CARE HOME ADULTS 18-65
Glenholme Oakdene Psychiatric Residential Care Home 30-32 Woodside Park Road North Finchley London N12 8RP Lead Inspector
Daniel Lim Key Unannounced Inspection 20th November 2007 09:00
Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.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 Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.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. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Glenholme Oakdene Psychiatric Residential Care Home 30-32 Woodside Park Road North Finchley London N12 8RP 020 8446 3401 020 8492 0530 glenholme.oakdene@zen.co.uk Address 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) Mr George Pirrie Macalister Mrs Elaine Alice Macalister Mr Andrew Kenneth Knight Care Home 18 Category(ies) of Learning disability (18), Mental disorder, registration, with number excluding learning disability or dementia (18) of places Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st July 2007 Brief Description of the Service: Glenholme/Oakdene is private care home that is part of the Woodbury Group. The company also runs other care homes and supported living homes. The home is registered to provide personal care for a maximum of eighteen younger adults of either gender, who have mental health needs. The home’s stated aim is to enable service users to gain sufficient life skills and confidence so that they are able to eventually move into semi-independent or independent living accommodation. To achieve the above, the home aims to support and empower residents to make their own decisions and take responsibility for their own actions within a homely environment. Part of the life skills development is centred on residents using local amenities, with support if required, in order to develop contact and equip residents to live within the community. The premises consist of two houses which have been converted and joined together, with interconnecting doors and halls. Each of the two houses have a lounge, dining room, communal bathrooms and kitchen. All residents have their own individual bedroom. Two residents are accommodated in bedsits. The home is located within a short walk of Woodside Park underground station, bus routes, North Finchley High Road and Tally Ho Corner and local shops and supermarkets. The weekly fees for residents living in the home range from £925 - £1,050. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out on 20 November 2007 and took a total of five and a half hours to complete. During this inspection, the inspectors, Daniel Lim & Tom McKervey were assisted by the registered manager, Mr Andrew Knight and one of the two registered providers, Mr George Macalister. The inspector was able to interview a total of eight residents. The feedback received from them was mixed and indicated that although some were satisfied with the care provided, others were not. Feedback was also received from questionnaires received from two healthcare and social services staff and eighteen residents. These indicated that the respondents were generally satisfied with the care provided. Specific issues raised in interviews and questionnaires are detailed in the body of this report. Statutory records were examined. These included four residents’ case records, the maintenance records, accident & incident records, complaints’ records and fire records of the home. These were well maintained. The premises including residents’ bedrooms, communal bathrooms, laundry, kitchen, gardens and communal areas were inspected. The home was comfortable and adequately equipped. Three staff on duty were interviewed on a range of topics associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. Staff records, including evidence of CRB disclosures, references, supervision and training records were examined. It was noted that essential training had been provided. In addition, the minutes of residents’ and staff meetings were examined. These indicated that residents and staff had been consulted and informed of changes affecting the running of the home. What the service does well:
The feedback received in completed questionnaires from residents, were on the whole, positive and indicated that residents were generally satisfied with the care provided. Several residents indicated that they were well cared for and staff had treated them with respect and dignity. Residents were noted to be able to go out freely and they had been encouraged to be as independent as possible.
Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 6 The manager stated that the home had been able to care effectively for residents and prevent serious injuries or incidents of self-harm occurring amongst residents. This he said was due to staff being experienced in identifying times when residents are relapsing and providing prompt intervention. The forms for pre-admission assessments and care planning were of a good quality and the care plans examined had been carefully prepared. The home had a large garden and seating had been provided for residents. The required safety inspections of the home had been carried out. New staff had been recruited in accordance with the required procedures. The registered provider had co-operated fully with adult protection investigations carried out by Social Services and complaints made had been promptly responded to. What has improved since the last inspection?
