Inspection on 24/10/06 for Limber Oak

This inspection was carried out on 24th October 2006.

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Limber Oak 26/02/09

Limber Oak 06/12/05

Limber Oak 13/07/05

Limber Oak 22/02/05

Limber Oak 13/10/04

Limber Oak 19/03/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Pinta

Kestrel House, St Anne`s Opportunity Centre,

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

CARE HOME ADULTS 18-65 Limber Oak Crookham Common Nr Newbury Berkshire RG19 8DH Lead Inspector Sandra Grainge Unannounced Inspection 24th October 2006 10:00 DS0000011213.V308547.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 DS0000011213.V308547.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. DS0000011213.V308547.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Limber Oak Address Crookham Common Nr Newbury Berkshire RG19 8DH 01635 871213 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) Mrs Pamela Mary Eales Ms Lyn Allen Care Home 7 Category(ies) of Learning disability (7) registration, with number of places DS0000011213.V308547.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Learning disability, some of whom may also have a physical disability. Date of last inspection 6th December 2005 Brief Description of the Service : Limber Oak is registered to provide accommodation and care for up to seven Service users who are aged between eighteen and sixty-five years and have a learning disability and some associated physical disability. Limber Oak is a privately owned spacious two-storey building, it is built on a slope and so has the appearance of two bungalows. The home is situated in an unnamed country lane that has no through traffic. The grounds are extensive and include an orchard and a paddock for goats. The property is not signposted on the main road and is difficult to find. The amenities of Thatcham and Newbury are a few miles away; there is a shop on a nearby caravan site and a public house is within walking distance. There is a bus service from the main road. Fees at 24/10/06 :£1,189--- £1,1372 per week DS0000011213.V308547.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key report contains information collected during an unannounced site visit to Limber Oak made by a locum inspector. Information held in the service file pre informed the inspection together with data provided by the registered manager. In addition, prior to the visit, Service user views had been sought in a survey “Have your say”. No forms were returned to CSCI. None of the service users in Limber Oak is able to complete a survey; sadly, no one had presented their views for them. During the visit and tour of the premises care practice and Service users’ interaction with the staff was observed. No visitors came to the home during the site visit. Records were inspected and the inspector spoke to staff including the senior care worker who was in charge in the morning and the deputy Manager when she came on duty at lunchtime. The inspector spent time with all seven service users. What the service does well: What has improved since the last inspection? The service operates a club in the local village hall that is attended by service users from several homes in the area. Session time arrangements have been adapted to meet service users’ needs; they were obviously pleased to be going out to the club. To improve facilities for service users in the home several air conditioning units were installed during the summer. Following the admission of a new service user to the home the management team has learnt to make the assessment process less rigid and more flexible to suit the needs of the prospective new person. DS0000011213.V308547.R01.S.doc Version 5.2 Page 6 Healthy eating plans are now in place for all service users. The administration of medication procedure has been reviewed and practice made safer for Service users. 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. DS0000011213.V308547.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 DS0000011213.V308547.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, Quality in this outcome area is good. A service user’s family had information about the service prior to admission; it had assisted them to make a choice about the home. This judgement has been made using available evidence including a visit to this service . EVIDENCE: The service has a Statement of Purpose. There are hopes that this can be produced in a format that service users can understand better. There has been one vacant place created in Limber Oak in the last year. The garage was converted into a separate bedroom with ensuite facilities especially for a named Service user who has difficulty living continually in the group setting. The senior care worker explained the assessment process for admission, which includes trial visits that take place prior to the offer and acceptance of a new service user to the house. Each service user has an individual contract and statement of terms. DS0000011213.V308547.