Inspection on 02/11/06 for Coppice and Oakside

This inspection was carried out on 2nd November 2006.

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

Coppice and Oakside 30/10/08

Coppice and Oakside 07/11/05

Coppice and Oakside 20/04/05

Coppice and Oakside 28/09/04

Coppice and Oakside 21/04/04

Coppice and Oakside 13/11/02

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Coppice and Oakside Shipley Common Lane Off Heanor Road Ilkeston Derbyshire DE7 8TS Lead Inspector Tony Barker Unannounced Inspection 2nd November 2006 09:25 Coppice and Oakside DS0000019965.V315845.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 Coppice and Oakside DS0000019965.V315845.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. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coppice and Oakside Address Shipley Common Lane Off Heanor Road Ilkeston Derbyshire DE7 8TS (0115) 9329603 01159443690 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) United Health Limited Marilyn Jean Atkin Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two Units - one manager Oakside - be occuppied by a maximum of 4 service users Coppice - be occuppied by a maximum of 6 service users 7th November 2005 Date of last inspection Brief Description of the Service: Coppice and Oakside is a purpose built Home offering 10 places for adults with a severe learning disability, set in 2 bungalows linked at the rear through the enclosed garden areas. The physical environment of the Home was designed to a high standard and is spacious. The majority of the current resident group were admitted as part of the closure of Aston Hall Hospital, near Derby, and all had spent long periods living in an institutional environment. The range of abilities demonstrated by the 2 groups of service users is quite different, with the 4 service users in Oakside being more independent and having higher communication and self-help skills. Because of their levels of disability, the Home provides service users with an intensive package of support on a 24 hour basis and staffing levels are accordingly high. The fees currently range from £850 to £900 per week. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) is trying to improve the way inspectors engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are currently testing a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes people whose knowledge about social care services comes directly from using them. The time spent on this inspection was 8.25 hours and was a key unannounced inspection. The ‘expert by experience’, and his support worker, were introduced to staff and service users at the start of their visit and a brief introduction to the Home was given to them. At the end of their visit there was a de-briefing. The Manager, one social care worker and four service users were spoken to and records were inspected. There was also a tour of the premises. Two service users were case tracked so as to determine the quality of service from their perspective. Service user’s verbal skills were limited but those at Oakside were able to express their views to the ‘expert by experience’. This inspection focussed on all the key standards and on the progress made towards achieving the requirements and recommendations made at the last inspection. The pre-inspection questionnaire was reviewed prior to this inspection. What the service does well: Service users had their needs assessed before admission to the Home so that staff could provide individually tailored care. Their needs and personal goals were reflected in a good range of written care plans and risk assessments. They were enabled and supported to make choices and take responsible risks in order to increase their independence. Service users were involved in fulfilling and age-appropriate social and leisure activities within the Home and in the local community. They were able to maintain appropriate family relationships and were provided with a healthy diet. Daily routines reflected their individual choice and promoted independence. Service users were receiving personal support in the way they preferred and required. Their health needs were being well met in an individualised way. They were benefiting from the Home’s complaints policy and procedures and were being protected from abuse. Service users were living in a homely, comfortable, safe and clean environment that was furnished and maintained to a high standard. They were being supported by a well-trained staff group and protected by the Home’s recruitment procedures. They were benefiting from a well run home with a good management approach. Service users’ health and safety was being fully promoted. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 6 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. Coppice and Oakside DS0000019965.V315845.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 Coppice and Oakside DS0000019965.V315845.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users had their needs assessed before admission to the Home so that staff could provide individually tailored care. EVIDENCE: All the service users had lived in this Home for several years. A full assessment of the service users’ needs was made prior to their admission, as confirmed by detailed examination of care records at a previous inspection. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs and personal goals were reflected in a good range of written care plans and risk assessments. They were enabled and supported to make choices and take responsible risks in order to increase their independence. EVIDENCE: The care plan files of both case tracked service users were examined. They contained numerous care plans and risk assessments that were comprehensive and covered a very wide range of day-to-day activities. Service users’ abilities were recorded as well as their likes and dislikes. These documents were a valuable guide to staff. The care plans had all been updated in September 2006 and the ‘Evaluation of Care Plan’ sheets indicated that review of these plans was being undertaken on a regular basis. However, there were some anomalies between the headings on the evaluation sheets and the actual care plans. This was pointed out to the Manager. The ‘expert by experience’ recommended that each service user have a ‘person centred