Improvements had been made in the area of health & safety. The registered person had ensured that the fire alarm is tested weekly and this was documented. The two fire extinguishers which had not been serviced within the past twelve months had been serviced. Window restrictors had been fitted to and engaged in some bedrooms. Security arrangements for the home had been reviewed. Improvements had been made in the staffing arrangements. The home had a minimum of two care staff on duty during the night shift. Arrangements had been made for all staff to be provided with updates in their training on the care of residents with challenging behaviour and new staff had been provided with adult protection training. Improvements had been made in the care of residents. The registered person had ensured that residents, or their representatives have been consulted regarding their care plans. This was evidenced in the form of signed care plans. Residents or their representatives had been consulted regarding their involvement in cleaning chores and agree to this involvement. This was evidenced in the form of signed care plans. Residents’ consultation meetings / forums had been held at least once every two weeks and the minutes of these meetings were available for inspection. During these meetings residents had been consulted regarding the meals to be provided. In addition, the registered provider agreed to encourage staff to attend nutrition training provided by the local mental health team / learning
Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 7 disabilities team. A nutrition / weight reduction care plan had been prepared for a resident who needed it. This included a weight monitoring chart. A risk assessment regarding the sexual vulnerability of a resident had been carried out. This risk assessment included a strategy for minimising risks identified. The provision of social and therapeutic activities with residents had been reviewed and a more varied programme of activities had been organised. The door bell was answered promptly and residents have access to their visitors. Any limitations / restriction on visitors had been documented in the care plans and agreed with residents concerned. Improvements had been made in adult protection. The registered persons had made effort to ensure that residents are protected from abuse and their complaints are promptly responded to. Complaints received were recorded in the complaints book. The registered provider had promptly reported the allegations of abuse to social services. In addition, the home’s adult protection procedure had been updated. Improvements had been made in the management of the home. The registered provider had provided CSCI with a plan aimed at assisting the registered manager to improve his management skills. Residents had the opportunity to sign (to indicate approval) when money is withdrawn from their accounts. Such arrangement had been documented in the financial care plans of the residents concerned and agreed with them. Residents’ representatives and Social Services had been made aware of these arrangements. There is a comprehensive policy and procedure for the management of residents’ finances. Effective quality assurance and monitoring systems in accordance with Standard 39, NMS had been put in place. What they could do better:
Improvements are required in the area of health & safety. The registered person must update the risk assessment of the resident who sometimes smoke in her bedroom. The updated risk assessment must include strategies for minimising any fire safety risk. This is to ensure the safety of residents.
Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 8 Window restrictors must be fitted to and engaged in all bedrooms for safety and security reasons. Weekly checks of the emergency lighting must be carried out. This is to ensure that any malfunction is identified and promptly rectified. The temperature of the room where medication is stored must be monitored daily and maintained at no higher than 25 C. This is to ensure that medication is stored correctly. Improvements are required in the care arrangements for residents. The registered person must review the need to have more one to one support sessions for residents. This is to ensure that the care needs of residents are responded. The resident’s bedroom, identified in the section on “personal and healthcare” must be kept clean enough and free of hazards and the care plan of this resident must be reviewed with professionals involved to ensure that it is appropriate. The registered provider must investigate complaints made by certain residents to ensure that residents are treated with respect and dignity and their concerns are promptly responded to. A review of staffing is required. This must include a review of staffing levels and the deployment of staff during the day shifts to ensure that the care needs of residents are fully met. Curtains in bedrooms must be properly hung and armchairs which are dirty must be cleaned. 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. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 9 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 Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 10 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 People who use this service experience a good outcome. This judgement has been made from evidence gathered both during and before the visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken by the manager or a sufficiently skilled member of staff. This ensures that the admissions to the home are appropriate. EVIDENCE: There is no change in the quality rating for this section as no new residents have been admitted since the last inspection. Following the last inspection, admissions were temporarily suspended in accordance with a recommendation by CSCI. This recommendation has now been removed. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 11 Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 12 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 People who use this service experience a good outcome. This judgement has been made from evidence gathered both during and before the visit to this service. The service recognizes the right of individuals to take control of their lives, and effort had been made to ensure that this happens in practice. Care documentation was generally of a high standard and residents had been regularly consulted regarding the running of the home. EVIDENCE: Individual care plans had been prepared for residents. A sample of four care plans were examined. These were generally well prepared and regular care plan reviews had been carried out. Following a requirement made in the last inspection report, residents had been consulted regarding their care. This was evidenced in the signed care plans examined. There was also evidence that
Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 13 residents had signed and agreed to be involved in household chores such as cleaning their bedrooms and communal areas as part of their rehabilitation. Residents’ forums had been organised and there was documented evidence that they had been consulted regarding the management of the home. This was also confirmed by some residents interviewed. Appropriate risks assessments had been prepared for residents. These were of a good standard. The case records of one resident who was seen to be vulnerable to sexual abuse were examined in detail. There was evidence that staff were aware of the problem and an appropriate risk assessment had been prepared in consultation with the resident and the social worker involved. The risk assessment of a resident who sometimes smoked in the bedroom and was a potential fire risk had not been updated since February 2007. This was brought to the attention of the manager and registered provider. They agreed to update the assessment and ensure that any potential risk is minimised. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 14 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 People who use this service experience a good outcome. This judgement has been made from evidence gathered both during and before the visit to this service. The feedback received was mixed. Some people who use this service were fully satisfied while others were not fully satisfied with the service provided. Some feel that the service does not fully respond to individual choices and staff were not always sympathetic. The registered persons have responded to concerns expressed and arrangements were in place to ensure that their views are listened to and their preferences are responded to. This ensures that residents’ can be adequately cared for and their needs can be met at the home. EVIDENCE: Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 15 Following a requirement made in the last inspection report, the manager informed the inspectors that effort had been made to introduce a wider variety of activities for residents. These included meals in the pub, a trip to the zoo, art sessions, cookery, film nights, snooker, special interest groups for male and female residents. Documented evidence was provided. He further added that a Christmas pantomime is due to be booked for residents. The case records examined, contained social care plans and indicated that some residents have access to activities provided by local day centres and sheltered workshops and employment schemes. Residents usually travel to these centres on their own, using public transport. New residents are usually accompanied by staff when they start attending day centres / work schemes. Residents interviewed were able to confirm that a wider range of activities had been organised. Residents interviewed were able to confirm that they had been visited by their relatives. Following concerns expressed by the inspector during the last inspection of the home, the registered persons had ensured that residents have access to their visitors unless there were special documented limitations / restriction on visitors. Some residents interviewed stated that they were well cared for and staff were respectful towards them. Comments made included, ”nice staff” “I am satisfied” “yes, they are helpful” and “happy here!” However, some residents who were interviewed during the inspection stated that staff were not always responsive or sensitive towards them. They stated that some staff sometimes raised their voices when talking to them. The manager stated that staff had been instructed to treat all residents with respect and dignity. He agreed to remind staff of this again (He has confirmed that this was done). This matter was also discussed with the registered provider who took appropriate action and has notified social services of the allegations made. The two kitchens were found to be clean. A record of fridge and freezer temperatures had been kept. These were satisfactory. The menu examined appeared varied. The lead inspector spoke to three residents who were having their lunch. All three indicated that they were satisfied with the meals provided. While these residents were satisfied with the meals provided, two others expressed disappointment. One stated that he did not always receive sufficient food, another stated that fresh fruits were not always available. The registered persons reassured the inspectors that following the last inspection, residents had been consulted regarding the meals provided to ensure that residents’ preferences and views are responded to. There was evidence that
Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 16 such consultation had been started. This was confirmed by residents interviewed. The manager also reassured the inspectors that he would be reviewing the provision of meals to ensure that residents are satisfied with the meals provided (He has since confirmed that this is now routinely done at the 2 weekly residents’ forums and residents have an opportunity to comment on the food provided). Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 17 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 People who use this service experience an adequate outcome. This judgement has been made from evidence gathered both during and before the visit to this service. People who use this service have access to healthcare services in the local community and health needs of residents are monitored. There was evidence that most residents’ healthcare needs had been met. However, further and more attention must be given to ensuring that the needs of certain residents identified in this section are met. Medication records were well maintained, but improvements are needed in the storage of medication. EVIDENCE: There was evidence from interviews with residents and in the case records that support had been provided to residents and they had been encouraged to be as independent as possible. Residents were noted to be able to go out and Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 18 return freely. The case records examined indicated that residents were able to purchase things they liked and some were able prepare their own meals. Some residents interviewed were of the opinion that staff were caring, supportive and respectful towards them. However, four residents interviewed stated that staff were not always supportive towards them and they did not spend enough time with them discussing their anxieties and concerns. The perception of these residents is that some staff were often busy or not interested in them. In addition, a completed questionnaire received from a visiting health / social care professional stated that staff spent too much time in the staff room. The manager explained that there may have been occasions when staff were busy and they may not always be able to respond promptly to demands made by residents. He further added that where necessary, more time had been allocated for staff to talk to certain residents. He nevertheless agreed to review the need to have more support sessions for individual residents, when required. These concerns were also discussed with the registered provider, who agreed to meet with residents to investigate their complaints. Residents who were interviewed stated that they had access to psychiatric and nursing professionals such as the psychiatrist and community psychiatric nurse. This was confirmed in the case records examined. There was documented evidence that the care of residents had been reviewed regularly. The minutes of these reviews, including reviews done by healthcare and social services professionals were kept in the case records and available for inspection. The inspectors noted that the bedroom of a resident was dirty and items of clothing were strewn on the floor. The inspectors noted that this was a potential health & safety hazard. Although this resident had a care plan, the plan did not appear to have been effective in achieving the required improvement. A requirement is therefore made for this care plan to be reviewed with professionals involved (such as the psychologist and occupational therapist). A second requirement is made for the registered person to ensure that the bedroom is kept clean enough and free of hazards. The case records of a resident with a weight problem was examined in detail. Following requirements made in the last inspection report, The records now contained a weight chart and care plan addressing the issue. The inspectors noted that staff had been successful in assisting this resident in reducing her weight. The inspectors further noted that the case records of a resident who was seen to be vulnerable to sexual abuse now contained a risk assessment and a relevant care plan with strategies for minimising the risk had been prepared in consultation with professionals involved. The medication charts were examined. These indicated that medication had been administered and the charts were appropriately signed. The temperature
Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 19 records of the room where medication was stored had not always been recorded daily. This was brought to the attention of the manager who agreed that it would be recorded daily. A requirement is made for the registered person to ensure that the temperature of the room where medication is stored is monitored daily (and recorded) to ensure that it is no higher than 25C. One resident stated that he was unhappy living in the home. He stated that he wanted to move into another home. He agreed that his name could be revealed to the manager). This issue was discussed with the registered persons who agreed that the resident’s placement would be reviewed with the responsible social worker. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 20 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 Some people who use this service experience an adequate outcome. This judgement has been made from evidence gathered both during and before the visit to this service. The arrangements for responding to complaints and for adult protection was on the whole, satisfactory. The required polices and procedures for safeguarding residents were in place and staff were aware of them. However, the feedback from residents was mixed and indicated that although some were happy with the service and care provided, other residents were unhappy and do not feel that they had been treated with respect by some staff. EVIDENCE: The home had a complaints procedure and this was included in the service users’ guide. The complaints book was examined. Several complaints had been recorded since the last inspection in July 2007. One complaint from a resident was made to the inspector since the last inspection. This was brought to the attention of the manager, with the approval of the complainant. He responded promptly and appropriately. The home had an adult protection procedure. Following a requirement made in the last inspection report, the adult protection procedure had been updated. A copy of this procedure was available for inspection. It included specific guidance to staff on reporting allegations of abuse to Social Services and The
Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 21 CSCI. It also specified the need to suspend a member of staff if necessary. The manager stated that a copy of the procedure had been sent to the local adult protection co-ordinator. The inspectors further noted that the registered provider had co-operated fully with Social Services and CSCI in ensuring that recent allegations of abuse are fully investigated. Three residents interviewed stated that they were well treated and staff were respectful towards them. However, other residents interviewed continued to express unhappiness at the way they were treated by some staff. The perception of these residents was that some staff did not really care about them and were at times insensitive to their feelings. These allegations were discussed with the manager and registered provider. The manager explained that there may be occasions when staff are busy and may not be able to respond promptly. The registered provider stated that there is a possibility that the unhappiness felt by some residents may be associated with issues / factors outside the home. In view of the complaints and concerns expressed the registered provider must investigate the complaints and concerns and ensure that residents are treated with respect and dignity. In addition, allegations of abuse made, must be reported to Social Services. The registered provider agreed that this would be done. The registered provider has informed the inspector that the local Social Services department had been informed. Residents expressed confidence in the registered provider and indicated that he was sensitive and was responsive to concerns expressed by them. There was evidence that most of the staff had been provided with adult protection training. When interviewed, they were aware of the procedure to follow when responding to allegations or incidents of abuse. The registered persons were invited to provide evidence of good practice and compliments received. One letter from a relative expressing gratitude for the care provided was available for inspection. The registered persons stated that other compliments had been received verbally. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 22 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 People who use this service experience a good outcome. This judgement has been made from evidence gathered both during and before the visit to this service. The home provides a physical environment that is generally well maintained and appropriate to the specific needs of the people who live there. Residents are allowed to personalise their bedrooms. Residents stated that they were pleased with their accommodation. EVIDENCE: Residents interviewed stated that they were satisfied with the accommodation provided. The home was adequately furnished. There were two lounges and a sheltered area in the garden where residents can sit in. Bedrooms inspected had been personalised by residents with their
Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 23 own pictures and souvenirs. The laundry on the ground floor was inspected and found to be satisfactory. The garden which is located at the back of the home was well maintained and seating had been provided. No specialist equipment were provided as all residents were mobile and none of them required specialist equipment. One of the inspectors noted that the curtain in one of the bedrooms did not hang properly and some armchairs appeared dirty and worn. This was brought to the attention of the registered persons who agreed that curtains would be properly hung and the armchairs would be cleaned. They further stated that the armchairs were purchased about 5 years ago. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 24 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 People who use this service experience an adequate outcome. This judgement has been made from evidence gathered both during and before the visit to this service. The service has a good recruitment procedure that is followed in practice. The service recognizes the importance of training and tries to deliver a programme that meets statutory requirements. Improvements had been made in the staffing levels. However, further improvements are needed to ensure that the service fully meet the needs of residents. EVIDENCE: Three staff on duty were interviewed on a range of topics associated with their work (such as fire safety, adult protection, care of residents with mental illness, equality & diversity, staffing arrangements, team work). They were noted to be knowledgeable regarding these topics. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 25 The duty rota was examined. Staffing levels were as follows: - 2 carers during the morning shift - 3 carers during the evening shift - 2 carers on duty during the night shift. The manager and his two deputy managers were supernumerary. Following a requirement made in the last inspection report, there were 2 staff on duty during the night. Ancillary staff working at the home comprise one full time cleaner who works Monday to Friday. Some residents interviewed indicated that the staffing levels were not always adequate as staff appear unable to respond to their needs or spend adequate time with them. This was also reiterated by one staff interviewed who stated that that there were occasions when there appeared to be insufficient staff (such as when staff had to go on escort duty or when staff go off-sick when they are scheduled to work and they are not replaced. To ensure that residents receive adequate care and attention, a requirement is made for the staffing levels to be reviewed again. This review must also include the manner in which senior and junior staff are deployed. The training records examined, indicated that staff had been provided with most of the required training (such as health & safety, care of residents with mental disorders, fire training, food hygiene and adult protection). Recruitment records examined indicated that the required recruitment procedures (including obtaining of satisfactory CRB disclosures and two references) had been followed. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 26 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, 39, 42 People who use this service experience an adequate outcome. This judgement has been made from evidence gathered both during and before the visit to this service. The manager had an understanding of the key principles and focus of the service, based on organisational values and priorities. He is working to improve services and provide a better quality of care. Some deficiencies were however, noted in the arrangements for ensuring the health and safety of residents. EVIDENCE: The registered manager stated that he had received his RMA. He indicated that he had extensive experience in caring for residents with mental health problems and a forensic history. The overall feedback received from residents
Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 27 indicated that while some were happy with the management of the home, others were unhappy. Following requirements made in the last inspection report, the registered provider had provided CSCI with a plan aimed at assisting the manager improve his management skills. During this inspection, significant improvements had been made in the management of the home. These improvements included frequent consultation with residents (two weekly residents’ forum), prompt response to concerns expressed by residents, a wider variety of activities, increased staffing during the night and better care documentation. The fire records examined contained details of fire drills, emergency lighting checks, fire training and fire alarm checks carried out. The fire alarm checks had been carried out weekly. The inspectors were however, uncertain if the emergency lighting had been checked weekly as it was not documented in the emergency lighting section of the fire records / fire log book. This was discussed with the manager who agreed that checks had not always been done weekly and on occasions, they were documented in a different section of the log book. The manager agreed that in future the tests would be done weekly or in accordance with the manufacturer’s recommendation. Following requirements made in the last inspection report, the two fire extinguishers (identified to the deputy manager) had been serviced. Window restrictors were provided in some bedrooms only. For safety and security reasons, window restrictors must be provided for all bedrooms and they must be engaged. This was brought to the attention of the registered provider and manager who agreed to fit them. The home had a valid certificate of insurance. The financial records of two residents were examined. Receipts had been obtained for items and services purchased on behalf of residents. Following a requirement made in the last inspection report, withdrawals and expenditure were signed by staff and by the resident concerned. In addition, the home had a comprehensive policy and procedure for the management of residents’ finances. The home had a development plan and there was evidence that effective quality assurance systems were in place. A service user audit had been carried out and the report had been published The issue of security was discussed. Following a requirement made in the last inspection report, security arrangements had been reviewed. As a result, a new front door answering system was in place and this allowed staff to respond to the front door bell from any part of the home. Staff had also been instructed to answer the door bell promptly. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.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 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 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 2 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43
DS0000010445.V353437.R01.S.doc 3 3 x 3 X LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 3 X X 2 x
Version 5.2 Page 29 Glenholme Oakdene Psychiatric Residential Care Home 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 YA9 Regulation Requirement Timescale for action 13/12/07 13(2) 13(4)(b)(c) The registered person must ensure 15(1)(2) that all residents’ risk assessments are up to date. This must include the risk assessment of the resident (identified to the manager) who sometimes smoke in the bedroom. The updated risk assessment must include strategies for minimising any fire safety risk. This is to ensure the safety of residents in the home. 2 YA18 12(1)(2) The registered person must review the need for care staff to have more support sessions for individual residents, when required. This is to ensure that the care needs of residents are met. 21/12/07 3 YA19 13(4)(c) 23(2)(d) The registered person must ensure that all residents’ bedrooms are clean enough and free of hazards and this must include the
DS0000010445.V353437.R01.S.doc Version 5.2 13/12/07 Glenholme Oakdene Psychiatric Residential Care Home Page 30 resident’s bedroom identified in the section on “personal and healthcare”. 4 YA19 13(4)(c) 23(2)(d) The registered person must ensure that the care plan of the resident identified in the section on “personal and healthcare” is reviewed with professionals involved. This is to ensure that the care plan is appropriate. 5 YA20 12(1)(a) 15(1)(2) 13/12/07 The registered person must ensure that the temperature of the room where medication is stored is monitored daily and recorded to ensure that it is no higher than 25C. This is to ensure that medication is stored correctly. This requirement is restated The previous unmet timescale was 01/09/07 6 YA22 22(3) The registered provider must investigate the complaints and concerns expressed by certain residents and ensure that residents are treated with respect and dignity. 7 YA24 16(2)(c) 23(2)(d) 24/12/07 The registered person must ensure that curtains in bedrooms are properly hung. This is ensure that residents live in a pleasant and well maintained environment.
Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 31 31/12/07 17/12/07 8 YA24 23(2)(d) The registered person must ensure that armchairs are cleaned. This is ensure that residents live in a pleasant and well maintained environment. 20/12/07 9 YA32 18(1)(a) The registered person must carry out a review of staffing. This must include a review of staffing levels and the deployment of junior and senior staff during the day shifts to ensure that the care needs of residents are met. 13/01/08 10 YA42 23(4) The registered person must ensure that weekly checks or checks at intervals in accordance with the manufacturer’s instructions, of the emergency lighting are carried out. This is to ensure that any malfunction is identified and promptly rectified. 20/12/07 11 YA42 13(4)(6) The registered person must ensure that window restrictors are fitted to and engaged in all bedrooms. This is to ensure the security and safety of residents This requirement is restated. The previous unmet timescale was 01/09/07 17/12/07 Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V353437.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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
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