Inspection on 31/07/07 for Glenholme Oakdene Psychiatric Residential Care Home

This inspection was carried out on 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found no outstanding requirements from the previous inspection report, but made 29 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Glenholme Oakdene Psychiatric... 20/11/07

Glenholme Oakdene Psychiatric... 21/11/05

Glenholme Oakdene Psychiatric... 27/06/05

Glenholme Oakdene Psychiatric... 24/01/05

Glenholme Oakdene Psychiatric... 02/08/04

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

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 31st July 2007 09:05 Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.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.V343963.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.V343963.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.V343963.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 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 a supported living homes. The home is registered to provide personal care for a maximum of eighteen younger adults of either gender, who may either have mental health needs or learning difficulties. 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 consists 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.V343963.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 31 July & 2 August 2007 and took a total of nine and a half hours to complete. During this inspection, the inspector was assisted by deputy manager (Ms Eileen Moore) and one of the two registered providers ( Mr George Macalister). The inspector was able to interview six residents. The feedback received from them indicated that they were not satisfied with the care provided. Feedback was also received from healthcare and social services staff. These indicated that they were concerned regarding the care of residents. Statutory records were examined. These included six residents’ case records, the maintenance records, accident & incident records, complaints’ records and fire records of the home. The premises including residents’ bedrooms, communal bathrooms, laundry, kitchen, gardens and communal areas were inspected. Four staff on duty were interviewed on a range of topics associated with their work. Staff records, including evidence of CRB disclosures, references and training records were examined. In addition, the minutes of residents’ and staff meetings were examined. What the service does well: Several residents were able to go away on holiday to Blackpool this year. Residents were noted to be able to go out freely. The forms for pre-admission assessments and care planning were of a good quality and several of the care plans examined had been carefully prepared. The home has a large garden and seating had been provided for residents. The required safety inspections of the home had been carried out. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 6 Residents stated that a number of staff were respectful towards them The care of residents had been regularly reviewed. New staff had been recruited in accordance with the required procedures. What has improved since the last inspection? What they could do better: Improvements are required in the area of health & safety. The registered person must ensure that the fire alarm is tested weekly and documented. The two fire extinguishers (identified to the deputy manager) which had not been serviced within the past twelve months must be serviced. unless the manufacturer indicates otherwise. Window restrictors must be fitted to and engaged in all bedrooms. The registered person must review security arrangements for the home. Improvements must be made in the staffing arrangements. The registered person must carry out a review of staffing levels and the deployment of staff during the day shifts to ensure that the care needs of residents are met. The home must have a minimum of two care staff on duty during the night shift. All staff must update their training on the care of residents with challenging behaviour. All new staff must receive adult protection training. Improvements are required in the care of residents. The registered person must provide evidence that residents (or their representatives) have been consulted regarding their care plans. This evidence could be in the form of signed care plans. The registered person must provide Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 7 evidence that residents (or their representatives) have been consulted regarding their involvement in cleaning chores and agree to this involvement. This evidence could be in the form of signed care plans. Residents’ consultation meetings must be held at least once every two weeks. To evidence that this is complied with, minutes of meetings must be available for inspection. The registered person must consult with residents and the dietician regarding the meals provided to ensure that residents are provided with choice and a healthy balanced diet. The registered person should encourage staff to attend nutrition training provided by the local mental health team / learning disabilities team. The registered person must carry out a risk assessment regarding the sexual vulnerability of the resident identified in the section on Individual Needs & Choices. This risk assessment must include a strategy for minimising risks identified. The temperature of the room where medication is stored must be monitored daily (and recorded) to ensure that it is no higher than 25C. The registered person must review the provision of social and therapeutic activities with residents and enable them to have access to activities which are appropriate for them and suit their preferences. The registered person must ensure that the door bell is answered promptly and residents have access to their visitors. Any limitations / restriction on visitors must be documented in the care plan and agreed with residents concerned. The registered person must ensure that there is a nutrition / weight reduction care plan for the resident identified in the section on Personal Healthcare & Support. This must include a weight monitoring chart. Improvements must be made to ensure that residents are protected from abuse and their complaints are promptly responded to. Complaints made must be recorded in the complaints book and promptly responded to. The registered person must report the allegations of abuse (made by residents) to social services (this was done). In addition, the home’s adult protection procedure must be