plan’ describing the person, what they like and what they want. This could be a book or a box containing easy words, pictures and objects and kept by the individual service Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 10 user to show other people. The aim would be to “help people be more in control”, the ‘expert by experience’ said. The ‘expert by experience’ found, from his discussions with service users, several examples of them making choices and decisions on a regular basis. For example, one service user had chosen the times of day to smoke in the conservatory at Oakside. Another service user had indicated a dislike of wearing socks, by ‘signing’ to staff, and others regularly took staff by the arm to lead them to where they want to go. The Manager said that “choice is a big thing here”. The ‘expert by experience’ suggested to staff that they could make choices easier for service users by using pictures and photographs of objects and places, kept in a book or folder specifically created for this purpose – for instance as a means of indicating food choices. He was pleased that staff were open to this idea. There was a good range of risk assessments, showing that the Home was aware of potential risks to which the service users were exposed and indicating ways of managing these risks. For example, the challenging behaviour displayed by one service user had resulted in emergency procedures being written to address these in future as well as in a number of environmental measures being taken to improve security for service users and staff. These risk assessments had all been recorded, or reviewed, within the previous 12 months and so were up to date. The social care worker spoken to gave examples of service users taking responsible risks in order to increase their independence. For instance, one service user with poor mobility will go to the toilet with staff following rather than staff taking. The ‘expert by experience’ also noted that service users were allowed to take risks and gave an example of one service user, in the past, being provided with ‘private time’ with a friend of the opposite sex. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were involved in fulfilling and age-appropriate social and leisure activities within the Home and in the local community. They were able to maintain appropriate family relationships and were provided with a healthy diet. Daily routines reflected their individual choice and promoted independence. EVIDENCE: All service users were being provided with a personal one-to-one day with a member of care staff each week. One service user was daily attending a day centre. The social care worker considered that service users were involved in activities that they valued and found fulfilling. For example, the service user who attends a day centre “always chats” about what they have done and another service user will say “Record” on rising in the morning to indicate a wish to hear music and then sings along with the music. Two service users’ Activities Diaries and a Weekly Activities sheet for The Coppice were examined. These indicated that service users were being provided with a good range of activities to stimulate them. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 12 A pair of days each week had been designated for days out of the Home, the Manager said. The ‘expert by experience’ was pleased to note that the Home had its own minibus used to take service users on trips out. He also found out that service users know people in the local community and, as an example, said that one service user had pointed to the house over the road saying, “she’s my friend over there”. Examples of facilities accessed in the wider community, given by the Manager in the pre-inspection questionnaire, included shops, pubs, restaurants, the theatre, garden centres and the zoo. The ‘expert by experience’ found that service users could go out at weekends to where they wanted to go. The ‘expert by experience’ noted that service users have good holidays with staff, both as a group and individually. He also said that service users do “fun things” such as knitting, colouring and jigsaws – adding that they have chosen to attend social clubs as well as chosen to stop attending. Some service users had regular contact with their relatives, others had few if any relatives who maintained contact. The ‘expert by experience’ was told by staff that they “send photographs home to families” to show how happy service users are. He also found that relatives visit the Home, saying that one service user had said, “I phone Mum, and Daddy’s coming soon”. However, he felt that a spare fold-up bed should be obtained so that people could ‘stay over’ where, currently, they couldn’t. The Manager spoke of one service user who had no family contacts and described how special attention was given to this service user at Christmas when other service users, in that house, went to spend time with relatives. Also, staff buy this service user Christmas and birthday presents to compensate for lack of family. The social care worker who was spoken to provided examples of the Home promoting the independence of service users at Oakside through everyday routines such as meal preparation and clearing up afterwards and in mopping floors. She said that, “routines make people feel secure”. One service user from each bungalow goes out food shopping with staff each Thursday, she added. The ‘expert by experience’, and his support worker, were offered lunch at Oakside and he said, “the food was good”. He noted that service users could choose what food they liked and that alternatives were offered. Menus were examined and these indicated that service users were being provided with a balanced and nutritious diet. Food-stock levels were satisfactory and good practice was being followed by recording details of food actually eaten by service users in case of any outbreak of food poisoning. Tea-time at Oakside was observed to be a relaxed occasion with staff eating with service users. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were receiving personal support in the way they preferred and required. Their health needs were being well met in an individualised way and they were generally being protected by the Home’s procedures for dealing with medicines. EVIDENCE: The social care worker spoke of service users making their own choices of when to rise each morning, saying that these times range from 5/6am to 10/12am – the latter times relating to two service users, one of whom has breakfast in their room. This supported the Manager’s statement, on the preinspection questionnaire, that breakfast was provided from 6am to noon. The ‘expert by experience’ noted that service users could “stop up late”. He observed staff spending “lots of time” with service users and felt that staff “care about them” – giving an example of staff responding to an upset service user at The Coppice by putting on a favourite DVD for the service user to sing to. One of the care plans of one case tracked service user, that related to elements of personal hygiene, explicitly mentioned the need to maintain the service user’s privacy and dignity. There was a notice in the laundry room requesting staff to respect service users’ clothing. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 14 One case tracked service user had a useful written ‘Assessment of Medical Health Needs’ that recorded risks, abilities and support needs. On this same file were records of medical appointments with a separate sheet for each health professional including notes relating to the appointment. There was much evidence of this service user’s health being screened and monitored with good use being made of external health professionals. The other case tracked service user’s file included a ‘Waterlow’ assessment of the service user’s tissue viability, as well as body maps showing sores and scratches, as part of monitoring the risk of pressure sores. An extensive list of health appointments, since January 2006, was seen on another service user’s file. The Manager referred to staff staying with one service user while in hospital, including over-night stays. Prescribed medication for service users was securely stored. The recording of this medication was examined and found to be satisfactory except that there was one hand written entry, for antibiotics, that had not been signed or dated. A sheet of staff names, signatures and initials was in place in order that any uncertain entries on MAR sheets could be cross-referenced. There was evidence of service users’ medication being reviewed by relevant doctors. The Manager stated that all staff had been provided with an assessed in-house medication training course and some had undertaken an additional 13-week distance learning course. Good practice was being followed regarding the use and recording of ‘prn’ (as and when required) medication. No controlled drugs were being used. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were benefiting from the Home’s complaints policy and procedures and were being protected from abuse. EVIDENCE: A complaints procedure was in place and completed complaints forms were examined in respect of two formal complaints received during the previous 12 months. These had both been made by the parents of one service user and had been appropriately dealt with. A hard-back book, recording some contentious issues raised by these parents to staff, was examined and considered by the Inspector to be good practice. The ‘expert by experience’ commented that, “If I had a problem with the Home I wouldn’t be able to speak to someone from outside the Home about it” and suggested having an independent advocate in regularly. “Maybe in a residents meeting”, he said. The Manager knew how to contact advocates for service users and had done this in the past. The ‘expert by experience’ gave her two additional contact details. Policies and procedures regarding ‘safeguarding adults’ and ‘whistle blowing’ were in place. The social care worker who was spoken to said that these policies are regularly discussed at staff meetings and she fully understands them. She said she had been provided with training on matters relating to adult abuse and the Manager confirmed that all staff had received this inhouse training. A record of this training in August 2006 was examined. There had been one referral to the Social Services Department, within the previous 12 months, regarding a ‘safeguarding adults’ incident. This had been in respect of abusive behaviour from one service user to others and had been Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 16 appropriately managed. One of the case tracked service users needed to be restrained while attending health appointments with the chiropodist, dentist and GP. This was necessary and appropriately carried out. There had been four such restraint occasions within the previous 12 months and recording of these was satisfactory. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 17 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 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users were living in a homely, comfortable and safe environment that was furnished and maintained to a high standard. It was clean and hygienic. EVIDENCE: The premises were attractive, well furnished and well maintained. Walls were decorated with mirrors and pictures, giving a homely appearance. Bedrooms were attractively decorated and well personalised. The ‘expert by experience’ thought that the layout of rooms was good and particularly liked the ‘friendship tree’ on a wall in The Coppice and the displayed photographs of service users there. He also liked the recently converted sensory room, used by service users for relaxation. The Manager spoke of areas having been re-decorated and plans for further decoration and new carpets throughout the Home. She also listed a range of equipment purchased for service users since the previous inspection. The standard of the Home’s environment and of maintenance was commendable. Everywhere in the Home was clean and without any offensive smells. The laundry room in The Coppice had a washing machine, dryer and sluicing sink. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 18 The Manager confirmed similar facilities at Oakside. The social care worker who was spoken to described good practice regarding the transportation of soiled materials such as wet bedding. The Home’s Infection Control policy was seen to be satisfactory. There was recorded evidence of staff having completed Infection Control training over the months of June and July 2006. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 19 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): 32,34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were being supported by a well-trained staff group and protected by the Home’s recruitment procedures. EVIDENCE: 50 of the care staff had achieved a National Vocational Qualification (NVQ) to level 2 or above. This met the National Minimum Standard to maintain a staff group with at least 50 qualified staff. Staffing levels were not checked at this inspection but have been in excess of the required standard at previous inspections. The Manager said that staffing levels have remained constant and that staff turnover has decreased, leading to a currently stable staff group. The ‘expert by experience’ commented that, “there were lots of staff” and “everyone got attention”. The file of a member of care staff appointed in December 2005 was examined. It was found to contain all of the elements, required by current Regulations, regarding staff recruitment practices. The ‘expert by experience’ felt that service users should become involved in the recruitment and interviewing of staff. This would further improve service users’ feeling of self-worth and involve them in making decisions that would effect them every day. However, Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 20 the ‘expert by experience’ also noted that one service user had felt part of a decision to dismiss a previous member of staff following incidents of abusive behaviour. There was evidence of the staff member appointed in December 2005 being provided with induction training to Skills for Care Common Induction Standards. Her training booklet had been appropriately completed, signed and dated. The social care worker confirmed that her induction was valuable and was spread over several weeks from her appointment in September 2005. She spoke of having regular training and training records confirmed the Manager’s statement that all staff had been provided with all mandatory training. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 21 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 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were benefiting from a well run home with a good management approach. Their health and safety was being fully promoted. They were benefiting from the Home’s quality assurance system, although this could improved. EVIDENCE: The Manager had submitted her material for the Registered Manager’s Award, at National Vocational Qualification (NVQ) level 4, in October 2006 and was awaiting verification of achieving this. She had worked with people with learning disabilities for 8 years. The social care worker said the best thing about this Home was the job satisfaction it gave her and the “friendly and helpful staff”. She spoke of there being “good teamwork” and of “everyone working for the welfare of service users”. The ‘expert by experience’ also spoke of staff being “really friendly” and added that “we were looked after well, with tea and food”. He stated that Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 22 the Manager “came across very well”, particularly in relation to promoting independence and choices for service users. The Manager was directly observed showing insight and empathy with service users. There was evidence of monthly independent audit visits to the Home on behalf of the Registered Provider, as required by Regulation 26, having been undertaken in 2006. A ‘Six Point Plan for Service Development’, from the year starting July 2006, was examined. This was well worded, although it had no action dates to check progress. Quality assurance questionnaires, to assess opinions on the quality of service provided by the Home, were completed by relatives in 2004. The Manager was recommended to widen surveys to include service users, using independent advocates, staff and external professionals, as well as relatives. The ‘expert by experience’ recommended that service users should “get together once a month to talk about house stuff...without the staff...(giving them) more control and choices”. This recommendation links with an earlier one relating to the involvement of an independent advocate. The Manager said that there were informal group discussions with service users around quality of life issues, including what things they wanted to do and whether they were happy living in the Home. Good food hygiene practices, and safe storage of cleaning materials, were observed. The Manager said there were written risk assessments for the Home’s environment. Weekly fire alarm tests were recorded as well as regular fire drills being held. Gas appliances were being serviced. All other equipment maintenance and service checks were up to date and there were no Health and Safety problems. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 23 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 X 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 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. Refer to Standard YA6 YA6 YA7 YA15 YA20 YA23 YA34 YA39 YA39 Good Practice Recommendations The headings on the care plan evaluation sheets should correspond with the actual plans of care. Each service user should have a ‘person centred plan’ as described in this report. A book or folder of pictures and photographs, specifically created for this purpose, would make choices easier for service users. The purchase of a spare ‘fold-up bed’ should be considered so that friends or relatives can ‘stay over’. All hand written entries, on medicine records, should be signed, countersigned and dated. The involvement of an independent advocate at regular service users’ meetings should be considered. Service users should become involved in the recruitment and interviewing of new staff. The Home’s ‘Six Point Plan for Service Development’ should include action dates in order to check progress. Quality assurance surveys should include service users, DS0000019965.V315845.R01.S.doc Version 5.2 Page 25 Coppice and Oakside using independent advocates, staff, relatives and external professionals. Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Coppice and Oakside DS0000019965.V315845.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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