Inspection on 21/04/08 for Little Oaks Residential Home

This inspection was carried out on 21st April 2008.

CSCI found this care home to be providing an Poor service.

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

Other inspections for this house

Little Oaks Residential Home 25/06/09

Little Oaks Residential Home 13/10/08

Little Oaks Residential Home 04/10/07

Little Oaks Residential Home 25/07/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Little Oaks Residential Home 22 Bridgwater Road Taunton Somerset TA1 2DS Lead Inspector Sally Murphy Unannounced Inspection 21st April 2008 11:30 Little Oaks Residential Home DS0000066384.V361452.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 Little Oaks Residential Home DS0000066384.V361452.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. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Oaks Residential Home Address 22 Bridgwater Road Taunton Somerset TA1 2DS 01823 322427 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) pam.degun@tiscali.co.uk Mrs Parminder Kaur Degun Dawn Berry Care Home 4 Category(ies) of Learning disability (5) registration, with number of places Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability- Code LD The maximum number of service users who can be accommodated is 5. Date of last inspection 4th October 2007 Brief Description of the Service: Little Oaks Residential home is a two storey detached bungalow dating back to the 1930’s. The home is situated in a residential area of the town and is a short walk from local shops. There is adequate parking and good sized gardens. The home is registered with the Commission for Social Care Inspection (CSCI) to provide personal care for up to five people with learning disability between the age of 18 and 65 years who require personal care. The registered person is Mrs Parminder Degun and the Registered Manager is Dawn Berry. The fee range is between £350.00 and £900.00 each week. This does not include hairdressing, some outings and personal shopping. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. Since the last key inspection the Commission for Social Care Inspection has met with the Registered Provider and previous Manager and carried out a random inspection. Prior to this inspection surveys were sent to people living at the home, relatives, staff members and health care professionals. The responses received have been incorporated into this report. We (CSCI) also sent an Annual Quality Assurance Assessment (AQAA) to the Registered Provider, which was due to be returned by 18/4/08. This had not been received at the time of this report being written. This inspection was carried out by one inspector over one day. We were able to meet with people living and working at the home, tour the building, observe care practices and view records. The following is a brief summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Little Oaks provides care for up to five people who have a learning disability within a small and homely environment. The home is located close to shops and community facilities. People are able to participate in the running of the home. Rooms are single occupancy. People are able to have keys and lock their bedroom doors if they wish. Surveys were received from four people living at the home. Within these people were asked Do you make decisions about what you do each day? To which each person stated that they are ‘always’ able to do this. People were also asked Do you know who to speak to if you are not happy? To which each person stated that they did. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 6 People living at the home are able to participate in a range of activities, dependent upon their individual needs and preferences. There are appropriate systems in place to protect those people who require assistance in managing their finances. What has improved since the last inspection? What they could do better: Care records must be person centred, and include evidence of consultation with people living at the home. Where appropriate care records must include clear plans or goals to enable people to develop and maintain daily living skills. Where people display challenging or aggressive behaviour an appropriate plan must be developed to ensure that staff respond in an appropriate and consistent manner. Where people self medicate, a risk assessment must be completed, and an appropriate plan developed to ensure that they receive the necessary support and monitoring to continue taking their medication safely. The complaints procedure requires review to ensure that is contains all necessary information and is accessible to people living at the home. The Registered Persons must ensure that any allegation of abuse is promptly shared with Somerset County Council under the Safeguarding Adults procedure. Maintenance work is required in many areas of the home to ensure that people live within a homely, comfortable and safe environment. This includes the Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 7 repair of windows, renewal of paintwork, and provision of bedside lights within some rooms. Some people’s bedrooms had been personalised to reflect their needs and lifestyles, however further support was required to achieve this for all of the people living at the home. Bedding and soft furnishings must be of an appropriate standard, and carpets that are worn and stained must be replaced. The home is generally maintained to a good standard of cleanliness, however further actions are needed within the communal bathroom and laundry to reduce the risk of cross infection within the home. The registered manager must ensure that appropriate documentation is obtained prior to a member of staff commencing work at the home. References must be sought from a staff members’ last employer wherever possible. There must be appropriate systems in place to ensure that staff receive supervision until the CRB disclosure has been received by the home. The registered manager must record the hours that they work on the duty rota. The registered manager must gain further knowledge of the policies relating to the Safeguarding of Vulnerable Adults and POVA and must take appropriate measure to safeguard people living at the home. Quality assurance processes must be improved to ensure that areas for improvement are identified and appropriate plans put in place. The Annual Quality Assurance Assessment (AQAA) must be completed and forwarded to CSCI. CSCI must be notified of all significant incidents in accordance with Regulation 37 of the Care Home Regulations 2001. The registered person must provide details of the actions being taken in response to the recommendations given as a result of the fire risk assessment being completed. 