Inspection on 13/01/06 for High Oaks (1)

This inspection was carried out on 13th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Oaks (1) 23/07/08

High Oaks (1) 30/07/07

High Oaks (1) 26/04/06

High Oaks (1) 09/08/05

High Oaks (1) 09/02/05

High Oaks (1) 14/10/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 High Oaks (1) 1 High Oaks St. Albans Hertfordshire AL3 6DJ Lead Inspector Hazel Wynn Unannounced Inspection 13th January 2006 10:00 High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 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 High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 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. High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service High Oaks (1) Address 1 High Oaks St. Albans Hertfordshire AL3 6DJ 01727 844 523 01727 844 523 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) Walsingham Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 6 people with learning disability or physical disability (when associated with learning disability). 9th August 2005 Date of last inspection Brief Description of the Service: 1 High Oaks is registered to provide care and accommodation for up to six young adults with a learning disability. It is maintained and operated by Walsingham and is situated in a residential area of St.Albans, Hertfordshire. The accommodation comprises a lounge/dining area, kitchen, bathroom, utility room, toilet and one bedroom on the ground floor.(This bedroom would be suitable for a resident with a physical disability in association with a learning disability.) On the first floor are five bedrooms, a bathroom and the office/staff sleeping accommodation. The home has ample parking area to the front with a large garden to the rear, which has seating areas accessible to residents. If they choose to, residents can help maintain the garden and grow a variety of fruit and vegetables for use in the home. High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place during the afternoon of the 13th January 2006 and was a positive inspection in terms of the care outcomes observed. The residents appeared at ease and had a comfortable and appropriate relationship with the staff present throughout this unannounced inspection. The medication and financial records checked were in order and the general standard of the care plan documentation seen was good; work was in progress to complete new formats for care plans. Some previous requirements have been addressed; the newly fitted kitchen and decorated hallway and lounge looked very attractive. There remains a relatively minor issues with food hygiene and housekeeping, but overall the home provides a pleasant and suitable environment for its residents together with a good standard of personal care. The outcomes produced in this report are a ‘snapshot’ of the day when this inspection took place. What the service does well: What has improved since the last inspection? Since the last inspection, the home has had a newly fitted kitchen and the hallway, stairs, landings and lounge have been professionally decorated to a high standard and looked very attractive. Efforts have been made to date all food on opening (one item had been missed). A start had been made on new care plan formats, which, when complete, will provide a quick reference guide for staff regarding the involvement of care professionals and will also enable ease of tracking. Weights were being recorded in metric measurement and were entered consistently. The oven and utensils were maintained in a clean and hygienic condition. The home was kept clean and fresh. High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 Information for service users and prospective service users is comprehensive and provided in a format that enables them to understand and participate in the assessment and contractual process appropriately. Prospective service users visit and “test drive the home” prior to a final agreement to placement. Individual and user friendly agreements containing the terms and condition is provided to each service user. EVIDENCE: The statement of purpose, service user guide and assessment documentation have been seen previously and contained the necessary information in a clear and accessible format. Prospective service users are always invited to test-drive the home and this forms part of the admissions and assessment procedures; the inspector has previously observed this and records of the visits remain on the files seen at this inspection. There have not been any new admissions into the home since the last inspection in February 2005. The “Person Centred Planning” approach of the home is clearly focussed on establishing and meeting the needs and aspirations of those using its services. High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 - 10 The residents are increasingly being involved in the process of planning and delivery of their care and are encouraged to fully participate in decisions that affect their lives. Service users are supported to take risks as part of an independent lifestyle. Service users can be assured that information about them is handled appropriately and that their confidences are kept. EVIDENCE: There had been a service users meeting on the day before this inspection took place and the service users were supported by an advocate from POWHER; the residents’ meetings records were seen at his inspection. POWHER advocates regularly assist at the resident’s forums to help and facilitate in the process. The Person Centred Planning approach and documentation that is being introduced, together with appropriate staff training, provides evidence that the home is genuinely attempting to put the service user at the heart of decision making in the home; progress now needs to be made to complete the transfer of information, as soon as possible, so that all relevant and up to date information is available in one file for each service user. All activities are risk assessed for each service user and copies of the risk assessments were seen