Inspection on 30/04/09 for Oak Cottage

This inspection was carried out on 30th April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oak Cottage 26/11/08

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 07/08/2009.

Key inspection report CARE HOME ADULTS 18-65 Oak Cottage Oak Street Merridale Wolverhampton West Midlands WV3 0AD Lead Inspector Deborah Sharman Unannounced Inspection 30th April 2009 09:00 Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Oak Cottage DS0000070082.V375309.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.V375309.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, excluding learning disability or dementia (MD) 3 The maximum number of service users to be accommodated is: 3 2. Date of last inspection 26th November 2008 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.V375309.R01.S.doc Version 5.2 Page 5 Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 6 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. We carried out this unannounced key inspection over 9.5 hours on 30 April 2009. One Inspector conducted the inspection during this time period and a pharmacy Inspector looked at how medication is managed between 11.00am and 4.00pm. No one connected with the service knew we were coming. 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 which 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 used information known to us about the service i.e. previous reports, requirements and the provider’s response to us about these. We were also aware of the findings of the fire service from a recent inspection and we used this information to help us to inspect. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. We did not send out surveys prior to inspection but took some out with us to the service and distributed them to staff and people living there on the day that we visited. At the time of writing we have received 2 back from people living at the home and four from staff. It is currently our policy not to send surveys to relatives and relatives were not available to talk to during the inspection. Some of the information provided to us at inspection is contradicted by information received later in the written surveys. The manager was not available when we arrived but arrived soon after to answer questions and support the inspection process throughout the rest of the day. We spoke to four staff and we spoke separately to both people who live at Oak Cottage. We assessed the care provided to both people from discussion, observation and by using care documentation. 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. During the tour people did not invite us into their bedrooms so we didn’t look at them. During the inspection we became aware that the Health and Safety Executive had visited the service after our last key inspection. After this inspection, we telephoned them to discuss their findings and actions taken since their visit. Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 7 All this information helped to determine a judgement about the quality of care the home provides. What the service does well: What has improved since the last inspection? What they could do better: Care planning and risk assessment systems are brief. Additional information and guidance is needed in these to help staff to fully meet people’s needs safely. The manager must ensure that information is available and up to date for people living, working at and visiting the service. For example complaints Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 8 information was available at this inspection but hidden, people remain without contracts of residence, an out of date inspection report was on display. Also, the registration certificate on display was out of date and was significantly misleading. People are being supported to attend health care appointments but systems to ensure these are not missed need to improve. We found one person’s dental appointment had been overlooked. Also he had not been taken back to the doctor in a timely way to review treatment that had been prescribed but not taken. The service could not fully evidence that the appointment had taken place at all and generally the standard of health records is not consistent and do not support the service to monitor and manage health needs effectively. Medication management has improved and specific significant risks have reduced. However it is important that the service now applies the learning and changes across all aspects of medication management. Staff need to undertake a number of training courses to help them to meet service users needs. New staff are not always being recruited safely and are not being inducted to the required national standard when they start work. This means they are not sufficiently prepared for the role. There are insufficient monitoring and quality assurance systems in place to support the manager to make the required level of improvements within required timescales. At this inspection breaches were identified in relation to health and recruitment systems, evidence was seized and subsequently a Statutory Requirement Notice was issued to ensure improvement. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 9 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.V375309.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 5. People using the service experience poor quality outcomes in this area. People are not provided with sufficient up to date information about the service to help them to know their rights and responsibilities. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There have not been any changes to the group of people living at Oak Cottage since we last inspected. Therefore we were not able to assess people’s experiences of admission to the home. Instead, we followed up matters identified as needing improvement during our last key inspection. We found that the home’s brochure or Statement of Purpose, was not dated but accurately tells readers that the home is not registered to provide nursing care. We were concerned to find that the home was continuing to display in a public place an out of date certificate of registration that incorrectly tells people they are able to provide nursing care. An inspection report dated November 2007 was also on public display but this too is out of date and does not reflect the Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 11 most recent inspection outcomes. Both these omissions have the potential to mislead people about the service. It seems that people living at the home have been given a Service User Guide although one person living there could not locate it when asked and another person, when asked if he’d seen it before said, ‘no’. The service was not able to demonstrate that it had made progress by providing contracts of residence to either of its residents to help them to understand their rights and responsibilities. A template is on the manager’s laptop but its format would also not be suitable for one person accommodated at Oak Cottage. Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. People using the service experience adequate quality outcomes in this area. People’s rights and wishes are respected as they are supported to make choices about their day-to-day lives. Systems to support staff to meet people’s needs have improved in part although remaining omissions have the potential to affect the care people receive. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Both people living at Oak Cottage told us they love it there and one person who was asked, said he feels being there is helping him. People’s right to make choices is respected. One person told us he decides what time he goes to bed, what time he rises and what he eats. We observed Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 13 staff consulting him about breakfast and preparing what he had requested. We also observed him discussing with the manager and staff a request to attend a three-day rock festival. His wishes are being considered but he was informed that all the risks would need to be assessed. We overheard the manager and a staff member later discussing the possible risks. A visit from the Health and Safety Executive in November 2008 found the need to improve risk management. We have noted some improvement since our last inspection. Checks on people during the night are being carried out and are evidenced in written records. Written care plans and risk assessments are now in place for both residents although those available do not consider all significant needs and risks. Those in place are brief and do not always fully consider the issues. We spoke to staff who have some knowledge of identified risks and how to manage these but there are some gaps in their knowledge and improved risk management systems would better support them. Omissions in care planning can affect the care people receive. This is discussed under the Personal Care and Health standards later in this report. Oak Cottage DS0000070082.V375309.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): This is what people staying in this care home experience: 12, 13, 14, 15, 16, 17. People using the service experience good quality outcomes in this area. People have contact with their friends and family, enjoy their meals and are supported to enjoy activities of their choice both at home and in the community. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We spoke to the people who live at Oak Cottage about their lifestyles. Both people really enjoy their lives with one person telling us he likes Oak Cottage and ‘especially the activities’. We can see from discussion, observation and a variety of documentation that people have contact with friends and family and are supported to enjoy their different interests and hobbies. These include very regular visits to the pub, cinema, bowling, culturally appropriate day care and Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 15 football matches. In addition, people are very much looking forward to a holiday abroad this year. We observed one person to be fully engaged in a board game with a staff member. Both were enjoying the activity. Both people living at Oak Cottage told us that they enjoy the meals and we observed staff asking them what they wanted to eat, and preparing what they chose. We also observed staff encouraging one resident to do his washing and another to help tidy his room. This resident told us he was very pleased he had learned to do his washing and although ironing was currently thought to be unsafe, he hoped he would be able to learn to do this in the future. People are encouraged to talk about their aspirations as we overheard this person also talking to staff about wanting a flat one-day. Oak Cottage DS0000070082.V375309.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. People using the service experience adequate quality outcomes in this area. People are receiving health screening but more attention could be given to the changing needs of residents. Better systems of recording and monitoring are required to ensure that people are supported to attend all health appointments. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Outcomes for people are mixed. We can see that people are receiving some health care screening and are being supported to attend appointments. For example we could see one person attends regular blood screening, has attended the dentist and meets with his psychiatrist. Another person has been to the GP about new health conditions and has had support from Hearing Services. However, we are not assured that systems are sufficiently developed to ensure this is always the case for both people living at Oak Cottage. Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 17 Care plans do not sufficiently describe people’s health needs or refer to appointment schedules. The quality of health records varies. Some are detailed which supports consistency of care. Some records are poor where the outcomes of health appointments or incidents are not recorded or the record is difficult to understand. Staff have not received training in record keeping and the manager is aware that this is needed. We were therefore not always able to see what the outcome of an appointment had been, and staff could not explain it to us. Systems are not always sufficiently in place to monitor people’s health conditions. Staff need more support and guidance to ensure changes in condition or refusal to take treatment is brought to the GPs attention so the matter can be medically reviewed. Antibiotics prescribed for one person were refused and there is no evidence the matter was reviewed with the GP. We were told that it was discussed with the GP after a 3-week period, but this was neither timely nor recorded. This is so in respect of personal care needs too. Guidance about people’s personal hygiene needs isn’t specific and monitoring is sparce. Where care records indicated a concern about the regularity of personal care, an identified need, care plans were not reviewed in response to this. Systems are also not sufficiently in place to ensure that people’s medical appointments are not missed. We found at the last inspection that an appointment had been missed and at this inspection we found a dental appointment had been cancelled and the rescheduled appointment missed. This was discussed with staff the following day and they were reminded to check the diary at the start of their shift. There was a delay in making a replacement appointment and when we checked, we could see that the new appointment had not been marked in the diary. So if as advised, staff were to check the diary, they would not be alerted to the appointment. The pharmacist inspector visited Oak Cottage during the key inspection to establish whether the service had complied with the Statutory Requirements Notice (SRN) issued on the 12th March 2009 for breaches to regulation 13(2). The service was required by the 25th March 2009 to have safe arrangements in place for the handling, administration and recording of medicines. We found that overall the medication practices had improved compared to the practices seen at the previous inspection. We found when reviewing the records of one of the people who used the service that the service was recording the receipt of the medication upon arrival at the service. We found that the home had a system for accounting for medication that had been carried over from the previous month. We found that due to the bank holiday Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 18 and the early arrival of the medication there was some confusion with the recording of the medication carried over onto the current MAR chart. The way in which the receipt and carrying over of the medicines had been carried out gave the impression that there was more medication present in the home than there really was. Following an explanation and a review of the drug audit book the correct quantities present at the beginning of the month were established. We found when reviewing the administration records in conjunction with the medication present that this person was receiving their medication as prescribed. The service must be congratulated on the drug audits that they were carrying out on a weekly basis. The information being recorded in the drug audit book was permitting the service to ensure that medication was being administered as prescribed. Unfortunately the same standard of handling and record keeping was not seen with the second person, when their recently prescribed medication was examined. This person had recently been prescribed an antibiotic and the home had recorded the receipt but had failed to record the quantity received. We found that the person the antibiotic had been prescribed for had refused to take the antibiotic so after two days the service discarded it. We found a record of the antibiotic’s return to the pharmacy but again the service had failed to record the quantity that was being returned. We found that the service had made no attempt to contact the person’s doctor to obtain advice on what the service should do to treat the infection. We found that it was 21 days before the issue was raised with the doctor; fortunately the infection had resolved itself. This outcome should not detract from the fact that the service should have sought advice from the person’s doctor when it became clear that the medicine was not going to be taken by the person it had been prescribed for. We found that since the last inspection more staff had successfully completed the safe handling of medicine training and all of the staff apart from two had been assessed as competent to handle and administer medication safely. We found therefore that the service had complied with the Statutory Requirements Notice and are providing an adequate service in relation to the handling and administration of medicines held within the home. Oak Cottage DS0000070082.V375309.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. People using the service experience adequate quality outcomes in this area. People feel safe living at Oak Cottage and there have not been any incidents. Risk management systems need to develop to ensure all significant risks are identified and managed. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People told us they feel safe at Oak Cottage and we can see that some improvements have been made to better protect people. More staff have received safeguarding training and there have not been any accidents, incidents, allegations, restraints or missing persons since we last inspected. Written safeguarding policies are now available and staff had a reasonable idea of action they should take in the event of abuse or if someone goes missing. Checks are now being carried out and recorded during the night too. Some risk assessments are now in place for both residents but there are some omissions in the range and depth of assessments. Sufficient control measures are not in place for example, to inform staff how to protect one person from the risk of falling downstairs when drunk or how to adequately manage aggression. Staff are waiting to receive training in the management of aggression to keep them safe and to help them confidently meet people’s needs safely. One member of Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 20 staff we spoke to was aware of how to diffuse an incident but said s/he would use restraint if required, using training acquired from a former employer. We advised the staff member to seek clarification about this. Care