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. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 8 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 Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 9 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): 1 & 5. (Standards 2,3 & 4 do not apply). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receiving the service and their families are provided with appropriate information regarding the home. People are provided with a written contract outlining the terms and conditions of their stay. EVIDENCE: A copy of the Statement of Purpose and Service User Guide was provided. These provide appropriate information regarding the services and facilities available at the home. The contract was seen for one person. This gave details of what is included in the weekly fee, and any notice periods required. The home is fully occupied and there have been no new admissions since the last inspection. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 10 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): 6,7,8,9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate plans have been developed outlining the level and type of assistance required by each person to meet their needs, although it was not clear whether people had been consulted regarding how their needs are met. People living at the home are encouraged to exercise choice and are supported in taking risks. Care records did not evidence that how some people were being supported to develop and maintain daily living skills. EVIDENCE: Care plans have been thoroughly reviewed and a new system introduced for recording peoples’ needs. Care plans were viewed for all of the people living at the home. Care records included basic information regarding people’s needs Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 11 and preferences. The language used within some care records was not person centred, and it was not clear to what extent people had been involved in the development and review of their plans of care. Records had been reviewed on a monthly basis. Care records included evidence of people accessing the local community and exercising choice. One person at the home uses Somerset Total Communication. There was evidence of consultation with the Speech and Language Therapist, and arrangements had been made for staff to receive training in Somerset Total Communication. The review completed by Social Services for one person states that they should receive assistance to develop and maintain independent living skills, with the aim of moving from residential care to supported living. However their care plan does not include clear plans, or goals to achieve this. Risk assessments had been completed for each person in relation to the activities that they participate in. Some people living at the home receive support to access their finances. All transactions regarding people’s monies are supported by two staff signatures and receipts. Monies were checked for three people and each tallied with the records kept. The Registered Manager advised that they audit these regularly. It was recommended that they record when the audit has taken place. Records relating to people living at the home are stored securely and appropriately maintained Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 12 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): 11,12,13,14,15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to participate in a range of activities to suit their individual preferences and needs. People are supported in maintaining contact with family and friends and in accessing the local community. Since the last inspection, people have had a greater involvement in choosing and preparing meals at the home. EVIDENCE: A notice board has been put up in the hallway, which provides details of the staff on duty, and displays photographs of activities and holidays that have taken place. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 13 People are able to spend time in their room or communal areas, as they prefer. Many people have stereos and televisions within their bedroom. People are supported to attend day services, clubs and activities. Some people living at the home go to work. One person living at the home is being supported to go on holiday to Disney world. During the course of the inspection we were able to speak with two people. When asked whether they were able to choose what they do? One person stated ‘sometimes’ and another that ‘its fine’. Surveys were received from four people living at the home. Within these people were asked do carers listen and act on what you say?,to which three people stated ‘always’ and one that this is ‘sometimes’ the case. The Registered Manager advised that they have sought to improve the quality and range of meals provided. This has included more food being prepared at the home, rather than ready prepared foods and greater involvement from people living at the home in choosing the weekly menu. Care records evidenced that people had living at the home had been involved in food preparation and that they had enjoyed these activities. People living at the home eat together on a Sunday. The time of this meal has been changed recently to meet the preferences of people living at the home. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 14 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): 18,19 & 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home receive support to access health care services. There are not appropriate plans in place to ensure that staff are able to meet some people’s health and behavioural needs. The management of medication is generally safe. EVIDENCE: People are provided with support to access health care services. Care records include details of any visits from social and health care professionals. Care plans provide information regarding the level and type of assistance that each person requires to meet their personal care needs. Plans for some people included information on the tasks that they can complete and promoted independence. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 15 Within the surveys received from those living at the home, people were asked, do staff treat you well?, to which each person stated that this was ‘always’ the case. Daily records for one person included instances of them displaying verbal aggression and invading other peoples personal space but there was no plan in place to ensure that staff act in an appropriate and consistent manner to support them. For another person the behavioural care plan requires further development to include information on triggers, so that staff may take appropriate action. For a third person there was an appropriate plan in place. The records for one person stated that they have epilepsy but there was no further information recorded. A care plan must be developed to address this persons epilepsy needs, so that staff are clear regarding the symptoms to observe for and actions to be taken. Medication records and storage was examined. Medication is stored securely. Medication records had been audited by the Registered Manager and two gaps noted. They advised that these had been discussed with the staff concerned. One person at the home manages their own medication. A risk assessment had not been completed regarding self-medicating, and there was no plan in place regarding how and when staff would monitor and support this person to ensure that medication had been taken appropriately. The homely remedy policy states that people cannot be given any medication, such as paracetamol or cough medicine unless it has been prescribed by their GP. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 16 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): 22 & 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The complaints procedure requires review to ensure that is contains all necessary information and is accessible to people living at the home. The Registered Manager has not demonstrated a good knowledge of the Safeguarding Adults procedure and has potentially placed people at risk of harm. EVIDENCE: The home has a complaints procedure. This is not available in an accessible format such as widget or Somerset Total Communication. The complaints procedure states that people should ask for a form to record their complaint but this is not appropriate to the needs of people living at the home who do not all have good literacy skills. The Registered Manager has advised that the home does not maintain a complaints log. The complaints procedure must be amended to advise that people may contact CSCI at any stage. Within the surveys received from people living at the home, each person stated that they did know how to make a complaint. Since the last inspection one person living at the home had raised concerns regarding one staff member. The Registered Manager took actions to safeguard the person, but there was some delay before this was referred to Social Services. These concerns were subsequently considered under the Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 17 Safeguarding Adults procedures and as a result of this, a referral has been made to POVA. During the course of the inspection the Registered Manager advised that a person had also raised concerns regarding two former staff members. The information given indicated psychological and verbal abuse. The Registered Manager stated that these staff members left before she was in post, but was aware that they were working within a care home locally. This information had not been shared under the Safeguarding Adults procedures with Social Services. The Registered Manager stated that they were not prepared to obtain further statements from this person or staff members. A further discussion was held regarding the potential risk to other people that staff may be working with. Failure to act up on information shared regarding these staff members may place vulnerable people at risk. These matters will be followed up with the Registered Manager and Provider following the inspection. The whistle blowing policy includes details of external agencies that may be contacted such as CSCI. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 18 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): 24,26,27,28, & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Maintenance work is required in many areas of the home to ensure that people live within a homely, comfortable and safe environment. Some people’s bedrooms had been personalised to reflect their needs and lifestyles, however further support was required to achieve this for all of the people living at the home. The home is generally maintained to a good standard of cleanliness, however there are not appropriate procedures in place to reduce the risk of cross infection. EVIDENCE: Since the last inspection there have been some improvements to the environment. This has included maintenance of the gardens, fitting of a new Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 19 carpet in one person’s room, installing a further banister for the stairway and an improved system for auditing the cleanliness of the environment. A tour of premises was conducted with the Deputy Manager. A notice board had been put up that included details of staff on duty and photographs of activities and holidays that had taken place. It was noted that paintwork required some repair within the hallway. There is a communal lounge and dining area. These areas are homely and contain photographs of people living at the home. People living at the home are able to watch television or watch DVDs. People are able to spend time in communal areas or their bedrooms as they choose. Within one person’s room the window had been scored or scratched on the outside. This would significantly