High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 10 on the individuals’ files perused at this inspection. (See the risk assessment requirement for all service users having access to 1st floor windows without restrictors, Standard 42). Training in confidentiality is provided to all staff as part of the induction process and as part of ongoing training. Policies and procedures are in place in respect of confidentiality and information about individuals was observed to be appropriately and securely stored. High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 - 17 The opportunity for personal development is provided. The home’s service users are encouraged and enabled to access a range of appropriate social, leisure and educational activities within the community and to maintain and develop personal and family relationships wherever possible. The service users rights and responsibilities are recognised in their daily lives. The service users enjoy a healthy diet and enjoy their meals and mealtimes. EVIDENCE: Evidence that personal development opportunities are part of the care plan was available in the documentation perused at this inspection. Talking to service users and staff during the inspection provided ample evidence of the participation by service users in a varied range of individually appropriate activities within the local community and further afield. Risk assessments for individual activities had been completed and were kept reviewed on each file. Service users family and friends details were clearly indicated on the files perused and contacts were recorded. Advocates from POWHER support the service users, as part of the home’s efforts to ensure the service users rights and responsibilities in their daily lives High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 12 are recognised and respected; staff training provided also supports this part of the company’s ethos. The menus seen provided a variety of healthy and varied diets and the dietician gives monthly input. The dining facilities are attractive and a request for beverages from one of the service users was responded to swiftly. High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 - 21 All service users are assisted as required and preferred with their personal care needs and to access the community health services they require. It is appropriate that the service users do not self medicate. The temperature for the storage of medication was not known and could not be verified. Ageing, illness and death of a service user would be handled with respect and according to individual wishes. EVIDENCE: Care plan documentation records the involvement of a range of community health professionals and where appropriate hospital services. Care plans tracked showed that assessed requirements such as weight monitoring are carried out regularly and recorded. A bottle of liquid antibiotic was stored in the medication and the instructions on the bottle stated: not to be stored above 25°C; there was no thermometer to check the temperature and a requirement was made for the temperature of the medication storage area to be checked and recorded daily. A sample of medication records was checked at this inspection and was found to be accurate and complete. The policy and procedure manual contained a policy and procedure for the management of medication. High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 14 The home has a policy and procedure for supporting service users who are ageing, who become ill, are dying and in the event of death. Staff receive training in loss and bereavement and this is also offered to service users where appropriate. High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 – 23 Efforts are made to ensure that those using this service are able to comment on it, that their views are taken fully into account. Service users are generally protected from abuse, neglect and self-harm (but see standard 42 in respect of window restrictors). EVIDENCE: No complaints have been recorded since 2003. An advocate from POWHER had supported the service users at their meeting on the day prior to this inspection. The involvement of POWHER, an independent advocacy organisation, is documented in care plans and residents’ meetings notes. The home has an Adult Protection Procedure and a whistle blowing policy to enable staff to understand the issues around adult abuse and to act appropriately in the event that it is suspected to have taken place. Those financial records checked during the last inspection were accurate and subject to a robust system of audit and control. The proprietors agent reports to the CSCI monthly and includes her findings of a random sample check of service users finances. Individual risk assessments for activities both in and out of the home are carried out to support service users to enjoy an increasing independent lifestyle and these were available on the files perused at this inspection. It had been recommended at the last inspection that a risk assessment be carried out High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 16 in respect of first floor windows without restrictors; no evidence was found at this inspection that this had been done and a requirement has now been made. High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 - 28 & 30 A homely, comfortable, pleasant and safe environment is provided for both residents and staff (but see standard 42 in respect of window restrictors). Individual bedrooms suit service users needs, lifestyles and the promotion of their independence. Toilets and bathrooms provide sufficient privacy and suit individual needs. There is sufficient shared space, which complements the adequate space of individual service users rooms. EVIDENCE: The hallway, stairs, landing and the lounge have recently been redecorated to a high standard and a new kitchen has been fitted. There is a large lounge and diner with alternative seating for dining in the large kitchen. Bathing and toilet facilities were adequate and clean and policies and procedures were in place with