plans need to more fully detail what is expected of staff in such circumstances. Similar concerns have been identified by the Health and Safety Executive but an action plan to address these has not been provided to them as requested. People have told us that they haven’t been told how to complain and pictorial guidance on the premises was available but obscured from view. However, staff have been told in a staff meeting what to do if someone complains and people living there felt, they would be able to talk to someone about any concerns. Both people were keen to tell us that they don’t need to complain about anything, as they are very happy. We looked at systems for managing service users’ money. Documentation fully accounts for expenditure and people whose money it is signs for all financial activity. Staff we spoke to are satisfied that people’s monies are sufficiently protected. We can see that people are involved in collecting their own money but we spoke to one person who said he was not aware how his trips to football matches are funded. Recruitment practice continues to be of concern and does not fully protect people from new staff who may be unsuitable to work with vulnerable people. Oak Cottage DS0000070082.V375309.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. People using the service experience good quality outcomes in this area. People enjoy living in a spacious and comfortable home that is kept clean. The risk to one resident at times from stairs has not been addressed. We have made this judgement using a range of 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. We talked to the people who live there who like their home and said it is comfortable and that they have everything they need in their bedrooms. The premises generally meet people’s needs. However sufficient steps have not Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 22 been taken to protect staff and a resident from the risk posed by stairs when the resident is under the influence of alcohol. We noticed that the bathroom is now furnished with soap and towels to encourage people to wash their hands. Staff must remember to remove and discard their latex gloves when leaving the area in which they have been working in order to minimise the risk of cross infection. Staff have not yet had infection control training. Oak Cottage DS0000070082.V375309.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. People using the service experience adequate quality outcomes in this area. Staff are motivated, interact well with people and have a growing understanding of their needs. Training is being provided but records are poor. New staff are not always being recruited safely and are not receiving minimum training to equip them for their role. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: When we arrived two staff were on duty and one person was at home, the other having gone out with friends. From talking to staff and from looking at the rota we can see that two staff as a minimum are usually on duty although we could see staff lone work occasionally. Following advice from the Health and Safety Executive, young staff who lone work have had some relevant safety training although more is planned. Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 24 People told us that they like the staff and find them helpful. We observed staff interact with people positively and sensitively, offering and acting on choices that people made. Staff are receiving training and the manager is aware of the team’s training needs but evidencing this is piecemeal and time consuming as training records are not up to date. Staff feel they are receiving enough training and support. It is positive that since the last inspection, staff meetings have been held regularly and are documented well. One to one supervision meetings are not being held sufficiently regularly to support and develop staff formally. Also we found that although new staff receive an in house brief induction are not receiving an induction to national standards. These new staff form part of the staffing ratio with immediate effect and are not being sufficiently prepared. This does not give them sufficient time to understand their role before they are taking responsibility for people’s care. We continue to have some concerns about recruitment practices. Staff files are mostly better organised. However the manager struggles to robustly evidence steps she has taken to recruit new staff safely. People’s actual start dates are not recorded on their files and when asked, this question often cannot be answered. It is difficult at times to see whether references provided are from the most recent employer as omissions in completing the application form are not documented as followed up with applicants. Of most concern however is continued none compliance in obtaining Criminal Record Bureau checks for all new staff before they start work. We could see that one person recruited since we last inspected had started work a few days before the Criminal Record Bureau check was issued. The Manager could not provide evidence to the contrary and we seized evidence of this under our regulatory powers. Oak Cottage DS0000070082.V375309.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. People using the service experience poor quality outcomes in this area. Some improvements have been made since the last inspection. However, the manager is not sufficiently improving and developing systems that monitor practice and compliance with legislation or the plans, policies and procedures of the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People living at Oak Cottage are happy and feel their needs are being met. Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 26 Locating some documentation during the inspection was difficult and delayed the course of the inspection. Failure to prioritise and address straightforward significant matters highlighted at and since the last inspection continue to cast doubt on the overall effectiveness of the management. Evidence was seized in relation to some breaches in recruitment and health management. However some improvements have been made since we last inspected. Meetings with staff have taken place regularly to seek to improve standards. Medication has been prioritised following the issue of a Statutory Requirement Notice and although not fully improved, we are satisfied that the immediate risks have been addressed. The Fire Service have inspected fire safety at the home since our last inspection and identified omissions in fire equipment maintenance and fire risk assessment. Most service maintenance certificates could be produced to assure us that equipment is now being safely maintained. The exception to this was a fire alarm system test certificate and Portable electric appliance test records. The manager said she would forward the fire alarm certification. Stickers on plugs indicated portable appliance testing had been carried out in spite of the absence of appropriate documentation. We could see that all other fire equipment had been tested by service engineers and are now being tested regularly by staff. It is positive that a fire risk assessment is now in place and fire drills are taking place regularly. The manager informed us that they had an inspection by the Health and Safety Executive the day after we last inspected in November 2008. We were able to see the notice left by the Inspector detailing a number of required improvements particularly in relation to the assessment and management of risk. The Health and Safety Inspector required the manager to submit an action plan within two months and we have found that this has not been provided nearly six months later. Data sheets have been obtained to provide information about hazardous chemicals but assessments about the level of risk they pose have not yet been carried out. The manager still cannot evidence receiving supervision and she confirmed that although she has received support through her informal network, she has not had a formal supervision meeting with her supervisor since prior to the last inspection report in November 2008. Given the poor outcomes identified in the last report, this is a concern. The manager has not implemented quality assurance systems to help her to assess and respond to the performance of the home and seems unclear what is required in this respect. However, we were able to see at this inspection that two meetings have been held with people living there in which their ideas and Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 27 feedback have been sought. One person is recorded as saying ‘this place is better’ and the other person living there said Oak Cottage is ‘already improved’. We can see that some steps have been taken to try to improve the service. We are concerned however that progress is too slow and that there is insufficient service monitoring to ensure quality in priority areas that have the potential to affect the health and safety of the people living at Oak Cottage. The provider-manager’s long-term goal is to appoint a separate manager to manage the service. She spoke to us about recognising the need in the meantime to obtain some management support. Oak Cottage DS0000070082.V375309.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 X 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 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 2 34 1 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 1 X 1 X X 2 X Version 5.2 Page 29 Oak Cottage DS0000070082.V375309.R01.S.doc 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 YA9 Regulation 13 Requirement 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. Not fully met April 2009. 2. YA34 19 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 Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 30 Timescale for action 30/04/09 30/04/09 homes recruitment practices. Requirement arising from first inspection November 2007. Not met November 2008. Not met April 2009 3. YA19 13(1)(b) Put a system in place to ensure 23/06/09 that Service users receive where necessary, treatment, advice and other services from any health care professional that is required, to maintain their health and welfare. Put a procedure in place to ensure that when appointments with care professionals are arranged, that these appointments are not overlooked and accurate records are made of outcomes for service users. 4 YA41 17(2)(3) 30/06/09 Ensure that all records specified in Schedule 4 of the Care Home Regulations 2001 are available, up to date and are at all times available in the care home for inspection by any person authorised by the Commission to enter and inspect the care home. You are advised that this must include but is not limited to • • • All pre employment checks for all staff, Copies of any POVA First check requested and received, Rotas which include all persons working at the care home and a record of whether Version 5.2 Page 31 Oak Cottage DS0000070082.V375309.R01.S.doc • the rota was actually worked Full documented information pertaining to wages including any time sheets for all staff. New Requirement arising from April 09 key inspection. 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 Signed contracts outlining the terms and conditions of 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. Not met April 2009 2. 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. Not assessed April 2009 as no new admissions to the home. 3. 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. Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 32 Recommendation arising from first inspection November 2007. Not met November 2008. At April 2009 information available but not clearly visible. 4. YA42 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. Not met April 2009 5. 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. Not met April 2009 6. YA39 Effective quality assurance and quality monitoring systems 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. New recommendation November 2008. Not met April 2009 7. YA41 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. Not met April 2009 Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 33 Oak Cottage DS0000070082.V375309.R01.S.doc Version 5.2 Page 34 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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