reduce the strength of the glass and poses a potential hazard. There was no bedside light. The light fitting for the bedroom was not homely and appeared to be suitable for external use. The room had been re-painted but this had not been completed fully and the previous colour could be seen around all of the edges of the room. One drawer had been broken, however this had not been repaired fully and continued to expose sharp edges. The carpet has been replaced within this bedroom. The pillows were flat and the bedding appeared to be worn. Discussions were held with the Deputy Manager regarding how this room could be further personalised to reflect that persons tastes. A further person’s bedroom was seen. It was found that the paintwork and the area where the hand basin has been required repair. The radiator had been covered and window openings restricted. There was no bedside light. The carpet was worn and stained. The Registered Manager advised that they were going to look at paint charts with this person to ensure that the colour scheme reflected their individual preferences. Another person showed the Inspector their room. This had been personalised to reflect their tastes and preferences. They confirmed that they liked the colour scheme and furnishings. They had posters displayed and showed the Inspector their CD collection. This person has a key to their room and chooses to lock this when they are not at home. The remaining two bedrooms are also kept locked by the people living within them and were not seen during this inspection. The Registered Manager advised that one person is receiving support from their key worker to develop appropriate skills to ensure that their room is clean and hygienic. This was evidenced within their care records. Another person at the home is currently re-painting their en suite bathroom. There is a communal bathroom on the ground floor. The tiles at the end of the bath were broken. The bath panel does not have a flat surface that is easy to Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 20 clean, and some paintwork requires repair. The washbasin had recently been re-fitted to the wall, and tiles needed to be fixed to the area above the hand basin. It is important for the prevention of cross infection that all parts of the bathroom are easy to clean and that there are not areas that can harbour infection. Liquid soap had been provided, however there was no bin available. Staff explained the rationale for this, and explained that paper towels are often disposed of within the kitchen. This practice presents a high risk of cross infection and an alternative system must be developed. Paintwork surrounding door handles, including the bathroom door handle is worn to the extent that the porous surface of the wood is exposed. These areas must be repainted to prevent risk of cross infection. There is a small laundry at the home. Part of the floor is missing. There appeared to be some toilet paper on the floor. The home has a domestic washing machine and dryer that are appropriate to the needs of the service user group. There was no liquid soap, paper towels or foot operated bin available and the sealant is broken surrounding the washbasin. The handle had broken on the window meaning that it could not be closed. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 21 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): 31,32,33,34,35 & 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing arrangements have improved since the last inspection. The Registered Manager has not operated a robust recruitment procedure and has not taken appropriate measures to safeguard people living at the home. Staff require mandatory training to ensure that they can do their jobs safely, and appropriately care for those people living within the home. EVIDENCE: Since the last inspection there have been several changes relating to staffing. The new manager has introduced a system of shorter shifts, with staff now working from 8-2, 2-8 then through the night from 8-8. Staffing at night time has changed from sleeping-in to waking nights. This has provided greater supervision and support to people living at the home, and has enabled people to access drinks and snacks during the evening and night should they wish to do so. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 22 Five new staff, including the Registered Manager, Deputy Manager and three care staff have been appointed. Recruitment records were examined. For one staff member, all documentation had been obtained prior to them commencing work, apart from a health declaration. The application for a second staff member did not contain appropriate information regarding the declaration of offences. The application form must be updated to state that all convictions must be declared, and that posts in the home are exempt from the Rehabilitation of Offenders Act. There was not a detailed 10-year employment history for this person. They had produced a CV but for one period of time it states ‘range of employers’ rather than the full employment details. Some information within their CV regarding periods of employment did not match those dates given within references and references had not been sought from the most recent employers. For the third staff member there was no record regarding the gap in employment prior to them commencing work at the home, and a reference had not been sought from their last employer. The Registered Manager stated that the previous employer had declined to provide a reference but this was not evidenced within the recruitment file. A reference must be requested from this employer and appropriate records maintained. Appropriate documentation had been obtained in relation to the fourth recruitment record seen. For two the new staff members, two references and a POVA first check had been received, but the home was awaiting their CRB disclosure. During the course of the inspection one of these staff members took a person out of the home to an appointment alone. This potentially places the person at risk. A copy of the CRB disclosure has subsequently been forwarded to CSCI. Records and duty rotas did not indicate the supervision