updated. Improvements must be made in the management of the home. The registered provider must provide CSCI with a plan aimed at assisting the registered Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 8 manager to improve his management skills. The registered person must provide residents the opportunity to sign (to indicate approval) when money is withdrawn from their accounts. Such arrangement must be documented in the financial care plans of the residents concerned and agreed with them. Residents’ representatives and Social Services must also be made aware of these arrangements. The registered person must also ensure that the home has a comprehensive policy and procedure for the management of residents’ finances. The home must have effective quality assurance and monitoring systems in accordance with Standard 39, NMS. This must include a published report of the results of a recent consumer survey and an annual development plan for the home. An action plan is required in response to any concerns expressed. 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.V343963.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.V343963.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: The case records of a resident (with mental health problems) who was admitted since the last inspection of the home were examined. It contained a comprehensive pre-admission assessment carried out by the referring agency and a further assessment carried out by care home staff. These assessments met the required standard. Risk assessments together with strategies for minimising risks had been prepared by staff from the home. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 11 An appropriate care plan had been prepared for this resident. His care was due to be reviewed the following week with professionals involved. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.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, 8, 9 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 recognizes the right of individuals to take control of their lives, but this does not always happen in practice as staff have a limited understanding of how to do this effectively. Each individual has a care plan, but the practice of involving people who use the service in the development of the plan is variable. EVIDENCE: Care plans had been prepared for residents. A sample of six care plans were examined. These were generally well prepared and regular reviews had been Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 13 carried out. However, four residents stated that they had not been consulted regarding their care. One said he was consulted only “once in a blue moon” There was no evidence in the case records to indicate that residents had agreed with these plans. Some residents stated that they were asked to clean their bedrooms and communal areas and they were unhappy about this. One stated that she could not reach some areas of her bedroom. As a result of this she stated that these areas were not cleaned. This was discussed with the deputy manager and registered provider who stated that it was an expectation that residents participate in the cleaning of the home and it was also part of their rehabilitation. In view of the dissatisfaction expressed by residents, the registered person must ensure that residents are consulted regarding their care and agree with their care plan. This evidence could be in the form of signed care plans. Where residents are involved in cleaning the home, this must be specified in their care plans and agreed with them. There was documented evidence that some residents had been consulted regarding the management of the home. However, these meetings were infrequent. To ensure that residents are fully consulted, residents’ meetings must be held at least once every two weeks. These must be minuted. Appropriate risks assessments had been prepared for residents. These were generally of a good standard. The case records of a resident who dressed inappropriately and was vulnerable to sexual abuse were examined in detail. There was evidence that staff were aware of the problem. However, there was no risk assessment or care plan with strategies for minimising the risk. The above were brought to the attention of the registered provider and requirements are made accordingly. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.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, 15, 16, 17 People who use this service experience a poor outcome. This judgement has been made from evidence gathered both during and before the visit to this service. Some people who use this service do not feel they are listened to or consulted. They feel that the service does not respond to individual choices. Some residents lacked social activities and mental stimulation. Some people who use the service are not satisfied with the catering arrangements and have expressed disappointment with the provision of meals. EVIDENCE: Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 15 During this inspection, the deputy manager informed the inspector that some residents had been taken to Blackpool for their holiday. She stated that various activities had been provided for residents. A service user audit carried out (last November) indicated that outings to the pub, bowling and cinema had been organised. 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 (run by charities such as MIND and the Richmond Fellowship) 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. In additional some activities had been organised for residents by staff. Residents interviewed however, stated that the home did not have sufficient activities and they were bored. Residents suggested that activities such as outings to places of interests and visits to the gym should be organised. No organised activities (within the home) were noted during the inspector’s visits to the home. It was further noted that social and healthcare professionals had previously expressed disappointment at the lack of activities for residents. Suggestions had been made by residents in the service users’ audit of November 2006. However, no information was provided in the report as to whether the suggestions made would be responded to. The provision of activities was discussed with the deputy manager who explained that residents did not always want to participate in activities organised. The inspector asked for, but was not provided with a weekly programme of activities. In view of the dissatisfaction expressed, the registered person is required