Inspection on 04/10/07 for Little Oaks Residential Home

This inspection was carried out on 4th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 16 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 21/04/08

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 09/07/2008.

CARE HOME ADULTS 18-65 Little Oaks Residential Home 22 Bridgwater Road Taunton Somerset TA1 2DS Lead Inspector Gail Richardson Unannounced Inspection 4th October 2007 09:30 Little Oaks Residential Home DS0000066384.V351132.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.V351132.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.V351132.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 Janet Carol Bird Care Home 4 Category(ies) of Learning disability (5) registration, with number of places Little Oaks Residential Home DS0000066384.V351132.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 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. The fee range is between £350.00 and £900.00 This does not include hairdressing, some outings and personal shopping. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place over 4 hours and 10 minutes on the 4th October 2007 by inspector Gail Richardson. A tour of the home took place all of the bedrooms and all communal areas were seen. There were 5 people using the service currently residing at the home. The inspector spoke to 1 person using the service and 3 members of staff ,the Registered Manager was available throughout the inspection. As part of this inspection the inspector surveyed the opinions of all people using the service and their representatives, GP’s, District Nurses and Care Workers, these responses will be used in the body of this report. Records relating to care, staff, finances and health and safety were examined. The inspector was only able to speak with one person using the service as all others were out, this person looked well cared for and expressed their opinion about the care they received. The inspectors would like to thank the people using the service and staff for their time and hospitality through out the inspection. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘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. What the service does well: What has improved since the last inspection? The garden area has been improved and upgraded for use by people using the service. There has been improved communication between the home and relatives/ representatives. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 6 The storage of cleaning solutions hazardous to health are now stored securely in line with COSHH guidelines. Risk assessments are now in place for radiators which do not have a protective cover. Medication Administration Record for a person using the service who self medicates now contains a signature by that person to say medication has been received on a weekly basis. Financial transactions are now signed by 2 staff members. What they could do better: The registered manager must ensure that the home has available on request a Statement of Purpose and service User Guide within the home to ensure that people using the service have clear information about the service being provided. The registered manager is required to ensure that appropriate consultation by a pre admission assessment has taken place with the service user or their representative prior to admission. The registered manager is further required to ensure the development of the care plans to ensure that all areas of identified need have a suitable care plan in place and that people using the service and their relative/reprehensive are involved in the care planning process. Regular review and documentation of these reviews is also required. These are required to ensure that all aspects of care are included in the care plan. The registered manager must ensure that all healthcare needs identified are acted upon and recorded to ensure that all care needs are met. The registered manager must ensure that all medications are administered correctly and procedures be in place to audit medication systems within the home. Immediate Requirement Made 04/10/07 The complaints procedure is recommended to be displayed clearly within the home and contain the contact details of CSCI to enable anybody wishing to complain has contact details available. The registered manager is required to ensure that the areas of the home including the bathroom which have a malodour maintain a satisfactory standard of hygiene. The registered manager must ensure that all staff employed at the home have undertaken a robust recruitment procedure to include Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 7 • Completing an application form • A 10 year employment history • 2 satisfactory references • A satisfactory POVA check • A CRB check and appropriate risk assessments. This is required to ensure that people using the service are not at risk of harm/abuse. Immediate requirement made 04/10./07 The registered manager is required to ensure that all staff receive adequate training to include mandatory training, NVQ training and training in abuse awareness. The home is required to ensure all staff complete this induction within a 12 week period. The registered manager is required to provide a record of all supervision of staff. This record is required to be stored securely within the home and in line with the Data Protection Act 1988. The registered manager must ensure that she is aware of all current legislation relating to staffing to ensure that people using the service are not placed at risk. The registered manager must ensure that hot water out lets are regularly checked and temperatures which exceed 43 degrees are reduced to ensure that people using the service are not at risk of injury. The registered manager is recommended to review and audit all accidents to identify trends and repeated incidences to reduce the risk of further accidents/injuries to people using the service. 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.V351132.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.V351132.