arrangements for those people who do not yet have CRB disclosures. It was noted that there were two occasions on the rota when the two staff members who do not have CRBs would be working together. This was discussed with the Registered Manager who advised that they would be present during these shifts and would provide supervision to both staff. However this would mean that the Registered Manager would need to be present during all personal care tasks and that this would have a significant impact on the range of activities available as neither of the two care staff on duty would be able to take people out alone. The Registered Manager has not recorded the hours that they work on the duty sheets. Each staff member had been provided with a job description and contract. The Registered Manager has introduced a Professional Development Folder for each staff member that includes their CV, job description, appraisal and supervision records, training records and certificate and internal memos. A record had not been maintained of the first days induction training. This is important to evidence that staff have received appropriate guidance regarding emergency procedures. The Registered Manager advised that staff had commenced the Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 23 Common Induction Standards training but that this had not yet been completed. A range of staff training has been arranged. This includes the safe handling of medication, fire training and food hygiene. There are plans for staff to receive training on Positive Intervention, autism and epilepsy. A copy of the staff training matrix was provided. This evidenced that the four newly employed staff also require training on first aid and abuse awareness. All of the staff team require training on challenging behaviour and intensive interaction. Within the surveys received from relatives of people living at the home, both respondents made reference to a relatively high staff turnover in recent years and the impact that this can have upon people living at the home Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 24 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): 37,39,40,41 & 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There have been some improvements within the home, however the Registered Manager has not taken appropriate actions in response to complaints raised and may have placed people at risk of harm. Quality assurance processes must be improved to ensure that areas for improvement are identified and appropriate plans put in place. Some further actions are required to ensure the health and safety of people living and working at the home. EVIDENCE: Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 25 The Registered Manager is Dawn Berry. She has been employed at the home since December 2007. She has many years experience of working with care homes, largely within those providing care to older people. Ms Berry has obtained the NVQ level 4 qualification. As previously stated under Complaints and Protection serious concerns have been raised regarding the Registered Managers handling of complaints. It is also of serious concern that the Registered Manager instructed a staff member to take a person out alone, prior to their CRB disclosure being received. CSCI received surveys from two relatives of people living at the home. These provided positive feedback regarding the care provided and particularly regarding the changes implemented by the new manager to ensure that each person receives the assistance required to meet their individual needs. Staff members also confirmed that they have the opportunity to regularly meet with the manager, and were pleased with the changes that had taken place. One staff member wrote that the ‘manager is very approachable’. The Registered Provider completes monthly visits, and forwards copies of these reports to CSCI. These reports include information regarding discussions with people living and working at the home, and review of the environment and documentation. Those reports forwarded to CSCI did not include reference to some of the issues raised regarding the environment within this report, and did not identify failure to follow a robust recruitment procedure despite some recruitment records being examined as part of the monthly visit. The home is also in the process of issuing surveys to people who live at the home and staff members to obtain their views of the service provided. During the course of the inspection we asked people if there was anything that they felt could be better? To which one person stated ‘the staff’, and another that there was nothing that should be changed. The home displays appropriate Employers Liability insurance and the registration certificate is displayed. The home has appropriate polices and procedures. These were reviewed on 25/10/07. All records relating to people living at the home are stored securely and are up to date. The Annual Quality Assurance Assessment (AQAA) was sent to the Registered Provider and was due to be returned by 18/4/08, however this had not been received at the time of this report being written. The kitchen had been maintained to a good standard of cleanliness. Cleaning and temperature records had been appropriately maintained. A cleanliness and Health and safety check had been completed on 16/4/08. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 26 A fire risk assessment has been completed by an external company on 31/1/08. This has raised a number of issues including: several doors (including bedroom doors) that do not comply with fire regulations, emergency lighting that does not meet current standards, that the internal stairway is not fully protected from fire and smoke, and a recommendation that the first floor is not used as sleeping accommodation. The Registered Provider must provide details of the action being taken in response to the concerns raised. The fire equipment was serviced on 23/1/08. This has been tested on a weekly basis, with the exception of 17/4/08 when this was not recorded. A fire drill was last completed on 17/4/08. Portable appliances were tested on 30/4/07. The electrical hardwiring certificate was last completed over five years ago. The Registered Manager advised that arrangements have been made for this to be updated on 11/5/08. Accident records had been completed as necessary. Care records evidenced that one person had been admitted to hospital. However this had not been notified to CSCI in accordance with Regulation 37 of the Care Home Regulations 2001. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 27 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 X 3 X 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 2 27 1 28 3 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 1 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 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 2 2 x 1 X 1 3 2 2 x Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 28 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 YA6 Regulation 15(2)(b) and (c) Requirement The registered manager is required to consult with the person using the service and/or their reprehensive and involve them in the care planning process. (Previous timescale for action was 01/12/07) 2. YA9 15 (2) Care records must include details of the plans / goals in place to enable people to develop and maintain daily living skills. The registered manager must ensure that all healthcare needs identified are acted upon and recorded. (Previous timescale for action was 01/12/07). This relates to need to develop appropriate plans regarding: - challenging or aggressive behaviour 30/05/08 Timescale for action 30/05/08 3. YA19 12(1)(a) 30/05/08 Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 29 - epilepsy needs. 4. YA20 13(2) Where people self medicate an appropriate risk assessment must be completed, and a plan developed regarding how this person will be supported and monitored to ensure that they continue to manage their medication safely. The complaints procedure must be available in a format that is accessible to people living at the home. A complaints log must be maintained. The complaints procedure should state that CSCI may be contacted at any stage. 6. YA22 13 (6) The registered persons must ensure that any allegation of abuse is promptly shared with Somerset County Council under the Safeguarding Adults procedure. The registered person must ensure that paintwork is repaired within the following areas: - hallway (near notice board) - in the bedroom where the hand basin was removed. - in the bedroom where the previous colour is still evident around the edges of the room. - around door handles. 8. YA24 23 (2) [b] The damaged window must be replaced. DS0000066384.V361452.R01.S.doc 16/05/08 5. YA22 22(7)(a) 30/05/08 09/05/08 7. YA24 23 (2) [d] 27/06/08 30/05/08 Little Oaks Residential Home Version 5.2 Page 30 The broken drawer must be repaired fully to ensure that there are not sharp edges exposed. The window in the laundry must be repaired. 9. YA25 23 (2) [p], & 16 (2) [c] A bedside light must be provided for each person, and where this is assessed as not being appropriate, this must be recorded within their care plan. Light fittings must be reviewed to ensure that they are homely and reflect people’s preferences. Bedding and soft furnishings must be of an appropriate standard and reflect individual’s tastes and preferences. Carpets that are worn and stained must be replaced. 10. YA27 16(2)(j) Within the bathroom, broken 13/06/08 tiles must be replaced, and tiles fitted to the area surrounding the washbasin. The bath panel must be replaced. Appropriate systems must be developed for used hand towels to be disposed of. 11. YA30 13 (3) Appropriate flooring must be provided within the laundry. There must be appropriate hand washing facilities for staff consisting of liquid soap, paper towels and a foot operated flip top bin. 12. YA34 19(Schedule The registered manager must DS0000066384.V361452.R01.S.doc 13/06/08 27/06/08 16/05/08 Page 31 Little Oaks Residential Home Version 5.2 2) ensure that all staff employed at the home have undertaken a robust recruitment procedure to include: A 10 year employment history (Previous timescale of 04/10/07 was not met). A health declaration and appropriate declaration of offences must be completed for each person. References must be sought from applicant’s last employer wherever possible and appropriate records maintained. 13. YA36 & YA23 13 (6) There must be appropriate systems in place to ensure that staff receive supervision until the CRB disclosure has been received by the home. The registered manager is required to ensure that all staff receive adequate training to include mandatory training, NVQ training and training in abuse awareness. (Previous timescale for action was 01/03/08). The registered manager must ensure that a record is maintained of all induction training. 09/05/08 14. YA35 18(1)(a) 13/06/08 15. YA37 13 (6) The registered manager must gain further knowledge of the policies relating to the Safeguarding of Vulnerable Adults and POVA and must take appropriate measure to DS0000066384.V361452.R01.S.doc 16/05/08 Little Oaks Residential Home Version 5.2 Page 32 safeguard people living at the home. 16. YA39 24(1) [a] & [b] The registered person must 30/05/08 establish and maintain a system for reviewing and improving the standards of care at the home. The Annual Quality Assurance Assessment (AQAA) must be completed and forwarded to CSCI. CSCI must be notified of all significant incidents in accordance with Regulation 37 of the Care Home Regulations 2001. The registered person must provide details of the actions being taken in response to the recommendation from the fire risk assessment. A copy of the new electrical hardwiring certificate must be forwarded to CSCI. 30/05/08 17. YA39 24 (1) 18. YA41 37 09/05/08 19. YA42 23 (4) [a] 30/05/08 20. YA42 13 (4) [c] 30/05/08 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 YA9 YA33 Good Practice Recommendations It was recommended that the registered manager records when they have completed an audit of peoples financial records. The registered manager should record the hours that they work on the duty rota. Little Oaks Residential Home DS0000066384.V361452.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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