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good. Each service user has a plan of care that has been designed to meet their assessed needs and include their individual choices. This judgement has been made using available evidence including a visit to this service . EVIDENCE: Each individual has a plan of care that has been designed to meet his or her assessed needs. There was evidence that plans are regularly updated. On the day when the inspector arrived one of the residents had a plaster cast on his leg to treat and immobilise a fractured ankle. This posed a problem because the cast did not allow him to stand on the injured leg. The staff were working in conjunction with the medical and nursing staff of the hospital to prevent further damage being caused. A member of staff was available to give one to one care for him. Service users are involved in the care planning process and are supported to make choices. The inspector met and talked to all service users. They seemed to enjoy living in Limber Oak in their familiar group. DS0000011213.V308547.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. Service users enjoy their lifestyle in the home where they have opportunities to develop social, emotional, and independent living skills. This judgement has been made using available evidence including a visit to this service . EVIDENCE: Service users attend can attend a local church if they wish and enjoy trips out of the home on foot or in the home’s transport vehicles. No one has a job and only one person was able to benefit from a continuing education programme. All were assisted to develop life skills. Family members are welcomed and everyone has family who visit. The local community is rather sparse in this rural area but because the lane is so free from traffic, service users are able to wander safely from the home in the company of staff. In addition, the grounds of the property are large. There DS0000011213.V308547.R01.S.doc Version 5.2 Page 11 are pet goats as well as a visiting flock of partridge. The garden contains a raised vegetable patch and some robust garden furniture, seating and swings. Staff cook meals with service user help where possible. Meals are shared in the two dining rooms of the house, and some service users participate in turn with the planning and shopping. A healthy food menu is offered and service users’ weight is monitored. Meals out in the local pub or other restaurants are popular. Staff support relationships between service users; friendships are enjoyed and staff assist to plan meals, outings and holidays together for friends. The staff assist service users to keep a record of their outings, holidays and activities. The photos are enjoyed and were shown to the inspector with obvious pleasure. Each individual’s privacy is respected and the staff took care to introduce the Inspector to service users and to explain the signs and triggers for aggressive behaviour. The staff, including agency staff, knew the service users well and they were able to predict behaviour patterns and manage potential tense situations with diffusion and good humour. In addition to the tame goats the home has two pet cats that are well cared for favourites. DS0000011213.V308547.R01.S.doc Version 5.2 Page 12 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. Staff provide personal support and care to meet service users needs in a sensitive and timely manner. This judgement has been made using available evidence including a visit to this service . EVIDENCE: Staff provide personal support and care to enable service users to lead as independent a lifestyle as possible. Each individual has a dedicated key worker who is responsible for his or her wellbeing. It was clear that the staff on duty were familiar with the needs of the residents in the house and have the skills and knowledge that service users are referred for professional medical and nursing care when necessary. One service user has a set of steps that enable her to move around and be more independent. A service user had recently sustained an injury that resulted in a broken ankle. Treatment had been given in hospital but it had been decided by the multi disciplinary team that the service user would recover more quickly in his own environment. This was not easy because he lacked the ability to understand that he could not walk on his leg that was supported in a plaster cast. Progress of healing was due to be reviewed in the near future but at the time if the DS0000011213.V308547.R01.S.doc Version 5.2 Page 13 inspection visit a member of staff was with him at all times when he was awake to prevent further damage. None of the service users is able to be responsible for the administration of medication. Medication is stored correctly and administered by staff trained to do this. During the last year an incident occurred that involved the administration of medication. No harm was done but an investigation has been carried out and as a result the procedure has been changed to improve the safety for service users. The supplying pharmacist regularly inspects the medication ordering, storage and administration. At the time of the visit the records were in order and medication was stored safely. DS0000011213.V308547.R01.S.doc Version 5.2 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. Service users are safeguarded from abuse by staff who adhere to the policy and procedures of the service . This judgement has been made using available evidence including a visit to this service . EVIDENCE: The service has a complaint procedure that is made available to Service users and their relatives. It was apparent that even though they are not able to make a formal complaint all the service users know how to make their wishes known and they expect the staff to understand and respond to their wishes. A record of