Inspection on 30/07/07 for High Oaks (1)

This inspection was carried out on 30th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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) 26/04/06

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 Sheila Knopp Key Unannounced Inspection 30th July & 1st August 2007 16:10 High Oaks (1) DS0000019422.V347466.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 High Oaks (1) DS0000019422.V347466.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. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 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 highoaks@walsingham.com www.walsingham.com Walsingham 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) Ms. S. House Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 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). 26th April 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. The ground floor 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. Information about the service provided at Highoaks, the Statement of Purpose and the Service User Guide, plus a copy of the latest inspection report, can be obtained on request from the manager or Walsingham. The fees for the service are based on individual assessments are currently in the range of £846 - £1116 per week (correct on 1/8/07). High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information in this report is based on two visits to the service. The purpose of the first unannounced visit on 30/7/07 was to meet with the individuals who live at High Oaks. One of the residents showed me around and introduced me to the other people who live at High Oaks. A further visit took place on the following day to review the management systems and to meet with staff. To gain the view of the people who live at High Oaks or visit in a social or professional capacity the Commission sent survey forms to the residents, their relatives, advocates and the health & social care workers they have contact with. It was requested that where residents needed support to complete the survey form sent to them that staff asked someone at that person’s day service to help them so an independent view was obtained. The views of 6 residents, 1 relative, 2 advocates and 2 health & social care workers who returned survey forms have been considered when writing this report. Information received about this service since the last inspection has also been reviewed. What the service does well: What has improved since the last inspection? The kitchen has been modernised and is well equipped for residents and staff. Walsingham have carried out a review of the environment and allocated funds to upgrade specific areas, which includes replacing worn, stained carpets in the lounge and hallway. Walsingham have continued to fund agency staff to make up for the shortfall among the permanent staff team. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Individuals looking to live at High Oaks would be involved in a thorough assessment process to identify their needs and aspirations. EVIDENCE: Walsingham have well developed polices and procedures in place to ensure the needs of individuals looking to move in can be met. This would include the opportunity to met the other residents and try out the service. The current residents have lived together at High Oaks for many years now. As individual needs have changed there is evidence from the care records and discussions with staff that they are reviewed and resources, such as additional staff support, outreach services and alterations within the house are identified to support them. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 & 9 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents appear to be well supported in the day to day routine of their lives but more good be done to be done to promote and develop their individual interests and aspirations. Further work is required to develop the use of person centred care plans as part of the process of continually listening and learning about what is important to individual residents in promoting their rights, choices and independence. EVIDENCE: All residents indicated via their survey forms and contact with the inspector that they liked living at High Oaks and felt well cared for. They said their privacy was respected. Five out of six people said they were involved in making decisions about the home. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 10 As residents came home during the afternoon they went about their individual routines of going to their rooms to relax or having a drink and snack. During the two visits positive interaction between residents and staff was observed. Staff kept an unobtrusive eye on each individual and were available to manage situations before they became a problem for the individual residents or others around. The inspector reviewed four sets of care records. Staff record what activities individual residents have been involved in and how they spent their day but there is little information about how individuals are involved in making choices and how they have responded to the activities and events that have taken place. The acting manager has identified that the care plans do not currently reflect the Walsingham approach to person centred information based on the perspective of the resident and what is important to them. Developing this approach more fully will enable staff to develop and promote the individual interests of residents. The advocacy arrangements to support residents in communicating their needs and wishes that were detailed in the last inspection report are no longer in place. It was reported that alternative arrangements are being considered to provide this additional level of support to residents. The staff interviewed were aware of triggers, which may indicate a change in behaviour that needed to be monitored. Agency staff felt they had been given enough information for them to be confident in managing situations, which may arise. In response to an earlier incident staff have received additional training in the use of appropriate restrictive physical interventions. The care plan of the individual concerned still needs to be updated to identify what specific techniques are appropriate to use in the event of challenging behaviour which may present a danger to the resident concerned and other residents and staff. It is understood that further meetings with the resident’s social worker are planned to put this information in place. No further incidents have been reported and staff report they use de-escalation techniques to diffuse situations. Walsingham has polices and procedures in place to support good practice in this area that include post incident support and de-briefing. A social care worker confirmed that annual reviews were taking place and care plans are adapted as necessary. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Individual arrangements are made to support the educational and leisure needs of each resident and enable them to maintain contact with their families. Residents are able to express their individual identity through the lifestyle choices they make in relation to clothing, hairstyling and how they spend their time. Their interests and personalities are reflected in the decoration of their rooms and the personal possessions they own. There is an awareness among residents of the need to respect each others privacy and personal space but this can be tested and lead to conflict if unchallenged by staff. Residents are provided with freshly cooked meals that they are involved in choosing and meet their dietary needs. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each resident has an individual weekly activity plan, which includes a variety of events outside the home, attending day services and one to one support with outside organisations to support individual interests. Transport is available to enable residents to access different places and events in the wider community during the evening and at weekends. Support is also provided for residents to maintain contact with their families. Walsingham staff attend equality and diversity training sessions so their practice respects each person as an individual who needs to be involved in decisions and choices about their lives. Holidays have not yet been booked for this year but were recently discussed at a staff meeting. Staff were concerned that because of the reliance on agency staff they would not be able to arrange holidays this year for residents. The acting manager reported that Walsingham have agreed that agency staff will be able to support residents on holidays. The resident who showed the inspector around their home so enthusiastically was aware of the issues of privacy and the need to ask people before entering their room. Residents have keys to their own room. Five out of six residents indicated on their survey forms that they liked their food. Residents are involved in menu planning and shopping. Individual dietary needs are identified and support is available from the community dietician who has contact with individual residents. A day centre worker said that the packed lunch the resident brought with them always looked nice. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive the support they need to maintain their personal appearance and hygiene in a manner, which reflects their individuality. Residents have access to the health care services they need to maintain their physical and emotional health. Overall the systems in place support good practice in relation to administering medication but there are areas that need updating. Clear information needs to be recorded on the care plan of a resident prescribed medication to calm them down to ensure it is given appropriately. EVIDENCE: All the residents had received assistance to achieve good standards of personal hygiene. Residents are supported to buy clothes that reflect personal preferences for styling and comfort. Staff report that residents visit various hairdressers in the locality. Aids and adaptations to assist the independence of individuals are in place and kept under review. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 14 There appear to be good links with local primary health care services and learning disability nursing teams and specialists. Regular reviews are carried out. The inspector was able to see that where residents needed specific treatment such as attending the dentist arrangements were made to look at their comfort and anxiety to reduce the impact of any procedures. Health action plans are being introduced for each resident, which will provides clear information regarding their medical history, current treatment and preferences in written and pictorial form. The folder can be taken to GP or hospital visits to provide consistent and reliable information. A health care worker who completed a survey form said that the staff were ‘A good team who take appropriate responsibility and consult promptly when necessary’. The Walsingham polices and procedures support good practice is managing medicines safely. It was reported that they are rolling out a programme of medication training at NVQ level 3 for all staff involved in these procedures. Clear guidelines were in place for residents who require emergency medication to be administered and the stock medicines were stored appropriately and were in date. It was recommended that the list of discretionary medicines that staff are able to give is reviewed and updated by the General Practitioners (GPs) concerned as it was last signed in 1998 and does not provide precise information on the reason for giving, doses or how often it can be given before referring back to the GP for further advice. The records of a resident prescribed Diazepam to be taken when required, need to be updated to provide staff with clear guidance on the indicators for its use and clarity regarding what specific descriptions of behaviour mean in relation to the individual concerned. There was no record on the current administration chart for a single dose of Temazepam stored in the Controlled Drug (CD) cupboard. The dose had not been required but the information had not been brought forward when the new chart was put in place. As there was no other record it meant that the continued security of the medication had not been checked. It is good practice to record Temazepam stocks in the CD book as well as the administration record. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff report residents are reminded of their right to express concerns to their key worker and at resident meetings. Re-instating the support of an external advocate to facilitate resident meetings would be a further aid to residents communicating how they feel. Concerns about an incident where a resident was thought to have been inappropriately restrained have been investigated under the Hertfordshire safeguarding adult procedure and steps taken to provide improved training for staff. Allegations of financial mismanagement are currently subject to a full investigation by Walsingham to identify whether resident’s rights and those of the organisation have been adequately protected. EVIDENCE: All six residents who completed survey forms said they felt safe and were treated well by staff. They all said they knew who to speak to if they were unhappy. Residents have access to a complaint procedure in pictorial format and staff report that they remind residents of their rights individually and at resident meetings. In the past an external advocacy worker has provided support at resident meetings and it is hoped to start this again. There is evidence from a social care worker closely involved with the residents at High Oaks that staff report issues of concern including accidents and incidents appropriately. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 16 A referral was made and investigated under the multi-agency Hertfordshire Safeguarding Vulnerable Adult procedure. This concerned the inappropriate use of physical restraint of a service user by an agency worker and allegations of financial mismanagement. The strategy meeting held in April confirmed that the ‘incident was not as serious as first thought and was the result of lack of specific training around implications of restraint’. The worker who had not received appropriate training in this area no longer works in the home. Specific staff training has just taken place but the guidance that relates to the resident concerned now needs to be incorporated into their care plan so a consistent and safe approach is applied. Walsingham carried out a review of information with officers from the police vulnerable adult unit and are now conducting an internal investigation into the management of the service. A further strategy meeting will be re-convened when the outcome of that investigation is known. Therefore at this stage the Commission is not able to verify that the procedures in place have been followed to protect residents. Walsingham have demonstrated a robust approach to investigating issues brought to their attention and working closely with other professional agencies. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. High Oaks provides a homely comfortable environment for the residents who live there. A review of staff and resident access to disposable hand towels and liquid soap needs to be carried out to promote good hand hygiene. EVIDENCE: The house is nicely decorated. Comfortable furnishings are provided. All areas were fresh and clean. Ornaments, pictures and photographs give it a homely feel. There is space for residents to gather for meals and conversation as they wish in the kitchen diner or L-shaped lounge. There is good access to the garden for those who wish to go in and out at will. The garden is mostly lawn but not over looked and there is a patio area and seating. Individual rooms have been personalised and were all well decorated and furnished. Restrictors are fitted to first floor windows and the hot water temperatures regulated to prevent accidents. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 18 Walsingham have recently carried out an audit and identified maintenance and refurbishment work that needs to be carried out to maintain standards. The assisted bathing arrangements are under review to replace worn equipment but also to look at alternative bathing systems, which will respond to the changing needs of residents. Staff need to carry out an infection control audit to ensure liquid soap and disposable hand towels or other suitable hand cleansing products are provided in key areas, such as the staff toilet, bathrooms and laundry room. This is to reduce the risk of spreading infection through poor hand hygiene. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 & 35 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. While Walsingham continue to try and recruit staff and maintain staffing levels with agency staff, it is of continued concern that residents are not being supported by a permanent well trained staff team who are fully involved in promoting the interest of residents and the service as a whole. The organisation’s policies and procedure on recruitment mean that the suitability of staff to work with vulnerable people is checked before new staff are employed. EVIDENCE: While residents are at home the aim is to provide three staff during the day with a sleep in night duty. Additional funding has been obtained to provide additional staff to support specific activities for individual residents. For the weeks beginning 22 & 29 August 2007 the information on the staff rota shows that over 60 of shifts were covered by agency staff. Regular agency staff are used where possible. On 30/7/07 there were two permanent staff on High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 20 duty and an agency care worker who had worked regularly at High Oaks for several months. There is evidence that Walsingham are continuing with recruitment campaigns to build a complete staff team and to cover long-term sickness. This is the second inspection report that raises concerns regarding the staffing arrangements. The acting manger reported that Walsingham’s procedures preclude agency staff from attending staff meetings and having formal supervision. This means agency staff are not fully integrated into the running of the service. As an organisation Walsingham has systems in place to train, induct and develop the skills of staff. However it was reported that none of the staff at High Oaks currently have National Vocational Qualifications (NVQ) and this needs to be addressed as part of the overall management strategy for the home to ensure staff have the relevant care skills to support residents. The employment information for two permanent staff and one agency worker were reviewed. This confirmed that appropriate recruitment and selection procedures are carried out before new staff have contact with vulnerable residents. A CSCI Performance relationship manager verifies the central systems Walsingham has in place. Managers of services are provided with confirmation that the required checks have been completed and are able to view application forms and references. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39, 42 & 43 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. As an organisation Walsingham puts the needs and views of service users at the forefront of what it does. They need to make sure that stable management arrangements continue to be put in place and are monitored to ensure its principles are fully implemented in practice. EVIDENCE: An application to Register a manager, as required under the Care Standards Act, has been submitted and confirmed by the Commission since the last inspection. Recently High Oaks has been managed by an acting manager from another home covering two days a week. A second full time acting manager has now High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 22 been introduced to carry on the work identified by her colleague to improve the management systems and provide stability. Senior Walsingham managers have been closely involved with the service during this time and have kept the Commission up to date on the management arrangements. Walsingham has quality auditing and reviewing systems in place that cover all aspects of the service. They are in the process of designing a new style survey to provide better information on the views of people who live in their homes. There are systems in place to check that health & safety reviews and tests are up to date. These are also checked and reported on, when senior Walsingham managers conduct their visits. Daily checks on hot water temperatures are recorded and the hot water tested during the inspection was within the required safety limits to prevent accidental scalding. Staff receive the statutory training they need to maintain safe working practices. There is a business plan in place for High Oaks, which links to the Walsingham Corporate plan. A copy of the annual business plan is available to residents in a user friendly format, should they wish to see it. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x 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 3 3 2 x 2 x 3 x x 3 3 High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 12 (1) 13(7) Requirement Update the care plan of the identified resident so there is a written protocol in place that details: 1. How and when restrictive interventions will be used. 2. The specific physical intervention techniques that are sanctioned. 3. The names of staff identified as being competent to use those methods with this person. 4. The review dates. Update care records for the identified resident prescribed Diazepam to provide clear guidance for staff on the indicators for its use. Carry out an infection control audit to ensure staff have the appropriate means to clean their hands at the point at which care is delivered and in the laundry and staff toilet - NHS Essential Steps to Safe, Clean Care(2006) Ensure the employment of any person on a temporary basis will not prevent residents from receiving continuity of care, DS0000019422.V347466.R01.S.doc Timescale for action 30/09/07 2 YA20 13(2) 30/09/07 3 YA30 13(3) 30/09/07 4 YA33 18 31/01/08 High Oaks (1) Version 5.2 Page 25 which is reasonable to meet their needs. 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 YA20 YA20 Good Practice Recommendations Record Temazepam in the Controlled Drugs register to establish a robust auditing trail. Ask the GPs concerned to review and update the discretionary medicines policy so there are clear guidelines for staff on the reason it is given, dose, interval between doses and how many times it can be given before the individuals symptoms are referred back to the GP for review. High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 High Oaks (1) DS0000019422.V347466.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!