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 2 4 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. No Statement of Purpose or Service User Guide was available at the home to enable prospective people using the service to make an informed decision. about the home. Pre admission assessment has not been formalised and documented, visits to the home prior to admission take place to enable the prospective person to see if the home is suitable for them. EVIDENCE: On the day of inspection the Registered Manager was unable to provide a Statement of Purpose or Service User Guide. There were no copies evident in peoples rooms or communal areas. The registered manager must ensure that information regarding the home is available to people using the service. 4 people using the service surveys were returned to the inspector and 2 of these confirmed that they received enough information prior to admission. 3 relative surveys stated that 1 always had enough information about the service and 2 said usually. The home has had one admission since the last inspection. Pre assessment documentation is required to ensure that the registered manager is confident Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 10 that all aspects of care can be met by the home. Records of home visits were available and the Local Authority had provided a comprehensive Single assessment Process document (SAP). However the registered manager confirmed that she had not formalised any pre admission assessment to ensure that the home could meet the persons needs or documented any consultation with that persons relative/representative. Residents surveys noted that 3 confirmed contracts had been received. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 11 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 poor. This judgement has been made using available evidence including a visit to this service. Care plans require further development to ensure that all areas of identified need are appropriately care planned and information provided for staff to support those needs. The people using the service are able to make some decisions affecting the running of the home. Risk assessments to promote independence are in place for some activities undertaken. Care Plan records are maintained in line with the Data Protection Act. EVIDENCE: Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 12 Two care plans were examined as part of the case tracking process and due to people using the service being away from the home only one person was available to speak to the inspector. Care planning systems in place at the home are in need of re-development to ensure that all areas of identified need are risk assessed and appropriate care planning put in place. One person had no care plan in place for an allergic response and further care plans highlighting behavioural issues did not include triggers for changes in behaviour. These are required to support both the person and the staff member to be aware of any circumstances which may affect behavioural changes. One occasion was identified when the person using the service complained of feeling physically unwell, there was no record of contact with the GP. The registered manager confirmed that this particular issue happens regularly, however no care plan was available to support the person and staff to deal with this ongoing situation. No night care plans were in place to advise and support people using the service to access staff should they need assistance in the night. Call bells are not available within the home and care staff undertake an on call sleeping night. No input in care planning was evident from either the person using the service or their relative/representative although a record of family contact was maintained. The last care plan review for one care plan examined was in May 2007. Risk assessments were in place for some activities and some areas of identified behavioural risk. One person using the service was noted to have purchasable medication in their room and alcohol, risk assessments must be put in place to ensure the persons safety . When asked do you receive the care and support you need, 1 survey said always and1 said usually, 2 said sometimes all 4 responded that staff listen and act on what the residents say and all 4 felt they received the medical support they needed. Relatives felt well informed about the care being given and comments included “They do their best to get in touch with me” Of the 9 staff surveys received, confirmed that 8 staff were involved in care planning for residents. One person using the service confirmed that they usually get up around 7am, however records indicated that on one occasion the person using the service did not wish to get up and was encouraged by staff to get up at 06:10 for a bath. The person stated that they had been up earlier than 7am on some occasions. The registered manager confirmed that people using the service are requested to return to their rooms at 10:30pm and the communal areas are locked. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 13 People using the service have access to TV in their rooms and can stay up as long as they wish. The registered manager confirmed that the home does not encourage the lounge TV to be switched on during the day as this inhibits the promotion of activities. On the day of inspection, 2 people using the service were at work, one was at college and one was on a home visit. The remaining person was observed to be sat in the garden with staff member colouring pictures. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 14 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): 12 13 14 16 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are supported to work, undertake educational programmes and maintain contact with friends and relatives. Leisure activities are provided by the management of the home. The home supports people using the service to maintain privacy and independence within their daily routines. More support is required to ensure adequate hygiene is maintained within the scope of this independence. The home provides an adequate menu and mealtime provision. EVIDENCE: The home supports 2 people using the service to work and one person to attend college. On the day of inspection a further person was on a home visit. Activities are provided and one person was able to tell me of a recent trip to the visiting fair and of holidays in Cornwall. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 15 The home records these activities in the daily record and risk assessments are in place as required. Resident’s surveys asked are there activities arranged by the home that you can take part in, 2 -always, 2-usually. One relative commented that “ Under the present ownership and management it is good that the residents are encouraged to interact, do things together and enjoy outings and trips, this is much appreciated”. The people using the service have access by key to their own rooms and staff are aware that some people using the service prefer that they do not enter without being invited. Some people undertake their own cleaning tasks and two people are supported to do their own laundry. One persons room and en-suite was noted to be unclean and contained debris including several empty beer cans and over the counter purchased medication. Staff were aware of this practice. The registered manager is recommended to provide the support and education needed to ensure that this person using the service can maintain independent living but is also maintaining a clean and safe environment to live in. The home supports people using the service to assist in making their own breakfast and cereal and toast are available. The registered manager advised that cooked breakfast is available. The lunch is a lighter meal of sandwiches, bacon rolls or pasties with the evening meal being the main meal of the day. On the day of inspection the evening meal was planned to be pizza and chips. Resident’s surveys asked if residents like the meals at the home, 2-always, 1usually and 1 said sometimes. Comments received when asked if people using the service enjoyed the meals included,” good food and healthy” and ”Not always”. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. People using the service are supported to maintain their own personal hygiene. Healthcare needs are not always addressed . Medication systems within the home require immediate attention to ensure people using the service are not placed at risk of incorrect dose administration. EVIDENCE: The home supports 3 people to maintain their own personal hygiene. Running water within 2 of those rooms has been risk assessed and removed and those people are assisted in the communal bathroom. When asked if the home supports people using the service as agreed relatives responded 2-always and 1 usually, comments received included, “Everything seems to be going very well indeed.”, and the home “Provides a happy caring environment”. And “Looking after my relative, they look very well and they try their up most to take care of them for me”. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 17 The report has previously highlighted an issue surrounding contacting the GP in Standard 6, records were available of hospital visits and visits by psychologists. Medication systems within the home were mostly adequate with 2 areas of concern. The medication storage facility was noted to have come away from the wall and so had become portable. The registered manager forwarded confirmation that this had now been rectified on 18/10/07. The stock levels of ‘as required’ medication were examined and it was agreed by the inspector and the registered manager that the level of one medication did not match the record of doses given and it appeared that some medication was missing. An Immediate Requirement was issued that the registered manager investigate this matter to establish the cause of this deficient and further audit processes be put in place to prevent a reoccurrence of this taking place and to prevent the possible incorrect administration of the dose prescribed. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The homes procedures for making a complaint require further contact information. The recruitment practices within the home do not protect people using the service from the risk of abuse. EVIDENCE: 3 relatives surveys and 4 people using the service surveys, confirmed that 4 people knew how to make a complaint and 3 did not and 4 people using the service surveys confirmed that people knew who to speak to if they were unhappy. Comments received included “yes the manager” and “Will ask for support or let the manager know”. The complaints procedure used by the home is provided the RCPA and does not provide contact details for CSCI, the registered manager is required to ensure these contact details are provided and that the complaints procedure is displayed publicly in the home. The registered manager stated that no complaints have been made but confirmed that 2 staff have recently left employment as a result of a dispute with the management. All 9 staff surveys confirmed that they were aware of policies about protecting vulnerable adults and how you report any concerns about poor care practice or allegations of abuse. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 19 The whistle-blowing procedure used by the home is supplied by the RCPA and does not have the contact details for CSCI, this is recommended to be added. No abuse awareness training has been undertaken by the staff at the home. All 9 staff surveys received confirmed that they had received a Criminal Record Bureau Check. Examination of recruitment files confirms that these check were not undertaken before staff files examined commenced employment and this action together with other poor recruitment practice may put people using the service at risk. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 20 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 25 26 27 28 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are able to personalise their rooms with their favourite items Some parts of the home were not clean at this inspection and malodour was evident in one areas. EVIDENCE: All areas of the home including the garden were seen at inspection. Bedrooms were noted to be personalised to the individuals own tastes. Doors had locks and people using the service had a key, no key fitted another lock. One room which the person occupying asks not to be accessed was noted that staff had some difficulty identifying a key to access. The registered manager is recommended to ensure that in case of emergency staff have available quick access to each room. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 21 On the tour of the home it was observed that no radiators had covers and that risk assessments were in place. 