Inspection on 05/12/06 for High Oaks

This inspection was carried out on 5th December 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Oaks 22/12/09

High Oaks 17/12/09

High Oaks 26/10/09

High Oaks 13/08/09

High Oaks 03/07/07

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

CARE HOME ADULTS 18-65 High Oaks Rectory Road Gissing Diss Norfolk IP22 5UU Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 5th December 2006 10:20 High Oaks DS0000067173.V323931.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 DS0000067173.V323931.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 DS0000067173.V323931.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Oaks Address Rectory Road Gissing Diss Norfolk IP22 5UU 01379 674456 P/F01379 674456 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) High Oaks Farm Limited Mr Gary Colin Stear Care Home 18 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (18) of places High Oaks DS0000067173.V323931.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered to accommodate up to eighteen (18) people of either sex, with mental disorder excluding learning disability or dementia. There must be a registered manager at the home, who shall be a first level Registered Mental Nurse. 2nd February 2006 Date of last inspection Brief Description of the Service: High Oaks is a registered nursing home providing residential nursing care for up to eighteen residents of both sexes, who have mental health problems. The home also provides short-term care. The current proprietor took over in July 2003, and is using all rooms for single occupancy. Communal areas are in the main part of the home, with bedrooms in a converted single storey extension. The home is in a rural setting, and affords peace and tranquillity for residents. Access to local towns and facilities, requires use of the home’s own transport as access to public transport is limited. Specialist support services required are accessed via G.P referrals. High Oaks DS0000067173.V323931.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was unannounced. Its purpose was to look at the routine of the residents, their safety and to ascertain what action has been taken in relation to the requirements made in the last report. All of these have been addressed although there are some areas that need further expansion. What the service does well: What has improved since the last inspection? There have been improvements in the internal environment with a number of areas being refurbished. Better procedures are in place for handling medication. The home now has in place a more robust system for recruitment. The staff now are in receipt of supervision as set out in the Standards. All areas of maintenance are recorded and records kept of the safety of systems. Visits are now made in accordance with regulation 36. High Oaks DS0000067173.V323931.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 DS0000067173.V323931.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 DS0000067173.V323931.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Persons who use the service have adequate information to make an informed decision about admission to the home. Prospective service users are given written confirmation whether their needs can be met. EVIDENCE: Case tracking confirmed good practice, it also confirmed that the process for assessing prospective residents was carried out over a period of time and settling in period to ensure that the residents needs can be met. The manager mostly deals with all the assessments and quite often discusses individual cases with the Registered Nurses. Newly admitted service users confirmed that they had been given sufficient information prior to admission that allowed them to make an informed decision about admission to the home. Contracts were seen for newly admitted residents and written confirmation that their needs could be met. High Oaks DS0000067173.V323931.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service, the inspection process and discussion with service users. Service users are encouraged to lead independent lives. EVIDENCE: The Inspector examined three care plans; these had been developed using the assessment process as the initial guidelines for care. The paperwork for the care planning system has been updated and was very detailed which related to the assessed needs of the individuals. There was evidence of evaluation and changes in care where relevant. There were detailed daily notes and communication sheets along with doctor’s notes. Risk assessments were in place with evidence of service users being encouraged to take responsible risks in relation to their therapeutic intervention of care. Those service users spoken with confirmed that they were encouraged to move towards leading independent lives and this was in relation to their assessed needs and ability. Meetings with service users are held every morning when service users are given the opportunity to participate in the day-to-day running of the home. High Oaks DS0000067173.V323931.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service, discussion with service users and the chef. Activities and meals are managed well. The service users are encouraged to be in control of their own lives and enhance their social skills whilst developing personally and meeting their assessed needs. EVIDENCE: Discussion with service users and staff confirmed that opportunities were given to encourage them in personal development and educational needs; some care plans had evidence of service user involvement in cooking and use of a budget to do this. A number of service users swim or visit a local gym, others participate in reflexology sessions and some choose to join in woodwork sessions. Opportunity is given in the morning meetings for the service users to choose what trips they would prefer to do that day and they confirmed that they had a lot of discussion as to what they all wanted to do for Christmas. The general consensus was that the service users felt that the meals were good and that the chef catered for different choices. During the inspection process it was noted that some of the service users were having one to one sessions with their counsellor. High Oaks DS0000067173.V323931.