to review the provision of social and therapeutic activities with residents and enable them to have access to appropriate activities. The deputy manager reassured the inspector that reasons for non-participation in social and therapeutic activities had been explored in keyworker sessions and documented in the daily notes. Residents stated that their visitors did not always get access to them as the door bell was not always answered. One resident said his visitors were told they could not see him when they called. He indicated that he was very distressed about this. The inspector noted that the door bell was not answered by any staff member when he visited the home. It was answered by a resident after eleven minutes. This was brought to the attention of the registered provider and a requirement is made for the door bell to be answered promptly. A further requirement is made for the registered person to ensure that residents have access to their Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 16 visitors. Any limitations / restriction on visitors must be documented in the care plan and agreed with residents concerned. Please also see the section on Conduct & Management of the Home. With one exception, all residents who were interviewed during the inspection stated that they had been mistreated by the manager and some staff. Comments made included, “they boss me around”, “swears at me”, “I have to carry bedsheets” to the next home. These allegations are detailed in the section on “Protection”. Allegations made by residents interviewed, were brought to the attention of the registered provider and deputy manager. The registered provider reassured the inspector that he would act promptly. Prompt action was taken by him during this inspection to address the concerns expressed. 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. Residents interviewed expressed dissatisfaction at the meals provided. They stated that they did not always receive sufficient food, there was limited choice and the meals provided did not always correspond with the menu. One stated that he had nothing to eat one evening as he did not like the meal which was served and there was no alternative meal available for him. The inspector noted that concern had also previously been expressed by social and healthcare professionals (in minutes of a strategy meeting) that there were poor menu choices and several residents were obese. A requirement is made for the registered person to consult with residents and the dietician regarding the meals provided to ensure that residents are provided with choice and a healthy balanced diet. Please also see the section on staffing. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.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. Some people who use this service have access to healthcare services in the local community and health needs are monitored. However, more attention could be given to the changing need of residents. Medication records were well maintained, but improvements are needed in the storage of medication. Some residents expressed dissatisfaction and felt that some staff do not treat them with respect and dignity. EVIDENCE: 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.V343963.R01.S.doc Version 5.2 Page 18 return freely. The case records indicated that residents were able to purchase things they liked and some were able prepare their own meals. However, residents interviewed stated that staff were not sensitive or supportive towards them. They indicated that staff were not responsive when they asked for assistance. With one exception, residents interviewed indicated that during the period of the night shift they did not always feel supported or receive attention when they needed it as there was only one staff on duty. (For further details, please also refer to the section on Concerns, Complaints & Protection and Staffing). With one exception, residents who were interviewed stated that they had access to psychiatric and nursing professionals such as the psychiatrist and CPN (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. One resident said he had not been seen by the doctor since he arrived. This was discussed with the deputy manager who provided evidence that an appointment had been made for this resident to be seen soon (This resident had given permission for his identity to be divulged). The case records of a resident who had epileptic seizures was examined in detail. It indicated that the seizures had been recorded and appointments had been made for her to be seen by her GP and a medical specialist. The case records of a resident with a weight problem was examined in detail. There was documented evidence that staff were aware of her weight problem. However, the records did not contain a weight chart or care plan addressing her weight problem (This resident had agreed that her identity can be divulged). The case records of a resident who dressed inappropriately and was vulnerable to sexual abuse was examined in detail. There was no risk assessment or care plan with strategies for minimising the risk. This is required. The above deficiencies were brought to the attention of the registered provider and deputy manager and requirements are made accordingly. The medication charts were examined. These indicated that medication had been administered and the charts were appropriately signed. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 19 The temperature records of the room where medication was stored had not always been recorded daily. This was brought to the attention of the deputy 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. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.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 a poor outcome. This judgement has been made from evidence gathered both during and before the visit to this service. Deficiencies were noted in the arrangements for responding to concerns expressed by people who use the service. Some service users stated that they do not feel listened to by some staff and they do not feel supported or properly cared for by some staff. Relationship with the local mental healthcare agency is poor. The procedure for safeguarding adults does not give clear and up to date guidance to staff on how to respond to allegations or incidents of abuse. EVIDENCE: The home had a complaints procedure and this was included in the service users’ guide. The complaints book was examined. No complaints were recorded in this book since January 2007. The inspector however, noted that at least one complaint had been made to staff. This was discussed with the deputy manager and registered provider and a requirement is made for all complaints to be documented and promptly responded to. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 21 The home had an adult protection procedure. The adult protection procedure was not sufficiently comprehensive as it did not include specific guidance to staff on reporting allegations of abuse to Social Services or The CSCI. It did not specify the need to suspend a member of staff if needed. It also did not mention the need to report perpetrators to the General Social Care Council for inclusion in the POVA list. A requirement is made in this report for the procedure to be updated. Residents interviewed expressed unhappiness at the way they were treated by staff. During this inspection, they made a number of serious allegations against the manager and some staff. These allegations related to verbal abuse, intimidation, poor financial practices and a lack of sensitivity by staff. The inspector noted that concerns had also been expressed by social and healthcare professionals during strategy meetings held earlier this year. These concerns centred around a negative management style and attitude and behaviour of some staff. Concern had also been by expressed by these professionals that residents had not been treated sensitively and with respect. Following the strategy meetings held earlier this year, the registered provider had made attempts to respond to recommendations made. However, concerns continued to be expressed regarding the behaviour of the manager and some staff. Allegations made by residents interviewed, were brought to the attention of the registered provider. He reassured the inspector that prompt action would be taken. He immediately reported them to the local adult protection coordinator. The manager was suspended after the inspection took place. Investigations by social services are underway. The registered provider also agreed to voluntarily suspend admissions until investigations have been completed. There was evidence that most of the staff had been provided with adult protection training. Arrangements must be made for the remaining staff to be provided with training. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.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, 25, 26, 27, 28, 29, 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 stated that they were generally pleased with their accommodation. EVIDENCE: Residents interviewed stated that they were on the whole, satisfied with the accommodation provided. The home was adequately furnished. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 23 The home has two lounges and a sheltered area in the garden where residents can sit in. Bedrooms inspected had been personalised by residents with their own pictures and souvenirs. Some bedrooms have ensuite facilities. 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. Some residents were seen sitting in the garden No specialist equipment were needed as all residents were mobile. The deputy manager informed the inspector that the home does not admit residents needing assistance with transfers. One resident complained that there was no hot water. This was checked during the inspection and the inspector noted that there was hot water. On resident complained that the vacuum cleaner was not working. This was checked. The vacuum cleaner was found to be in working order. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.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. However, the staffing levels restrict the ability of the service to fully meet the needs of people who use the service. Some people using the service do not have confidence in some staff and feel that staff either do not care about their needs or were sometimes too busy to respond to them. The service recognizes the importance of training and tries to deliver a programme that meets statutory requirements. However, there are some gaps in the training programme. EVIDENCE: Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 25 Four 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 generally knowledgeable regarding these topics. Staff stated that they had been instructed to treat all residents with respect and dignity regardless of their race, religion or sexual orientation. The duty rota was examined. Staffing levels were as follows: - 2 staff during the day shift - 1 staff on waking duty during the night shifts. The manager and deputy were supernumerary. Ancillary staff working at the home comprise one full time cleaner who works Monday to Friday. Some staff interviewed indicated that the staffing levels were not always adequate. They indicated that : - there should be extra staff on the night shift for safety reasons - there had been occasions on the day shift when only one carer was on duty (with the manager). - extra staff were not always provided for escort duty. Residents interviewed stated that there were insufficient staff on duty to attend to their needs. They stated that if a resident required extra attention during the night, the staff member on duty was kept occupied and therefore unable to attend (provide support) to them. Residents further stated that more cleaners were needed. They stated that they had to clean their rooms and communal areas because there were insufficient cleaning staff. They indicated that they were unhappy with this arrangement and could not do a proper job as they were unable to reach some areas of their bedrooms which needed cleaning or necessitated the moving of heavy furniture. (The inspector noted that residents had not been consulted regarding these chores and had not signed their care plans in agreement.) Some residents stated that having one staff on duty places them at risk in the event of a fire. Concern was also expressed by a relative who indicated that a resident had not been properly attended to during the night because of inadequate staffing. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 26 Further concerns were also expressed by social and healthcare professionals that the gender of staff is not always appropriate for the care of residents who preferred to be attended to by someone of the same sex. Having only one staff at night does not therefore allow the preferences of residents to be responded to. In addition to the above, the inspector noted that a number of the residents had a forensic history and had problems with illicit drugs and alcohol. In interviews, it was noted that there appeared to be a feeling of hostility towards staff as their perception was that some staff had mistreated them. The registered provider reassured the inspector that if extra staff or assistance were needed, either he or the manager could reach the home within a short time. He further explained that there had been an agreement with CSCI that the home could have only one carer on duty during the night shift. There were no records of any such agreement in the local CSCI office. Staffing levels must not remain static, but they have to be regularly reviewed to ensure that the needs of residents are met and ensure the safety of residents and staff. This arrangement to cover the night shift is however, unsatisfactory as it does not minimise potential risk and does not ensure that residents are adequately attended to on a daily basis. In addition, it places staff and residents at risk. To ensure that residents receive adequate care and supervision and potential risks are minimised, an immediate requirement was made for the registered to ensure that there is a minimum of two staff on duty during the night shifts. 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). The inspector however, noted that no staff attended a training session on diet and nutrition organised by the local mental health team. This had been organised for staff from the home following concerns raised regarding the competence of staff in this area. It was further noted that staff had been provided with training in the care of residents with challenging behaviour by the manager. In view of the allegations made, the registered person must ensure that all staff update their training on the care of residents with challenging behaviour. 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.V343963.R01.S.doc Version 5.2 Page 27 Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 28 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 Some people who use this service experience a poor outcome. This judgement has been made from evidence gathered both during and before the visit to this service. Several deficiencies were noted in the management of the home and in arrangements for ensuring the health and safety of residents. These deficiencies place residents at risk and affect the quality of care provided. Some people who use the service felt uncared for and were of the opinion that the management of the home was oppressive. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 29 EVIDENCE: The registered manager was not present during this inspection as he had taken some residents to Blackpool for their holidays. The overall feeback received from residents and staff indicated that the home was not well managed and some residents had not been treated with respect and dignity. This was also confirmed in feedback received from some social and healthcare professionals. These concerns have been discussed with the registered provider and deputy manager. In view of this, the registered provider must provide CSCI with a plan aimed at assisting the manager improve his management skills. 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 not been carried out weekly. This was brought to the attention of the registered provider who stated that it would be tested weekly. An immediate requirement was made for the registered person to ensure that fire alarm tests are carried out weekly. The inspector noted that two of the fire extinguishers (identified to the deputy manager) had not been serviced within the past 12 months. These must be maintained at least once a year unless the manufacturer indicates otherwise. Window restrictors were not seen or engaged in any of the bedrooms inspected. This included the window of a bedroom on the ground floor which was left open. For safety and security reasons, window restrictors must be provided and engaged. This was brought to the attention of the registered provider who agreed to fit them. The home had a valid certificate of insurance. The financial records of three residents were examined. Receipts had been obtained for items and services purchased on behalf of residents. Withdrawals and expenditure were signed by either the manager of deputy manager. This practice was discussed with the deputy manager. To ensure that residents are aware of these transactions and approve of them, residents must be given the opportunity to sign when money is withdrawn from their accounts. One resident complained that the manager knew the Pin number of his cash card and he was concerned that money may have been drawn from his account without his knowledge. This resident had agreed that his identity can Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 30 be disclosed. This allegation was brought to the attention of the registered provider and has been reported to social services. Another service user alleged that some money had been taken from her by a staff member and this had not been recorded and not returned to her. Social Services have been notified of this allegation. The management of residents’ finances was discussed with the deputy manager. She stated that none of the staff are signatories of residents’ individual accounts. When asked, she was not sure if there is a policy or procedure regarding the management of residents’ finances. In view of this, the registered person must ensure that the home has a comprehensive policy and procedure for the management of residents’ finances. The inspector asked for evidence of quality assurance systems. A service user audit had been carried out and the report dated November 2006 was available for inspection. Several issues were raised by residents. However, the inspector was not provided with evidence of an action plan or action taken to address issues identified. The home is required to have effective quality assurance and quality monitoring systems in accordance with Standard 39. This must include an annual development plan. Feedback must be actively sought from residents and their representatives and prompt action must be taken in response to concerns expressed. Deficiencies were noted in the security of the home. On arrival at the home, the inspector waited eleven minutes before the door was opened and he was let into the home by a resident. Prior to the door being opened, he rung the telephone number of the home. It was not answered by staff. On entering the home, he noted that the two staff on duty were sitting in the conservatory. The inspector further noted that the front door was left open on two occasions by a resident. This inadequate security arrangement places residents at risk. An immediate requirement was made for the security arrangements to be reviewed. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 31 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 1 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 x 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000010445.V343963.R01.S.doc 2 2 2 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 1 17 2 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 2 X 1 X 1 X X 1 X Version 5.2 Page 32 Glenholme Oakdene Psychiatric Residential Care Home No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 YA7 Regulation 15(1)(2) The registered person must provide evidence that residents (or their representatives) have been consulted regarding their care plans. This evidence could be in the form of signed care plans. 2 YA6 YA7 15(1)(2) The registered person must provide evidence that residents (or their representatives) have been consulted regarding their involvement in cleaning chores and agree to this involvement. This evidence could be in the form of signed care plans. 3 YA6 YA7 YA12 15(1)(2) 16(2)(m)(n) The registered person must ensure that residents’ consultation meetings are held at least once every two weeks. To evidence that this is complied with, minutes of meetings must be available for DS0000010445.V343963.R01.S.doc Version 5.2 Page 33 Requirement Timescale for action 13/09/07 07/09/07 07/09/07 Glenholme Oakdene Psychiatric Residential Care Home inspection. 4 YA9 13(2) 13(4)(b) (c) 15(1)(2) The registered person must carry out a risk assessment regarding the sexual vulnerability of the resident identified in the section on Individual Needs & Choices. This risk assessment must include a strategy on minimising risks identified. 5 YA14 12(1)(a) 16(2)(m)(n) The registered person must review the provision of social and therapeutic activities with residents and enable them to have access to activities which are appropriate for them and suit their preferences. 12(1)(a) The registered persons must ensure that the door bell is answered promptly. 7 YA15 12(1)(a) The registered persons must ensure that residents have access to their visitors. Any limitations / restriction on visitors must be documented in the care plan and agreed with residents concerned. 8 YA19 12(1)(a) 13(1)(b) 16(2)(i) The registered person must consult with residents and the dietician regarding the meals provided to ensure that residents are provided with choice and a healthy balanced diet. DS0000010445.V343963.R01.S.doc Version 5.2 Page 34 01/09/07 07/09/07 6. YA15 14/08/07 14/08/07 21/09/07 Glenholme Oakdene Psychiatric Residential Care Home 9 YA19 12(1)(a) 15(1)(2) 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. 01/09/07 10 YA19 12(1)(a) 15(1)(2) The registered person must ensure that there is a nutrition / weight reduction care plan for the resident identified in the section on Personal Healthcare & Support. This must include a weight monitoring chart. 01/09/07 11 YA22 22(3)(4) (5) 01/09/07 The registered person must ensure that complaints made are recorded in the complaints book and promptly responded to. 07/09/07 The registered person must update the home’s adult protection procedure. 12 YA23 13 (6) 13 YA23 13 (6) The registered person must report the allegations of abuse (made by residents) to social services. (Immediate Requirement) 01/08/07 14 YA35 13 (6) 18 (1) (c) (i) 13/10/07 The registered person must ensure that all staff update their training on the care of residents with challenging behaviour. 01/10/07 The registered person must DS0000010445.V343963.R01.S.doc Version 5.2 Page 35 15 YA35 13 (6) 18 (1) (c) Glenholme Oakdene Psychiatric Residential Care Home (i) ensure that all new staff receive adult protection training. The registered person must carry out a review of staffing levels and the deployment of staff during the day shifts to ensure that the care needs of residents are met. 07/09/07 16 YA32 18(1)(a) 17 YA32 18(1)(a) 13(4)(c) The registered person must ensure that the home has a minimum of 2 care staff on duty during the night shifts. (Immediate Requirement) 04/08/07 18 YA37 9(2)(b) 12(4)(a) 13(6) 18(1)(a) 12(1) 13(6) The registered provider must provide CSCI with a plan aimed at assisting the registered manager improve his management skills. The registered person must provide residents the opportunity to sign (to indicate approval) when money is withdrawn from their accounts. The registered person must ensure that the home has a comprehensive policy and procedure for the management of residents’ finances. 13/09/07 19 YA37 01/09/07 20 YA37 12(1) 13(6) 14/09/07 21 YA39 24(1)(2)(3) The registered person must ensure that the home has effective quality assurance and monitoring systems in accordance with Standard 39, NMS. DS0000010445.V343963.R01.S.doc 31/10/07 Glenholme Oakdene Psychiatric Residential Care Home Version 5.2 Page 36 This must include a published report of the results of a recent consumer survey and an annual development plan for the home. An action plan is required in response to any concerns expressed. 22 YA42 23(4) The registered person must ensure that the fire alarm is tested weekly and documented. (Immediate Requirement) 23 YA42 23(4) The registered person must ensure that the 2 fire extinguishers (identified to the deputy manager) are serviced. These must be maintained at least once a year unless the manufacturer indicates otherwise. 24 YA42 13(4)(6) The registered person must ensure that window restrictors are fitted to and engaged in all bedrooms. 25 YA42 13 (4)(6) The registered person must review security arrangements for the home. (Immediate Requirement) 01/09/07 01/09/07 01/08/07 01/08/07 Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 37 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA23 Good Practice Recommendations The registered person should suspend all admissions until adult investigations are completed. The registered person should encourage staff to attend nutrition training provided by the local mental health team / learning disabilities team. YA35 Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Harrow Area Office 4th 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 © 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 Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V343963.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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