3 radiators were confirmed to be permanently “locked off”. The registered manager must monitor and ensure that appropriate heating for those bedrooms is available as the weather changes. The home has redecorated and improved the lounge/dining and kitchen areas and these areas appeared very comfortable. He home appeared generally clean, however the bathroom area had a significant malodour of urine and the radiator in the bathroom was rusting and stained. This is required to be addressed. Each bedroom was noted not have hand washing facilities for staff who may be assisting with personal hygiene and the registered manager explained that staff assist the people using the service in the bathroom with personal hygiene. No hand-washing facilities are available in the communal bathroom there so staff are required to wash their hands in the staff/visitors toilet next door where paper towels are available. 3 residents surveys confirmed that the home is always clean and fresh and 1 said usually. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 22 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 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. The recruitment and staffing procedures of the home are not robust and may place people using the service at risk. Supervision records relating to staff are not available within the home. EVIDENCE: Resident’s surveys asked if staff were available when you need them said, 3always, 1 -usually. Comments received when asked; do you receive the care and support you need ?-“sometimes not happy” and , Do staff listen and act on what you say-“sometimes not always”. On duty in the day of inspection was the Registered Manager and 2 care staff, one of these staff was on induction training. The homes AQAA states that-All staff have a clearly defined job description and understand their own and others roles and responsibilities. Staff records were examined and no job descriptions were available. The records of 4 staff members were examined. All evidenced significant gaps in the recruitment process which may put people using the service at the risk Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 23 of harm.3 of those staff commenced employment prior to a POVA (Protection of Vulnerable Adults) check being received by the home. For 2 staff no application form was available and for all 4 staff employment history was incomplete or not available. Gaps in employment history had not been explored or documented. Only 2 CRB (Criminal Record Bureau ) checks had been received and no risk assessments had been undertaken for the results of the checks. 3 staff had no references in place and one staff with references were not identified as being from the most recent employer and were not authenticated in any way. An Immediate Requirement was made that staff must have completed satisfactory recruitment checks before they could be employed at the home and that the registered manager was required to inform CSCI of staff on duty and when recruitment checks were completed. Staff rota evidenced that staff were available throughout the day with one sleeping night staff in post. The Registered manager was not recorded on the rota and is required to do so. 2 staff have achieved an NVQ qualification and the registered manager is undertaking the Registered Managers Award. Staff undertake an induction programme, further evidence of completed mandatory training is to be forwarded to CSCI offices. 9 staff returned comment cards to CSCI, all 9 staff confirmed that they felt they had received adequate induction and supervision when they commenced their job. All 9 staff confirmed that they were clear of what the service users needs were and also 9 staff were aware of the duties they must not undertake. 9 staff stated on the comment cards supplied that they were receiving regular supervision. The registered manager showed the inspector a record log of staff supervision under taken, however the records of the content of this supervision were not available. The registered manager stated that they were stored at her own house. This practice is to be discontinued and all records related to staff stored securely within the premises. Little Oaks Residential Home DS0000066384.V351132.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 38 40 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home requires further development to ensure people using the service are not at risk of harm. Policies and procedures of the home require further development to ensure that they reflect the ethos and practice of the home and the storage of records requires review. The home promotes the health and safety of people using the service , hot water temperatures require review. EVIDENCE: The registered manager is Mrs Jan Bird who has been the registered manager for 10 months. She is currently undertaking the Registered Managers Award. Mrs Bird has previous care experience and therefore the Commissions feels Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 25 that a better understanding of the management of recruitment and the protection of vulnerable adults would have been expected. Quality assurance audits were not available at inspection. The policies and procedures at the home are provided by the RCPA and are not specific to the home. The registered manager is recommend to ensure that the policies used are service specific. There is currently no policies available for self medication administration and the staff guidance for receiving gifts. The storage of records within the home is mostly satisfactory and the storage of supervision record has been discussed in standard 36. However the registered manager stated that 2 staff recruitment records which include personal details related to staff were not available at the home as the Deputy had taken them. The storage of documents must be in line with the Data Protection Act 1988. The recording of accidents are not currently audited for incidence and trends and are recommended to be commenced. The health and Safety records were examined and were mostly satisfactory, however the recording of hot water outlet temperatures has not been routinely recorded and the manager could not provide the inspector with a thermometer. Records of the hot water temperatures for the 24/09/07 and 27/08/07 state that the hot water temperature exceeded 43 degrees. The records state that the manager was informed on both occasions, no action was indicated as being taken. The Fire system was serviced on 11/04/07 and the most recent weekly fire drill was 03/09/07. The Gas certificate was valid until 20/02/10 No emergency lighting or call bell system is in place. 