loving, responsive, expressive, inquisitive, independent, sometimes attention seeking, inner strength, caring & polite, solitary, assertive’. The plans give opportunity for personal likes and wishes to be prioritised in order of individual personal preference, for example one plan stated “X likes reading books and doing jigsaws, ensure that they are in easy reach for X. Provide rubber mat for X to put her jigsaw on”. Another plan stated, “X’s bedroom must be uncluttered - as X moves around on the floor X could hurt herself if there is clutter on the floor”. Recognising this as a priority for the individual demonstrates clear thinking in relation to the individual’s health and safety needs as well as ensuring ease of movement around the home. The inspector observed that all staff members were following both of these plans. The ELPs included assessment of risk and actions to minimise risk. Individuals are supported to consider activities and lifestyle choices within a risk guidance framework that ensures their safety, whilst undertaking activities of their choice. The inspector acknowledges the commitment of staff to support all house members following the death of an individual. Changes in emotional and behavioural needs have been recognised and supported. 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 15 & 16 Service users are supported to make lifestyle choices which recognise individuality, and are enabled to take risks within these choices. Long-standing friendships are supported demonstrating respect. EVIDENCE: Essential Lifestyle Plans 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 clear 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. A number of people visited the home not knowing an inspection was in progress. Thoughts and opinion regarding the support provided was extremely positive. 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 Page 12 An individual was visited by a long-standing friend, a relationship that continues due to staff transporting the individuals to meet up. The inspector was invited to join the service users and staff for lunch. Service users were provided with a number of choices and supported appropriately. 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 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 the following standard(s): The standards in this section were not assessed on this occasion. EVIDENCE: 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 Page 14 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 the following standard(s): The standards in this section were not inspected on this occasion. EVIDENCE: 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 24, 25, 26, 27, 28, 29 & 30 A clean and comfortable environment is provided and service users’ bedrooms reflect individuality. The design and layout of the home, inclusive of numerous adaptations, meets the needs of the majority of individuals although the size and layout of two bedrooms may not meet service users’ assessed needs. The inefficient heating system presents health and safety issues for all household members and must be repaired. The removal of radiators has left unsightly damage to walls and these must be repaired and redecorated. 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.
8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 Page 16 The dining room has been converted to a sensory room providing a comfortable and relaxing space. The conversion has left a number of holes in the wall following the removal of radiators, leaving areas scruffy in appearance and these should be repaired and redecorated. All of the shared spaces within the home are accessible to service users for shared and private use. Service users’ bedrooms reflect individual tastes, containing personal effects that ensure that individuality is recognised. Bedrooms vary in size and layout. One of the larger bedrooms is vacant and has provided an opportunity for an individual to move from one of the smaller rooms. The floor covering in the vacant bedroom has been replaced but is clinical in appearance and does not present a homely/comfortable space. A seam within the flooring is not flat and, when used, may lift, become unsightly and presenting risk. An individual who requires clear floor space to mobilise uses the other small bedroom. The individual’s ELP details, ‘Unresolved issues: The size and suitability of X’s bedroom’. Staff members described how the individual will often obstruct the doorway by lying on the floor at the end of the bed. The room has limited space for manoeuvrability as there is limited space between the door and the end of the bed. This clearly raises issues of risk, as access to the bedroom in an emergency could be restricted. The room does not offer the individual the same amount of space afforded to other service users. Bathrooms contain appropriate equipment to support service users’ physical needs. The home was bright, clean and tidy, although in areas was chilly and in one bathroom the room felt very cold. A new heating system was installed in November 2004. A ‘Repairs Log’ details 14 occasions over a 12-month period where there was no heating, no hot water or a number of radiators not working. Maintenance and repair records indicate that engineers have fixed the problems but the frequency of faults suggests the need for further investigation into the efficiency of the new system. An individual’s ELP states, “X has poor circulation and needs to wear two pairs of socks and a thermal vest during the day and at night”. An inefficient heating system presents risks to the physical health needs and health and safety of not only the identified individual but of the remaining members of the household. 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Staff were attentive and respectfu,l 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 service users. Both staff members demonstrated a sound knowledge of the complex needs of service users. A diverse training programme offered by the Oxfordshire Learning Disability NHS Trust underpins their knowledge base. Staff confirmed that formal supervision is conducted on a regular basis, with guidance and support available from the deputy manager at all times. 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 Page 18 Recent changes in the number of hours required to support service users have raised concerns and anxiety for staff members, but this is not reflected in their approach to supporting people in the home. The staff demonstrated throughout the inspection a commitment to ensuring that service users’ wishes are respected and acted upon. The inspector’s request to look at 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 household members 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 are present on file at the proprietor’s area or regional office and are available for inspection at any time. 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 The inefficient heating system presents health and safety issues for all household members and must be repaired. EVIDENCE: A new heating system was installed in November 2004. A ‘Repairs Log’ details 14 occasions over a 12-month period where there was no heating, no hot water or a number of radiators not working. Maintenance and repair records indicate that engineers have fixed the problems but the frequency of faults suggests the need for further investigation into the efficiency of the new system. An individual’s ELP states, “X has poor circulation and needs to wear two pairs of socks and a thermal vest during the day and at night.” An inefficient heating system presents risks to the physical health needs and health and safety of not only the identified individual but of the remaining members of the household. 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 Page 20 The inspector acknowledges that the deputy manager made a request for repair within the inspection. 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 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 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 2 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 1 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
8 Piggy Lane Score X X X x Standard No 37 38 39 40 41 42 43 Score X X X X X 1 x DS0000013125.V258493.R01.S.doc Version 5.0 Page 22 Yes 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 YA34 Regulation 19 (1)(b), (c) Requirement The registered manager must keep in the home and available at all times for inspection under Regulation 19 of the Care Homes Regulations 2001 and the Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004 Substituted Schedule 2 the following in respect of the Substituted Schedule 2 and Schedule 4, Paragraph 6 information: A checklist signed by the registered manager that must be attached to each staff file in the home which confirms that required documentation is present on file on the proprietor’s area or regional office and is available for inspection at any time. The registered manager must provide an action plan to outline a schedule of repair and redecoration of the home for sites where radiators have been removed. Timescale for action 28/02/06 2 YA24 23 (2)(d) 28/02/06 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 Page 23 3 YA42 23 (2)(p) The registered manager must ensure that the heating and hot water system is repaired and working at all times. 31/01/06 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 YA25 Good Practice Recommendations The manager should monitor the restrictions for an individual who is currently using the smallest bedroom in the home and assess whether the size of the room meets the individual’s needs. 8 Piggy Lane DS0000013125.V258493.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, 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
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