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service, discussion with staff and service users. Service users are well supported by staff. The handling of medication could be improved in some areas. EVIDENCE: Accumulated evidence (to be completed after fieldwork) The Inspector after discussion with service users gained the impression that they were well supported by all levels of staff and that they were encouraged to make decisions about their daily lives and enabled to make choices as to what they did. Medication is handled appropriately mostly, however the system for home leave medication and the way it’s managed needs to be reviewed. Those who self medicate have self-medicating risk assessments in place and these are reviewed. There was evidence in place of weekly audits for medication, it was also noted that there was an appropriate system in place for the disposal of medication. The care plans indicated observations of residents for side effects if on certain medication and the inspector noted that only sufficient Clozapine was kept for each resident until the next blood tests were due. High Oaks DS0000067173.V323931.R01.S.doc Version 5.2 Page 12 Medication policies and procedures were in place and seen by the Inspector. Those service users spoken to were happy with the way their medication is handled. High Oaks DS0000067173.V323931.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service, available evidence, the inspection process and discussion with the manager, staff and service users. Arrangements for dealing with complaints is satisfactory. The number of incidents involving service users needs to be reduced. EVIDENCE: Those service users spoken to felt that they were listened to and that they knew who to go to if they had any concerns. Plans are in hand to ensure that all staff members receive training in all areas related to the protection of vulnerable adults and management of aggression. In discussion with management it would appear to the Inspector that the incidents reported to the Commission were a result of conflict of interests with two members of staff and lack of knowledge on their behalf of how to deescalate explosive situations. It is therefore recommended that the skill mix of staff be addressed to ensure the better management of difficult situations. Staff spoken to, were very aware of all issues relating to the protection of vulnerable adults High Oaks DS0000067173.V323931.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service, on observations made during a tour of the home, available evidence and discussion with staff, service users and the manager. There has been some enhancement of the appearance of the home. EVIDENCE: The home was found to be clean and reasonably tidy. Service users whose rooms were inspected stated that they were satisfied with their accommodation and there was evidence of personalisation in these rooms; however, although a number of improvements to the environment have taken place there is still need for more improvement to take place in order to enhance the overall ambiance of the home internally and externally. The improvements that have been made are, complete refurbishment of the smoking room plus new flooring and a facility for smoke extraction has been added; new furniture has been bought for the non-smoking room. . A new front door is insitu, the corridor floor has been re laid and three bedrooms High Oaks DS0000067173.V323931.R01.S.doc Version 5.2 Page 15 have been re plastered; part of the roof has been replaced and new oil tanks are in position. Plans are in place for refurbishing the kitchen, and it is recommended that the purchase of a dishwasher be considered in these plans to encourage best practice and reduce the risk of infection and promote good hygiene in the area. High Oaks DS0000067173.V323931.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service, This judgement has been made by examining records discussion with staff and management. Improvements have taken place. EVIDENCE: Discussion with staff members confirmed that they felt that they were well supported by the management and that they were clear about their roles within the home; one staff member commented that she had been given more responsibility and felt supported in her new role. Another staff member said that she felt that she was listened to especially in matters related to health and safety within the home. Records for newly appointed staff were examined and were seen to reflect a more robust system for recruitment. The staff spoken to also felt that they were now given opportunities for training and records for staff training reflected this. New staff members confirmed that they had an induction and records for this activity were seen. Formal supervision is now in place including reflective supervision. NVQ training is continuing, however two staff members who have been encouraged to go on to complete their NVQ 3 are leaving. High Oaks DS0000067173.V323931.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service, using information gained from service users, staff and the manager. Records were also checked to provide further information. A formal system for monitoring the quality of the services needs to be introduced. EVIDENCE: The inspection process, discussion with staff and service users led the Inspector to form the opinion that the home is well run; the present manager although not in post long has started to make inroads into improving all aspects of management of the home. The staff and service users feel that they are well managed and supported. Maintenance records were examined and found to be in good order. A formal system for monitoring the quality of the services needs to now be implemented as the paperwork is in place for this activity to take place. High Oaks DS0000067173.V323931.R01.S.doc Version 5.2 Page 18 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 2 28 x 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 3 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 3 3 3 3 2 3 x 3 x High Oaks DS0000067173.V323931.R01.S.doc Version 5.2 Page 19 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA39 Regulation 24 Requirement The registered person shall establish and maintain a system for reviewing and improving the quality of care provided in the home. Timescale for action 01/03/07 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 DS0000067173.V323931.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 DS0000067173.V323931.R01.S.doc Version 5.2 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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