Inspection on 23/02/06 for House 2 Slade House

This inspection was carried out on 23rd February 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 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

House 2 Slade House 28/08/07

House 2 Slade House 03/08/06

House 2 Slade House 30/11/05

House 2 Slade House 16/02/05

House 2 Slade House 11/11/04

House 2 Slade House 09/03/04

House 2 Slade House 09/12/03

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

CARE HOME ADULTS 18-65 House 2 Slade House OLD NHS Trust Horspath Driftway Headington Oxford OX3 7JH Lead Inspector Catherine Kane Unannounced Inspection 23rd February 2006 10:45 House 2 Slade House DS0000013162.V284723.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 House 2 Slade House DS0000013162.V284723.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. House 2 Slade House DS0000013162.V284723.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service House 2 Slade House Address OLD NHS Trust Horspath Driftway Headington Oxford OX3 7JH 01865 228135 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) paul.tossi@oldt.nhs.uk Oxfordshire Learning Disability NHS Trust Mrs Catherine Sarah Baker Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places House 2 Slade House DS0000013162.V284723.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 3 30th November 2005 Date of last inspection Brief Description of the Service: The Step Down Service (House 2) is a three bedroomed house situated on The Slade site in Oxford. It provides a transitional placement for individuals who have a learning disability and have moved from secure in-patient environments. The service falls within the remit of the specialist health services at Oxfordshire Learning Disability NHS Trust (OLDT). The house provides short-term accommodation and outreach support for up to three people who are assessed to subsequently move into the community within a timescale of two years. Clinicians and the management team, before acceptance into the service, formally assess individual’s needs. Service users identify their own needs through a ‘life planning’ process/tool and are supported by staff to gain the skills required to achieve goals and eventually achieve independence in the community. House 2 Slade House DS0000013162.V284723.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place during the day of Thursday, 23 February 2006. The staff did not know the inspectors were planning to visit. The purpose of the visit was to see how the home is meeting National Minimum Standards. Two inspectors carried out this inspection, which took almost two hours. The inspectors spent this time with one of the residents who currently lives in the home. They also briefly met two other residents during the visit. The inspectors also spoke with the acting manager and one other member of staff. They read notes kept in the home, looked at care plans and saw how staff helped residents look after their medications. Whilst the temporary acting manager was working hard to make sure the home runs smoothly, the home has not had a registered manager for some considerable time. Staff need leadership and clear direction so that residents receive consistent quality of care. A manager must be appointed who must register with the Commission without further delay. The inspectors would like to thank each resident for taking the time to speak with them and thank the temporary acting manager and her staff for their assistance during the inspection. What the service does well: What has improved since the last inspection? House 2 Slade House DS0000013162.V284723.R01.S.doc Version 5.1 Page 6 The garden path and garden shed have been repaired. 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. House 2 Slade House DS0000013162.V284723.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 House 2 Slade House DS0000013162.V284723.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): 2 The home completes a clear and detailed assessment of need before a resident is admitted, giving assurance that care needs will be met. EVIDENCE: The temporary manager and team leaders assess suitability for placement at Step Down (2 The Slade). Assessment is completed before discharge from hospital and follows the Care Programme Approach (CPA) format, Mental Health Act (1983). Restrictions are included within CPA documentation. Assessment information clearly describes an individual’s support needs. The assessments take into account risk management strategies, detailing how the strategies can ensure that a resident is supported to take risks whilst remaining within the remit of their care plan. House 2 Slade House DS0000013162.V284723.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 and 9 Care plans and personal information for residents are written and maintained at a high standard. Consultation with residents regarding their support plans is conducted on a regular basis, allowing for the support provided being consistent, clearly relating to residents’ changing needs and wishes. EVIDENCE: The inspector observed the files of two residents, which contained assessment information including Care Programme Approach (CPA) discharge documentation and care plans. The files contained a number of clear documents relating to the support needs of residents, for example, CPA assessments, risk assessments/risk management plans, information regarding physical health, mental health, legal requirements and daily notes (recording significant events). Review documentation was also held within the file, meeting the requirements of the CPA process. If an individual disagrees with a care plan this can be referred to the CPA team for review. House 2 Slade House DS0000013162.V284723.R01.S.doc Version 5.1 Page 10 Resident’s Essential Lifestyle Plans are being reviewed and updated. Residents’ decisions relate directly to information provided in care plans and risk assessments. Input is recognised from individual’s families. Self-advocacy is encouraged. It was demonstrated that individuals are encouraged to take responsibility for their decisions and any subsequent consequences (relating to risk assessments). Risk assessments/risk management plans are an essential part of an individuals care plan. Assessments clearly relate to care contracts/agreements. Clear risk assessment and guidance is tailored to the individual support needs of residents. House 2 Slade House DS0000013162.V284723.