complaints is kept in the home and checked by the manager and the registered individual. No complaints had been received by CSCI. One complaint has been received by the home in the last year and this was recorded and managed appropriately. All staff receive training in awareness of abuse and this is now part of the coretraining programme as required following the last inspection. No allegations of abuse have been made; however, staff are able to describe the procedure that is to be followed in such an event. Some of the service users have a history of disruptive behaviour and aggression; the service has procedures in place for the management of episodes and staff are trained to notice warning signs and act proactively according to a behaviour management plan. DS0000011213.V308547.R01.S.doc Version 5.2 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): Quality in this outcome area is good. Service users live in premises that are suitable and the service is able to provide care and accommodation in a homely way. This judgement has been made using available evidence including a visit to this service . EVIDENCE: The house is bright, clean, airy, and free from offensive odours. The rooms are attractively decorated. The requirements of the fire service are met, as are environmental health standards. Each service user has a single bedroom with a shared bathroom. Bedrooms are individually furnished and reflect the interests and lifestyle of each occupant. There are two shared lounge /dining areas in the home, these are in addition to the large bed sitting room recently provided for a named Service user so that he can be alone when he chooses. DS0000011213.V308547.R01.S.doc Version 5.2 Page 16 There are plans to provide a Jacuzzi bath in the near future because many of the service users enjoyed these when they were on holiday. The assisted bathing equipment in current use is old and two bath chairs are chipped and hazardous for service users. These must be replaced. In addition, a broken washbasin in the ground floor bathroom has been damaged for some time and must be replaced. A newly installed shower does not have an appropriate shower seat for the service user and the water does not drain away properly. Laundry equipment in the home is capable of washing to infection control standards and staff follow procedures to prevent the spread of infection. DS0000011213.V308547.R01.S.doc Version 5.2 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): 31, 32, 33, 34,35,36 Quality in this outcome area is good. Service users are given care and support by staff who are recruited, vetted and trained to have the skills to meet their needs. This judgement has been made using available evidence including a visit to this service . EVIDENCE: A sample of staff files was inspected and found to be in order. A proper recruitment procedure is followed to ensure that service users are protected from abuse. A core of long-term employees has been trained by the service and they have specialist in- depth knowledge of service users. 54 of staff have achieved NVQ level two or above. Regrettably, agency staff are needed to provide sufficient numbers of staff as the recruitment of permanent staff has not been successful. To ensure safety for service users the agency staff are given training and supervision to familiarise themselves with needs of service users. Induction and ongoing training is provided. Staff are supervised as required and records are now kept of these sessions. DS0000011213.V308547.R01.S.doc Version 5.2 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, 41, 42,43 Quality in this outcome area is good. Service users are supported by a team of staff who have their best interests in mind. This judgement has been made using available evidence including a visit to this service . EVIDENCE: The registered manager for Limber Oak holds the registered managers award, she was not present for the inspection visit but had supplied hand written data that informed this report. A senior carer and the deputy manager were in charge during the day and they ably ran the home and assisted the inspector. There is an open positive atmosphere in the house and service users clearly trust the staff. DS0000011213.V308547.R01.S.doc Version 5.2 Page 19 There was evidence of compliance with health and safety legislation, manual handling regulations, COSHH regulations, control and service of water, gas and electricity supply. Accidents are recorded and monitored. DS0000011213.V308547.R01.S.doc Version 5.2 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 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 3 29 3 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 X 3 X X X 3 3 3 DS0000011213.V308547.R01.S.doc Version 5.2 Page 21 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 YA24 Regulation 23(2) (j) Requirement The Registered Individual is required to replace the damaged washbasin in the ground floor bathroom and complete the installation of the shower and fittings in the new garage conversion. The Registered manager is required to ensure that the damaged assisted bath chairs are replaced. Timescale for action 15/12/06 2 YA42 23(2) (c ) 15/12/06 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 YA24 Good Practice Recommendations The Registered Individual is recommended to provide directions to the home from the main road. 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