Inspection on 26/04/06 for High Oaks (1)

This inspection was carried out on 26th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 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) 13/01/06

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 June Humphreys Key Unannounced Inspection 26th April 2006 15:30 High Oaks (1) DS0000019422.V292303.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.V292303.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.V292303.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.V292303.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). 13th January 2006 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. The approximate weekly cost of a placement at this service is £969.83(this is due to be reviewed) High Oaks (1) DS0000019422.V292303.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of this inspection year. There were many positive aspects to the inspection. Time was spent with the manager of the home as well as talking to a number of service users, seeking their views and opinions. There was also a carer visiting a resident who spoke very highly of the service. Two of the residents spoken to have a level of learning disability which made it difficult to gain accurate information regarding their experience of the service. They were however seen to be relaxed and happy amidst their peers, staff members and their physical environment. The importance of advocacy services in the home is evident through the work POHWER are presently undertaking. The registered manager has worked hard since the previous inspection in January to meet the requirements made. All requirements have been except the registration of a manager, which was in the process of happening when the inspection occurred. What the service does well: The service was seen to provide a high standard of consistent care for a group of people who have a range of learning disabilities. The residents are encouraged to personalise their individual, and shared space. This reflects in the homely, cosy environment that is apparent when entering the home. There is an established system in place, which ensures that the health care requirements of the residents including any specialist resource are identified, recorded and addressed in a consistent manner. The care planning process is thorough and residents continue to receive appropriate assistance to address their individual needs. High Oaks (1) DS0000019422.V292303.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. High Oaks (1) DS0000019422.V292303.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.V292303.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): 1,2,3, and 5 Quality in this outcome area is good. This judgment was made using the available evidence at this inspection. Prospective Service users aspirations and needs are clearly identified through the assessment process prior to admission. Information provided to the service users about the home is written in an easy readable format with accompanying pictures. This enables the service users to make an informed choice about where to live. Person centred planning was in place and this was apparent in the high focus placed on individual service user needs. EVIDENCE: Prospective service users are assessed prior to admission, and given every opportunity to try the service. This is not only to see if they like the home environment, but also provides the other service users who already live at ‘High Oaks’ the opportunity to meet the person. There have been few admissions as the residents are a stable group who have lived together for sometime. The contract is in a pictorial format and clearly outlines the rights and responsibilities to the service users. The format used allows the service users to have an opportunity to be involved in the process. The details of two contracts were seen on the day of inspection. High Oaks (1) DS0000019422.V292303.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): 6,7,8,9 and 10 Quality in this outcome area is excellent. This judgment was made using the available evidence at this inspection. The high standard of care planning means that service users needs are subject to a robust system of assessment and review. Service users individual records were found to be secure and confidential. EVIDENCE: All service users have an individual service user plan, and an allocated key worker to support them. Information is stored in the upstairs sleeping in room, which is kept locked other then when in use. Two care plans were inspected. Both contained detailed information of the service users preferred way of doing things i.e. try to encourage the person to eat at the table with the other residents but be aware that she finds this difficult and may at times clearly state ‘No’. A Section with clear guidelines for managing behaviour was seen, and this appears to enable a consistent approach by staff. Care plans were found to be up to date, and all health appointments were clearly documented. High Oaks (1) DS0000019422.V292303.R01.S.doc Version 5.1 Page 10 Window restrictors have now been fitted to all first floor windows (standard 42) and risk assessments had been updated to reflect the change. Service users continue to be encouraged to participate in decisions made about the home, and residents meetings are held regularly. POWHER advocacy service has been involved in supporting residents for sometime. The manager advised that this work was due to finish. Clearly the work started is very impressive involving the residents in the organisation of the home and it is important that the work started is continued. High Oaks (1) DS0000019422.V292303.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): 12,13,15,16 and 17 Quality in this outcome area is good. This judgment was made using the available evidence at this inspection. Care plans demonstrate a high level of commitment to support service users in a wide range of activities, both within the home and outside in the community. Service users are involved in selecting the food they wish to eat; and staff support by providing information relating to varied, healthy eating. EVIDENCE: The inspectors saw that routines in the home are flexible, and varied according to individual choices, and needs. On the day of inspection several service users were at the day centre; another person had a visitor, and two people had been out and just arrived home. Most service users attend a day centre, or some form of activity outside of the home four days per week. All service users have one day off per week in order to attend to their personal tasks including washing, cleaning their rooms and personal clothes shopping, this is usually spent with their key worker wherever possible and often includes lunch out. High Oaks (1) DS0000019422.V292303.R01.S.doc Version 5.1 Page 12 Staff support and encourage all service users to develop independent living skills, and are actively encouraged to develop and maintain relationships socially within the local community. Staff and service users are involved in the preparation of food together. Dependent on the choice of the day and how complicated it is to cook meant how much the service users were involved. Much of the food was freshly cooked and this was a very positive system allowing everyone to do as little or as much as they were able. Snacks and drinks were available throughout the day, and there appeared to be no restrictions. High Oaks (1) DS0000019422.V292303.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): 18,19, and 20 Quality in this outcome area is good. This judgment was made using the available evidence at this inspection. Assessment and reviews are completed regularly and any changes to care well documented. The standard of medication practice is also good. EVIDENCE: The manager and staff within the home have developed detailed action plans regarding service users health needs. The format is user friendly, and has encouraged individuals to be involved. The service has access to a range of input from specialists such as community nurses, consultants as well as more routine dentists and G.P’S. All appointments are recorded with any necessary actions. Assessments and reviews are regular completed ensuring that the approach adopted is person centred and holistic, meeting each person’s individual needs. Medication records were checked and found to be correct. A requirement was made at the last inspection regarding the temperature medication must be stored. There is now a procedure in place to monitor the storage temperature of medication in the home. Temperatures are recorded daily. High Oaks (1) DS0000019422.V292303.