specific instructions to staff on individual files to support service users according to their preference and need with respect to dignity. The home was clean and hygienic throughout (see comment earlier regarding one item of food in the refrigerator that had not been dated Standard 42). High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 - 36 There is clarity of staff roles and responsibilities. A recognised induction programme is utilised and staff are appropriately trained to support the service users. Supervision is in place for the support of staff. EVIDENCE: Each staff member is provided with a handbook a copy of which is maintained in the office at the home; these contain copies of job descriptions and clarity of staff roles and responsibilities. Recruitment practices are robust and agreement has been reached that the CSCI’s Performance Relationship Manager will audit the recruitment files at the main office and update the inspector following audit; outcomes of the audit by the PRM were not available for this inspection report. Recruitment policies and procedures are in place. The training planner was seen at this inspection and provided a very satisfactory profile of training for staff. Staff confirmed that they receive regular supervision and support. Although there are vacancies within the staff team, agency staff, who are familiar with the service, are engaged to ensure staffing levels are maintained at previously agreed levels. One agency staff High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 19 who has been working in the home for approximately 18 months supported this inspection as she was in charge of the shift; the agency staff member was very professional, exhibited a good understanding of the service users needs and was knowledgeable about the organisations philosophy and vision. The home have a good system in place to ensure that agency staff receive the information they require in order to understand the individual needs and preferences of the service user group. Supervision records were seen at the last inspection, which indicated that staff are currently receiving at least six individual supervision sessions per year, together with regular team meetings. Staff on duty confirmed that supervision is in place and that they feel well supported by the acting manager. High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 and 43 Although the home is currently without a registered manager, the acting management team are maintaining an effective service for residents. Service users views underpin all self-monitoring, review and development by the home. The homes record keeping and the company’s policies and procedures safeguard the rights and best interests of the service users. There is concern about the lack of evidence that a risk assessment has been carried out in respect of windows on the upper floor that do have restrictors fitted; otherwise the health, safety and welfare of service users are generally protected and promoted. A registered manager needs to be in place who will satisfy standard 43. EVIDENCE: The home is being well run by the acting manager and the home’s care team but a registered manager needs to be in post and a requirement has been made. On the day of this inspection it was found that most food stored in High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 21 refrigerator had been dated upon opening but one item of part used pate had not been dated; the recommendation has been brought forward. Advocates from POWHER support the service users, as part of the home’s efforts to ensure the service users rights and responsibilities in their daily lives are recognised and respected; staff training provided also supports this part of the company’s ethos. A sample of the records maintained by the home were perused at this inspection and all were found to be clearly completed and up to date. A requirement has been made, that a generic risk assessment should be completed to support the lack of window restrictors to first floor windows that are without restrictors. Regulation 26 reports are received regularly and provide the inspector with ongoing information regarding the self-regulation/review carried out by the company. There is currently no registered manager and this situation has continued for a considerable period; currently the acting manager is providing and maintaining an effective service for the service users. In standard 37 and 43 a requirement has been made for a registered manager to be in post. . High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 22 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 3 1 X 3 3 3 1 1 High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 23 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 YA37YA & 43 YA42 YA42 Regulation 8 Requirement Timescale for action 30/03/06 2. 3. 13 (3) 13 (4) (c) 4. YA20 13 (2) A registered manager must be in post. The home has had an acting manager for a considerable period. All food containers should be 13/01/06 dated on opening. The distance first floor windows 14/02/06 open must be risk assessed and remedial action taken where necessary. Obtain a thermometer so that 14/01/06 the temperature of the medication storage room can be monitored and recorded daily to ensure that the correct temperature is maintained for the storage of medication at the pharmaceutical company’s guidance (e.g. lactulose, some manufacturers) must be stored at a temperature not exceeding 20° centigrade). The storage area appeared to be quite cool but the temperature could not be checked. (Liquid antibiotic was stored in the cupboard, which must not exceed 25°C). High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Complete the new care plan documentation, as soon as possible in order to ease tracking and to include a record of the involvement of health professionals, this will provide an easier reference point for staff. High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI High Oaks (1) DS0000019422.V275124.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!