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, 15 and 16 Residents have varied opportunities to take part in activities of their choice and within their local community. Contact with family is important to residents and staff help with this where necessary. Residents are supported to make lifestyle choices, which recognise their individuality. Support is provided to take risks within these choices. EVIDENCE: At the time of the inspection two residents were out as planned on their personal activities. One resident told the inspectors that they preferred to stay at home with staff and this was their choice, but they could do other things if they wanted to. House 2 Slade House DS0000013162.V284723.R01.S.doc Version 5.1 Page 12 From notes kept and from information provided by the temporary manager, the inspector feels that this home places importance on building positive relationships with residents’ families and supporting residents to keep in touch. Independence, individual choice and freedom of movement is linked to individual’s plans, guidance and discharge information. Respectful relationships have been developed between all house members; although it is recognised that behavioural issues can affect the maintenance of friendships. The daily individual routines continue to promote the independence of residents and each individual is expected to participate in housekeeping. House 2 Slade House DS0000013162.V284723.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 Service users’ personal and healthcare needs are appropriately supported. Needs and wishes are respected. Access to additional support from health care professionals is consistent and meets residents’ health needs. Medication is stored securely and administration is accurate, ensuring residents’ safety. EVIDENCE: Residents’ care plans clearly detail healthcare support needs. A member of staff stated that Essential Lifestyle Plans are used for residents to describe routines and preferences in order of importance. A document entitled My Health Profile is completed with residents. House 2 Slade House DS0000013162.V284723.R01.S.doc Version 5.1 Page 14 Visits to the doctor, the optician and the dentist are supported when needed and are recorded within care plans. Oxfordshire Learning Disability NHS Trust (OLDT) provides a responsible medical officer (consultant psychiatrist) for identified individuals. This relates to the requirements of the CPA process and the Mental Health Act 1983. Psychology and occupational therapy services are also provided by OLDT. Medication is stored in a wall-mounted, lockable cabinet in an office. Medication administration records are completed by the psychiatrist, written on an Oxfordshire Learning Disability NHS Trust Drug Administration and Prescription Record. Medication administration records were accurately completed by staff on a daily basis. Medication received into the home is accurately recorded. House 2 Slade House DS0000013162.V284723.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): 23 Staff awareness of adult protection procedures could be improved. EVIDENCE: Staff who met and spoke with the inspector during this inspection were able to provide some degree of understanding of the expectations for protecting vulnerable people from abuse. The inspector strongly recommends that all staff should be fully aware and understand local adult protection procedures in line with the Oxfordshire Multi-Agency Codes of Practice. House 2 Slade House DS0000013162.V284723.R01.S.doc Version 5.1 Page 16 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): Standards 24 and 30 were assessed at the inspection that took place on 30 November 2005. EVIDENCE: House 2 Slade House DS0000013162.V284723.R01.S.doc Version 5.1 Page 17 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): 34 The information available about staff that must be kept in the home had shortfalls. EVIDENCE: A member of staff who had recently transferred from another service run by the same organisation spoke with the inspector. She explained that her job description covered her working within services within the remit of the specialist health services at Oxfordshire Learning Disability NHS Trust that includes secure in-patient environments. These other services are not inspected by CSCI. She had not received a copy of the General Social Care Council Code of Conduct. A sample of staff records viewed by the inspector had major shortfalls in the information that was available. There were no details of the staff member’s job description, qualifications or training, or a signed declaration that satisfactory references, medical and CRB declarations had been received. Requirements relating to regulations regarding the keeping of staff information have been made at previous inspections. The organisation must ensure that all information and documents in respect of staff who work in this home required by regulation are kept in the home and available for inspection. House 2 Slade House DS0000013162.V284723.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 and 39 The home needs a permanent manager to provide leadership, guidance and direction to staff to ensure that residents receive consistent quality care. EVIDENCE: A new temporary acting manager has responsibility for the day-to-day running of the home with supervision from the clinical nurse manager who oversees other specialist health services. A requirement for the organisation to put forward a plan to appoint a manager to register with CSCI was made at the previous inspection. This has not been supplied by the orgainisation. A manager must be appointed who must register with the Commission without further delay. CSCI has not received copies of the proprietor’s representatives monthly visit reports since July 2005. These must be forwarded to CSCI on a monthly basis. The Oxfordshire Learning Disability NHS Trust, who runs this service, has financial and accounting systems subject to internal and external audits. House 2 Slade House DS0000013162.V284723.R01.S.doc Version 5.1 Page 19 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 X 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X X X House 2 Slade House DS0000013162.V284723.R01.S.doc Version 5.1 Page 20 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 YA28 Regulation 16(2)(g),(h) Requirement The registered person must provide an action plan detailing a reasonable timescale for the kitchen facility to be replaced or satisfactorily repaired so that it is safe for both residents and staff to use. Requirement from previous inspection. The organisation must put forward a plan to appoint a manager to register with CSCI. Requirement from previous inspection. Timescale for action 31/03/06 2 YA37 8(1)(a) 31/03/06 3 YA34 19(1)(b) The organisation must 31/03/06 ensure that all aspects of the regulations regarding the employment of staff are met. All information required must be kept in the home and available for inspection. House 2 Slade House DS0000013162.V284723.R01.S.doc Version 5.1 Page 21 4 YA39 26(5)(a) The registered person must send copies of the proprietor’s representatives monthly visit reports from August 2005 to February 2006 to CSCI, and thereafter on a monthly basis. 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA23 Good Practice Recommendations The inspector strongly recommends that all staff should be fully aware and understand local adult protection procedures in line with the Oxfordshire Multi-Agency Codes of Practice. 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