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgment was made using the available evidence at this inspection. Service users are listened to, and every effort is made to ensure they are protected from abuse. EVIDENCE: The manager and all permanent staff have completed training on the protection of vulnerable adults. There are a number of regular agency staff that work at the home but the manager assured the inspector that agency staff are made aware of the policy, and showed a copy of the basic induction used with agency staff. The agency staff member on duty, who was interviewed, showed an understanding of what to do should a resident report a concern, and was also able to show where the policy was kept. No complaints had been received since the last inspection; in fact the last recorded complaint was in 2003. There is however a comprehensive system in place to follow. The advocate service POWHER have been involved in working with service users and this has defiantely helped the residents having a say in how the home is run. The manager showed the paperwork, which had been completed in meetings and confirmed a commitment to continue to use this format. The financial records checked during the inspection were found to be accurate and the procedure in place appears very through i.e. the service users keep their own locked tins, which are checked with them, daily. High Oaks (1) DS0000019422.V292303.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is excellent. This judgment was made using the available evidence at this inspection. The home and garden area offers a pleasant and homely environment. The standard of hygiene is good, and the residents are actively involved in keeping the home clean and tidy. EVIDENCE: The residents feel proud of their home. When asked they replied “Lovely, just lovely”.” Another person said,” My bedroom is mine”. The manager said that when decorating a communal area she always asks residents for ideas, and then tries to incorporate what has been asked for. A requirement was made with regard to recording dates of opening for food in the refrigerator at the last inspection. This was checked and all opened food was dated. The fridge, cooker and microwave were found to be clean and hygienic. Staff make a great deal of effort to ensure the home suits individual service users needs and that bedrooms are personalised. High Oaks (1) DS0000019422.V292303.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 35 Quality in this outcome area is adequate. This judgment was made using the available evidence at this inspection. The home operates a robust recruitment process which should provide confidence and protection to service users. However a high level of agency staff are used to provide consistency of care, and the provider must ensure that permanent staff are in place to provide the necessary security to the people living in the home. EVIDENCE: The registered manager appears to have made effort since the last inspection to recruit permanent staff within the home. Recruitment of staff is an on going concern. Staff have been appointed but for various reasons there has been difficulties with confirming full employment history. The rotas clearly demonstrate an effort on the manager’s part to provide consistency in the care delivered, but this cannot substitute a permanent staff team. Walsingham offer all newly appointed staff a detailed and well-structured induction and foundation-training programme. This covers all mandatory training including, food hygiene, manual handling, first aid, risk assessment, fire safety and understanding of service users with a learning disability. High Oaks (1) DS0000019422.V292303.R01.S.doc Version 5.1 Page 17 The training is structured over a period of several months and forms part of the induction. The care plans provide a high level of detail and this enables agency staff to work with service users with ease. The manager advised that she always tries to be on duty herself if and when new agency staff starts working at the home. It is very important that if agency staff are going to be employed almost like permanent staff that this clearly acknowledged and that agency staff access training and supervision as would a permanent member of staff. The manager will need to be able to demonstrate this in practice. Team meetings are being held, but the minutes seen did show times when meetings did not occur i.e. December time, around the Christmas period. It is extremely important that these meetings occur monthly and include agency staff. Staff interviewed were very complementary with regard to the support received from the manager and said that she has an ‘open door policy.’ and will always find time to discuss issues with staff. High Oaks (1) DS0000019422.V292303.R01.S.doc Version 5.1 Page 18 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 , 42 and 43 Quality in this outcome area is adequate. This judgment was made using the available evidence at this inspection. Staff are managed and supported effectively and understand their roles and to whom they are accountable. There is however concern at the number of agency staff working in the home, and a need to continue to try to recruit permanent members of staff. A senior officer within the Walsingham group conducts regular monitoring visits and produces written reports on the conduct of the home. This ensures that standards are monitored and maintained for the benefit of the residents living in the home. EVIDENCE: All staff spoken with said they were very well supported both by the manager and deputy. There are clear mechanisms within the team such as the regular handovers, which allow opportunity for discussion and ensures consistency of the service provided. High Oaks (1) DS0000019422.V292303.R01.S.doc Version 5.1 Page 19 All staff understood the management structure of the home and their roles in delivering the service outlined in the home’s statement of purpose. Formal supervision is only one element in good management practice and the manager is often on shift herself to work with, or guide practice. The service has been without a permanent manager for a considerable amount of time and a requirement regarding registration was made at the last inspection. The current manager has been in post as acting manager for a lengthily period of time and has been interviewed and now is permanent. An application has been received for her to register as manager with C.S.C.I. The service would benefit from a yearly quality assurance report being produced. Many of the quality monitoring indicators are already in place and it would be a simple exercise of regularly gathering evidence and producing a report. High Oaks (1) DS0000019422.V292303.R01.S.doc Version 5.1 Page 20 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 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 2 X 3 X X 3 2 High Oaks (1) DS0000019422.V292303.R01.S.doc Version 5.1 Page 21 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 YA33 Regulation 18 Requirement The manager must ensure that active recruitment continues, ensuring that vacant posts are filled with competent, trained staff for the safety and continuity of the of the service users. Timescale for action 21/09/06 2. YA43YA37 8 A registered manager must be in post. (Application received) 21/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations High Oaks (1) DS0000019422.V292303.R01.S.doc Version 5.1 Page 22 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.V292303.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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