Inspection on 26/11/08 for Oak Cottage

This inspection was carried out on 26th November 2008.

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

Other inspections for this house

Oak Cottage 30/04/09

Oak Cottage 30/11/07

Similar services:

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOME ADULTS 18-65 Oak Cottage Oak Street Merridale Wolverhampton West Midlands WV3 0AD Lead Inspector Deborah Sharman Unannounced Inspection 26th November 2008 10:00 Oak Cottage DS0000070082.V370704.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 Oak Cottage DS0000070082.V370704.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. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak Cottage Address Oak Street Merridale Wolverhampton West Midlands WV3 0AD 01902 681235 01902 655793 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) Osei Minkah Care Limited Mrs Karimah Francis Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of care only: Care Home Only (Code PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning Disability (LD) 3 Mental Disorder (MD) 3 The maximum number of service users to be accommodated is 3. 2. Date of last inspection 30th November 2007 Brief Description of the Service: Oak Cottage is a back to back semi detached house in a residential area of Wolverhampton within a ten minute drive of the City Centre. The service is currently registered to accept 3 service users whose primary needs are learning disability and or mental ill health. The service intends to admit people who have a dual diagnosis of learning disability and mental ill health: younger adults who are cognitively impaired and presenting behavioural challenges. The property is domestic in style and is comfortably furnished in a light and modern style. There is a lounge and a conservatory that offers alternative seating. There is a small patio to the rear of the property and plenty of parking spaces for cars at the front. All 3 bedrooms, which are on the first floor, are single occupancy and have a washbasin and lockable facilities. There are two bathrooms for shared use and a separate laundry. The aim of the service is to provide person centred care in a warm, safe and enabling environment ensuring that service users have optimum control over their lives. Information relating to fees is not currently contained within information about the service Oak Cottage DS0000070082.V370704.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. One Inspector carried out this unannounced key inspection. We inspected from 10.00am until 6.30pm. As the inspection visit was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by us as key. These are the National Standards that significantly affect the experiences of care for people living at the home. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection we requested written information and data about the home in an annual return. This information was not provided on time. Upon issue of a Statutory notice for its non-provision, this was made available to us before we conducted the inspection. We had sent surveys to people who live and work at Oak Cottage and also to independent health professionals who have contact with the home. The return rate was poor as we only received two completed surveys back. These were both from staff. It is currently our policy not to send surveys to relatives and as none were visiting while we were there, we were also not able to speak to relatives. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. The manager was available throughout the day to answer questions and support the inspection process. We also spoke to staff and observed practice. When we last inspected, one person was living at Oak Cottage. That person has since moved on and two other people have moved in. We assessed the care provided to both of the people accommodated using care documentation and we sampled a variety of other documentation related to the management of the care home such as training, recruitment, staff supervision, accidents and complaints. We toured the premises, talked to people and we were able to observe interaction between staff and residents during this time. All this information helped to determine a judgement about the quality of care the home provides. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? At this inspection we could see that the Manager had carried out assessments before offering places to people applying. This is an improvement. At the last inspection, there were no medication records. These are now being kept and were available, although much needs to be done to ensure further improvement. At the last inspection one person was accommodated and there were only two staff employed, one being the manager. Since this time the service has expanded and a team of staff now exists. A rota is being maintained to demonstrate how the service is being staffed and this is an improvement. Although there was no documentary evidence, the Manager informed us that she has attended refresher training in adult protection issues to clarify her role as manager in the event of their being any allegations or Safeguarding concerns. We have reviewed the recommendation we made to assess the risk of unrestricted windows. The manager has assured us that this applied to only one window. Therefore, on the basis of the height of the window we have deleted this recommendation. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oak Cottage DS0000070082.V370704.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 Oak Cottage DS0000070082.V370704.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, 3, 4, 5. Quality in this outcome area is poor. When deciding whether to move in people can visit the home regularly beforehand. However, information about the home is either misleading or not available and does not provide full, clear, up to date and accurate information upon which to make their decisions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the home’s Statement of Purpose was not readily available and its content continues to mislead readers. It does not state the terms of the home’s registration, implies they are registered to care for people with physical disabilities and clearly states that the home is able to provide nursing care. It cannot. An administrative error by us served to compound the confusion. However, we would expect the provider/manager to understand the purpose and intent of the service and the limits that legally apply. Two people have moved in since we last inspected. Positively, the manager assessed their needs before they moved in, they visited over a protracted period of time before deciding to move in, and are settling well. Links between the home and the placing agency appear to be good and reviews involving all parties looking at how the new residents are settling have been carried out regularly. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 10 However, up to date assessments by the placing authority were not obtained prior to or at the time of admission for one of the two people admitted (being dated 2003). We have received contradictory information about the Mental Health Act status of one person admitted to the home. At inspection we were informed that Section 3 of the Mental Health Act applied, which if the case would mean that the person should not have been admitted. Since inspection the placing agency have told us the person is not subject to this restriction. The manager is adamant that sections 3 and 117 are in place and has told us that she has since confirmed this with the supervising hospital. The Manager has not, contrary to the annual return, sent letters to all parties involved in the placement, confirming that following assessment, she is confident Oak Cottage can meet the applicants’ assessed needs. Also, contracts have not been given to either resident and steps have not been taken to ensure contracts are available in suitably accessible formats. Most significantly some serious risks were identified prior to admission. Risks were not formally assessed either prior to, or for some months after, admission for one resident and remain not available for the second resident. Where risk assessments are in place some of the most significant risks have not been formally considered, although we were informed of measures in place in practice to reduce risk. The lack of formal systems however, leaves people vulnerable as it undermines consistency of approach and accountability. Oak Cottage DS0000070082.V370704.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, 9. Quality in this outcome area is poor. Systems are not in place to ensure in a timely way that staff are provided with guidance about how to meet people’s needs and reduce risks. People’s rights and wishes are respected however as we observed people making choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the last inspection, we made a requirement about care planning. It is therefore of concern that for one resident a care plan and risk assessments were not put in place until ten months after admission. A new member of staff who commenced two weeks prior to inspection developed the care plan available. The care plan is basic in content and does not reflect the extent of the person’s needs or diversity. A risk assessment in respect of the management of mental health however had been carried out to a good standard. Written assessments are not in place for all known risks. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 12 At the time of inspection neither care plan or risk assessments were in place for a second service user admitted some seven months earlier. We talked to this person’s key worker who in spite of the lack of written guidance was able to demonstrate that he knows the person well. He was able to describe the known risks for this individual and how these are managed without compromising the person’s independence and development. For example we were told that staff hold people’s lighters at night and checks are made at night if one of the residents is drunk. These checks could not however be evidenced. We observed people being offered choices about where they sit, what they wanted for tea and we could see a way forward being negotiated when someone expressed some concerns about how his bedroom is not fully meeting his needs. Discussion with a staff member showed a growing confidence in understanding in practice the tensions between people’s rights and responsibilities. This related to how to support a smoking contract agreed with a resident. Sight of care records gave further positive evidence of how people are afforded choices in their day to day lives from food, rising and retiring times and visits to and from family members. Attention must be paid to the language that staff use in care records. Examples found do not assure that those staff responsible have a sound value base and understanding of mental health needs. The manager agreed that the language was inappropriate but felt that in practice the staff member was excellent. Reviews have been held regularly with the placing funding authority although minutes were not available to help us to identify the extent of the satisfaction with the placement. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 13 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, 15, 16, 17. Quality in this outcome area is good. People are engaged in a programme of activities that they enjoy and that are individualised to them. They enjoy their meals and have contact when they want to with friends and family. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at Oak Cottage are engaged in a range of activities that they enjoy. We can see that people have regular contact with their families both within and away from the premises. People attend day care that meets their cultural needs, undertake voluntary work, have been away on holiday and receive support from an employment officer to work towards the goal of obtaining employment. Financial records showed us that people go to the cinema, the pub and attend the gym. One person was looking forward to attending the Wolves match that Saturday and tickets had been purchased. We informed the Manager and staff member that the resident should not be Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 14 paying for staff to attend the match with him. The service should bear this cost. The manager agreed to reimburse the resident. The fridge and freezer were well stocked and people told us that the dinners are ‘alright’. One person said he enjoys having Jamaican dinners. A staff member said that everyone decides together what they are going to have to eat and we could see this being discussed on the day of inspection. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 15 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. Performance is mixed with some health appointments kept and some overlooked. Whilst medication records are now in place much remains to be done to ensure the administration of medication adheres to good practice and is fully accountable. Currently the service cannot always demonstrate that people are receiving their medications as prescribed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents living at Oak Cottage have independent personal care skills but rely on staff to prompt them when necessary. Having met the residents it is evident that these needs are being met. They present as well groomed and dress in styles that reflect their personal preferences and age. We looked at health records for both residents and the picture of health provision is mixed. For one person in particular, we could see that he had been supported to attend some health appointments. Alternatively there was clear evidence that some key appointments had been overlooked. In addition there was no evidence that a sample requested by the Doctor had been Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 16 provided. The manager felt that it had but that it hadn’t been recorded. On asking for the result of the sample, this too was not known. Therefore, the service does not know whether the person requires treatment for the particular condition requiring investigation and diagnosis. Records at the end of October refer to the person as having ‘settled perfectly considering his health condition’. It wasn’t clear what this was or what if anything was done about it. For the second person, we could see that health concerns identified by him had been listened to by staff who supported him to consult the GP. This person also needs monthly blood tests as a result of prescribed medication. It took a very long time to assess whether these blood tests had been carried out because record keeping systems do not lend them selves easily to review. One test remains unaccounted for. The Manager was confident this test would have taken place as she explained a repeat prescription would not have been obtainable without the test. Records do not show whether routine health screening such as dental care have been provided for either resident since admission and a reminder has been sent through for one person. Since inspection the manager has confirmed the provision of dental treatment. Record keeping must improve to accurately reflect care and treatment provided. Medication records are now in place and the manager said she was pleased with the progress made. Only one of the two residents is currently taking prescribed medication and so we looked at how this is being managed. A number of improvements are still required. This is particularly pertinent as one of the prescribed drugs is Clozaril, which if misadministered has the potential to cause significant harm. There is insufficient written guidance to promote safe medication practice. For example the strength and doses of named medications are not given. Administration records are also light on important detail such as the required times of administration and the number of tablets to be administered. The service is not yet using a monitored dosage system and staff are having to calculate how to give 350mg of clozaril for example, with the 100mg and 25 mg tablets prescribed. This should be stipulated on the MAR charts so staff can sign separately for 3 x 100mg and 25mg x 2. Currently they are signing for having administered the whole dose as calculated by themselves. This is complicated further by the fact that using hand made administration records two different drugs are listed within one box. Most staff are signing separately for each drug within this box but on occasions one signature has been given. It therefore remains unclear whether both or one of the drugs has been signed for as given and if the signature is for one; it is unclear which of the two the signature relates to. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 17 We also found the service user according to records to be prescribed 20 mg of simvastin but 40 mg tablets to be available. We could not see if or where the prescription had changed. This could not be satisfactorily explained and should be reviewed urgently. Otherwise we could see that all prescribed medications were available for use, although the home is overstocked. This would indicate either poor ordering systems or may indicate that full doses are not being given as prescribed. Failure to carry out audits of medications over a period of time made this difficult to judge. The new staff member who had been employed for two weeks had prior to inspection started to count and record medications in stock. She was aware of some of the shortfalls in practice and recognised the need for staff training, which is just beginning. A carry forward system is not being used and therefore it is difficult for the service to account for how medication is being administered. The new staff member, who singularly accompanied us while we assessed medication, agreed the need for this. It was later, when looking at recruitment that we found this staff member had not been sufficiently checked prior to employment. It is of particular concern therefore that she had total and unsupervised access to the medication. Administration of ear drops also showed shortfalls and concerns. Instructions show they are not to be administered for more than seven days. This was not recorded as guidance for staff. Records show them to have been administered over a nine-day period with many gaps throughout this time in administration records. Sight of the eardrops also showed a significant amount remaining in the bottle, casting doubt in conjunction with records that these had been administered as prescribed. Health records for the person do not account for a change in health to warrant the drops and aural health has not been monitored to evidence whether the treatment has been successful. An entry in the communication book in November states ‘someone has been mixing up the medication and putting them in the wrong box’. This has the potential for serious consequences. Fortunately whilst only one resident is receiving medication, the risk to others is minimal. However risk of under or overdose to the person for whom they are prescribed is high if medications are mixed up. We were told that the intention is to move to a monitored dosage system. This should be pursued without delay to minimise some of the risks discussed. The manager should ensure that: • All staff receives training in the safe administration of medication without delay. • That staff competency to administer medication is subject to ongoing assessment • Regular audits of medication practice are carried out and any errors or omissions investigated and acted upon. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 18 • • • • • • • • All gaps in administration records are identified and brought to her attention without delay for investigation. Medication stocks are reviewed. Immediately prior to delivery of new stock, that existing stocks are counted and carried forward, added to new stock to give a new total stock. Review and improve written guidance ensuring the direction, dose, number of tablets and times of medication are clear on medication administration records. Should ensure that staff are signing separately for each type of drug administered. Should consider obtaining medication in monitored dosage systems as soon as possible to minimise risk. Should review the dose of Simvastin being prescribed and administered. Should review how Clozaril is being administered to assure safety at all times given the risks associated with this medication. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 19 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. Systems are not sufficiently in place to protect people. No one has come to any harm but there is the potential for this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service is not able to demonstrate what action it has taken to help people to know how to complain. Information is not publicly available and complaints have not been discussed in residents’ meetings. In surveys both staff told us they know what to do if someone has a concern about the home. An entry in the handover book states one of the residents complained he had had nothing to eat all day. Staff had not brought this to the manager’s attention for her to investigate. The manager and one staff member have had training in adult protection. Dates for further training for other staff are awaited. There have been no allegations and care records show people to be largely calm, happy and settled. Good record keeping accounts for expenditure and this protects people’s finances and possessions. It was through these records that we could see that a resident had paid for a football ticket for the staff member who will accompany him. The manager agreed to reimburse this, as the home should meet staff expenses. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 20 The service does not currently hold a copy of the local multi agency adult protection procedures. This is needed so that the manager/staff know how to respond in the event of an allegation. This was raised at the last inspection and has not been met. Risk assessments with clear controls to help staff consistently manage known risks in respect of individual service users were not available, as reported above. We became aware of three incidents. Two related to different residents going missing and the third was an incident of aggression against a staff member. None of these matters were reported to us under regulation 37. Paperwork was completed but not sent. In the first case, missing person procedures were followed and the Police found the resident. Events on the second occasion are more concerning. The resident was thought to have been missing all night, Police were informed but the resident was found the next morning to have been in his room all night. This demonstrates that procedures for missing persons were not followed, as the premises were not searched, the on call staff member was not informed and the resident was left unchecked throughout the night - a particular concern given his known condition. The incident also raises concerns about the effectiveness of handover, accountability and the thoroughness of night checks and routines. We found that recruitment practice continues to put vulnerable people at risk. This is discussed more fully under Staffing and Management. To clarify records of an incident of physical aggression, we talked to a staff member who demonstrated action they had taken based on an awareness of the need to not physically intervene. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 21 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, 30. Quality in this outcome area is good. People enjoy living in a comfortable and clean home. Some aspects of the environment are under review for one person who feels they do not fully meet his needs and preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home shows little has changed since the last inspection. The premises continue to be homely, light, modern and clean. One resident told us that he would prefer to sleep downstairs as he feels his bedroom is too big and he doesn’t like stairs. Whilst we feel that these matters should have been identified prior to admission where possible, it is positive that the manager is listening to his feedback and willing to try to address his concerns within the legal limits. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 22 In the last report, given the needs of the occupant at the time, we advised that the use of carpet in a bedroom be kept under review. This person has since moved on, the bedroom is not currently occupied and upon assessment was found to have no malodour. Since our last inspection, the Infection Control officer has visited and has carried out an audit showing 77 compliance. The manager said she is aware of areas that need to improve, has had to submit an improvement plan and is expecting a reassessment visit. We found the bathroom upstairs to be clean but without paper towels, or a fabric towel and soap. This will not encourage people using the bathroom to wash their hands. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 23 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): 32, 34, 35. Quality in this outcome area is poor. Staff recruitment is not sufficiently robust and at times continues to put people at risk. Staff training is underway but there is much to do to consolidate staff knowledge. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We could see that in the twelve months since our last inspection that the staff member employed then has developed enormously in terms of knowledge, confidence and competence. A new staff member we spoke to said she is very happy with how she had been supported to settle in and the training opportunities available to her both on and off the job. We asked for rotas and can see that these are now available to account for staffing. For the days we sampled we can see that two staff are available on most shifts providing one to one staffing. When we arrived at inspection however, there was only one staff member on duty. Waking night staff also work alone although an on call back up system is available to them. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 24 The biggest concern about staffing is the failure to ensure new staff have adequate checks, particularly as this was identified and discussed at the last inspection, in a subsequent meeting with the provider, was addressed in the provider’s action plan and confirmed as compliant in the annual return provided to us immediately prior to inspection. We looked at how three people have been recruited. For two of these people references received are weak in that they are either not from the most recent employer, are fifteen months old and therefore not up to date or cannot always be authenticated. However Criminal Record Bureau checks had been obtained prior to both people’s planned and actual start dates. The start dates of new staff are unclear however, and available evidence is contradictory. When talking to a new staff member, we were consistently told that this person had not yet started although discussion, rotas and evidence of work she had undertaken showed she had worked on the premises full time for two weeks. Start dates must be defined from when the person is first working on the premises and all pre employment checks must be in place prior to this. References were better available for this person, however of most concern is that neither a Criminal Record Bureau check nor a POVA first check had been obtained. The manager was also not able to demonstrate that these had been sent for. This person took a significant part in the inspection, was supervising staff, was auditing medication alone, writing care plans, contacting Social Services on behalf of the service and taking a full role in the management and running of the service. The manager agreed that advice had been strongly given at the last inspection and was unable to explain these shortfalls in practice that serve to put people at risk. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 25 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, 42. Quality in this outcome area is poor. People are happy living at Oak Cottage but since the last inspection the manager has not sufficiently developed systems to reduce risks and meet national minimum standards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The last inspection was the first inspection to have been carried out since the service was registered and became operational. At that time we found the manager had admitted a resident with needs she wasn’t registered to accept. Consequently since then the manager has reapplied and been re registered differently. We had then judged Oak Cottage to be adequate overall, but given the shortfalls in such a new service we asked the provider / manager to provide us with an improvement plan – a legal requirement. This was Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 26 provided late and the manager was reminded at the time of the importance of complying with target dates. It was therefore of some concern prior to this inspection that the annual return was not sent to us on the first or second time of asking. We issued a Statutory Requirement notice to the provider / manager and we received the annual return by the third date given. This alerted us to some concerns about how the home may be being managed. At inspection we found there to have been insufficient progress. We found the improvement plan to have been ineffective and the annual return to be inaccurate. For example we were told in it that ‘staff have all received the required checks’. Most things that we requested in order to judge how the home is being managed were either not available or were out of date. These included: • • • • Assessments of hazardous products; (a recommendation from our last visit). Evidence of the manager receiving supervision Regulation 26 visit reports. The manager said two such visits have taken place in August and November but reports had not been made available to her. The results of satisfaction surveys, which were planned at the last inspection. The manager said surveys have not been sent to people living at Oak Cottage yet but have been sent to families but none yet have been returned. A Quality Assurance tool couldn’t be located. • We asked for the following service maintenance certificates: • • • • • Portable electric appliance tests Electrical 5-year certificate Gas Landlord certificate Fire extinguisher service check certificate Fire detection equipment services All of these with the exception of the electrical five-year certificate were out of date. The Portable appliance test certificate was not available. The manager said this test had been carried out and that certification was awaited. We asked if water temperatures are being tested. The manager said they are being checked and are recorded on the back of the bathroom doors. When we looked the sheets were blank and no others were available when we asked. These matters in conjunction with the following: • • Non-reporting of notifiable incidents, Failure to adequately check new staff, DS0000070082.V370704.R01.S.doc Version 5.2 Page 27 Oak Cottage • • • • Failure to develop care plans and risk assessments in the months since the last inspection and since people’s admission to the home, Omissions in medication systems and the high risk associated with use of the drug clozaril, Failure to follow procedures in the event that a service user was reported missing Continued misunderstanding about the role of the home and the nature of its legal basis for operating, lead us to conclude that the quality of service is poor overall given the potential for risk that the omissions create. . Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 28 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 2 3 2 4 3 5 1 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 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 X 1 X 1 X X 1 X Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 29 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 Requirement A care plan must be prepared for each service user accommodated to describe how their needs in respect of health and welfare are to be met. This will ensure staff have sufficient guidance to know how to meet peoples care needs. New Requirement December 2008. Steps must be taken to ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. This will protect the service user from unnecessary risk and possible injury. Requirement arising from first inspection November 2007. Not met at November 2008. 3 YA19 13(1)(b) The registered person must 31/12/08 make arrangements for service users to receive where necessary DS0000070082.V370704.R01.S.doc Version 5.2 Page 30 Timescale for action 31/12/08 2. YA9 13 26/11/08 Oak Cottage treatment, advice and other services from any health care professional. This should include taking steps to ensure that appointments are not overlooked. New requirement December 2008. Steps must be taken to review 26/11/08 medication practice making sufficient arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This will ensure that medication management is accountable, will minimise the risk of mishandling and will enable the home to demonstrate that the service user is administered medication in accordance with medical direction to promote good health. Requirement arising from first inspection November 2007. 5. YA34 19 Not met November 2008. A person must not be employed to work at the care home unless it can be demonstrated that full and satisfactory information compliant with regulation 19 and Schedule 2 have been obtained in accordance with guidelines issued by the Department of Health. This will ensure that service users are protected by the homes recruitment practices. Requirement arising from first inspection November 2007. Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 31 4. YA20 13(2) 26/11/08 Not met November 2008. 6 YA41 37 The registered person must give 26/11/08 notice to the Commission without delay of the occurrence of any notifiable event as defined under regulation 37 of the Care Homes Regulations. New requirement November 2008. All equipment provided at the care home must be maintained in good working order. This includes, but is not limited to, arranging regular service maintenance for gas, electrical and fire safety appliances. New requirement December 2008. 7 YA42 23(2) 31/12/08 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 Refer to Standard YA1 Good Practice Recommendations The Statement of Purpose and Service User Guide must be fully reviewed to ensure that they represent the service user categories that the home is registered to provide care and accommodation for. This will inform potential service users and placing officers whether the home is appropriately registered and experienced to meet their needs and will avoid service users being inappropriately placed in future. Requirement arising from first inspection November 2007. Not met November 2008 and changed to recommendation. 2. YA5 Signed contracts outlining the terms and conditions of DS0000070082.V370704.R01.S.doc Version 5.2 Page 32 Oak Cottage residence should be provided to service users prior to admission or as soon as possible thereafter so they are fully aware of the rights and responsibilities of both parties. Recommendation arising from first inspection November 2007. Not met November 2008. 3 YA6 Care plans must describe how all the service user’s agreed assessed needs in respect of his health and welfare are to be met and must be kept under review. This will ensure that sufficient guidance is available to staff to ensure that they provide continuity of care in a way that meets all the needs and expectations of service users. Requirement arising from first inspection November 2007. Not met November 2008 and changed to recommendation. 4. YA9 Where practicable risks to service users and ways of controlling these risks should be assessed prior to admission to the home, or as soon as possible thereafter. Recommendation arising from first inspection November 2007. Not met November 2008. 5. YA22 Information about how to make a complaint should be clearly visible to service users and visitors to the care home to enable them to make a complaint easily should they need to. Recommendation arising from first inspection November 2007. Not met November 2008. 6. YA23 A copy of Wolverhampton’s Multi Agency Adult Protection Policy and Procedure should be available for reference in the care home. This will provide guidance in the event of a safeguarding concern that will enable the manager and or staff to act appropriately to protect service users in accordance with local expectations. Recommendation arising from first inspection November 2007. Not met November 2008. 7 YA39 Effective quality assurance and quality monitoring systems DS0000070082.V370704.R01.S.doc Version 5.2 Page 33 Oak Cottage based on seeking the views of service users, should be in place to measure success in achieving the aims, objectives and Statement of Purpose of the home. 8 9 YA39 YA41 New recommendation November 2008. Reports of Regulation 26 visits should be available for inspection. New recommendation November 2008. Steps should be taken to review how the outcomes of medical appointments are recorded to ensure they can be easily evidenced for the purpose of regulation and management monitoring / review. New recommendation November 2008. Risks posed by hazardous chemicals should be assessed in writing with control measures to limit risk considered and included. Recommendation arising from first inspection November 2007. Not met November 2008. 10. YA42 Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Oak Cottage DS0000070082.V370704.R01.S.doc Version 5.2 Page 35 - 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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