2 wardrobes were noted to not be secured to the wall and may present a risk of injury. The registered manager arranged for their restriction immediately and confirmation of their secure fixture has been forwarded to CSCI offices. 8 staff surveys received stated that they were provided with protective clothing and necessary equipment to do their work safely and cleaning staff confirmed that they had access to COSHH data sheets and had received training in the safe use of chemicals. Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 26 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 1 2 1 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 1 28 3 29 X 30 3 STAFFING Standard No Score 31 2 32 x 33 2 34 1 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 1 x 1 3 X 2 x 1 x Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 27 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 YA1 Regulation 4(2) Requirement Timescale for action 01/12/07 2. YA2 3. YA6 4. YA6 5. YA6 The registered manager must ensure that the home has available on request a Statement of Purpose and service User Guide within the home 14(1)(c)and The registered manager is (d) required to ensure that appropriate consultation by a pre admission assessment has taken place with the service user or their representative prior to admission. 15(2)(b) The registered manager is required to ensure the development of the care plans to ensure that all areas of identified need have a suitable care plan in place. 15(2)(b)and The registered manager is (c) required to consult with the person using the service and/or their reprehensive and involve them in the care planning process. 15(2)(b) The registered manager is required to ensure that regular reviews of all care plans take place and any changes are documented. DS0000066384.V351132.R01.S.doc 01/12/07 01/12/07 01/12/07 01/12/07 Little Oaks Residential Home Version 5.2 Page 28 6. YA19 12(1)(a) 7. YA20 8. 9. YA22 YA27 10 YA34 The registered manager must ensure that all healthcare needs identified are acted upon and recorded. 13(2) The registered manager must ensure that all medications are administered correctly and procedures be in place to audit medication systems within the home. Immediate Requirement Made 04/10/07 22(7)(a) The complaints procedure must contain the contact details of CSCI 16(2)(j) The registered manager is required to ensure that the areas of the home including the bathroom which have a malodour maintain a satisfactory standard of hygiene. 19(Schedule The registered manager must 2) ensure that all staff employed at the home have undertaken a robust recruitment procedure to include • Completing an application form • A 10 year employment history • 2 satisfactory references • A satisfactory POVA check • A CRB check and appropriate risk assessments. 01/12/07 01/12/07 01/12/07 01/02/08 01/11/07 11. YA35 18(1)(a) 12 YA35 18(1)(a) Immediate requirement made 04/10./07 The registered manager is 01/03/08 required to ensure that all staff receive adequate training to include mandatory training, NVQ training and training in abuse awareness. The registered manager is 01/12/07 required to review the induction process to meet the Common DS0000066384.V351132.R01.S.doc Version 5.2 Page 29 Little Oaks Residential Home 13. YA36 18(2) 14. YA37 9(2)(1) 15. YA42 13(4) 16. YA42 13(4c) Induction Standards and ensure all staff complete this induction within a 12 week period. The registered manager is required to provide a record of all supervision of staff. This record is required to be stored securely within the home. The registered manager must ensure that she is aware of all current legislation relating to staffing to ensure that people using the service are not placed at risk The registered manager must ensure that hot water out lets are regularly checked and temperatures which exceed 43 degrees are reduced. The registered manager is recommended to review and audit all accidents to identify trends and repeated incidences to reduce the risk of further accidents/injuries to people using the service. 01/12/07 01/12/07 01/12/07 01/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA5 Good Practice Recommendations The registered manager is recommended to ensure that all people using the service have in place a contract outlining the terms and conditions of residency. The registered manager is recommended to implement a support system to ensure that people using the service are supported to remain independent but also have the help needed to maintain a suitable standard of hygiene within their rooms. The registered manager is recommended to clarify within the care plan the agreed routines for the home and the DS0000066384.V351132.R01.S.doc Version 5.2 Page 30 2. YA16 3. YA18 Little Oaks Residential Home 4. 5. 6. 7. 8. YA22 YA23 YA24 YA26 YA30 reasons for their implementation, this is with reference to the times of getting up and returning to the bedrooms at night. The home is recommended to ensure that the complaints procedure is available and displayed within the home. The registered manager is recommended to include the contact details of CSCI in the homes whistle blowing policy. The registered manager is recommended to ensure that keys are clearly identifiable to enable staff to access bedrooms quickly in the case of an emergency. The home is recommended to ensure that adequate heating can be made available to the 3 bedrooms which the radiators have been “Locked off” To arrange for external agency to check all water outlet and central heating annually as part of prevention of Legionella To ensure provision of paper towels as an effective infection control strategy The home is recommended to provide all staff with a comprehensive job description. The registered manager is recommended to record the hours she works at the home on the homes rota to enable staff and people using the service to identify her availability. The registered manager is recommended to review the policies and procedures in place to ensure that they are service specific. 9. 10. 11. YA30 YA31 YA33 12. YA40 Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Little Oaks Residential Home DS0000066384.V351132.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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