Inspection on 26/02/09 for Oak House

This inspection was carried out on 26th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Oak House Oak House Darley Cliffe Upper Sheffield Road Barnsley S70 4AG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anne Prankitt     Date: 2 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Oak House Darley Cliffe Upper Sheffield Road Oak House Barnsley S70 4AG 01226733294 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Holly Bank Trust care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service 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 Code LD Date of last inspection Brief description of the care home Oak House is a care home registered to care for people who have a learning disability. The home can accommodate up to six people in two buildings which are adjacent to each other. The Oaks can accommodate up to four people. Hallways and corridors are wide to make access for wheelchair users easier. There is a kitchen area and large communal sitting room. There is also a small dining area. There are four single bedrooms with ceiling track hoists, specialist beds, and en suite facilities. The Acorns is a seperate annexe whch can accommodate two people. It has a large lounge and two bedrooms which are provided with the same facilities as at The Oaks. There is a small kitchen area there. The service is situated near to a range of facilities such as shops, pub and a place to worship. Public transport passes the end of the driveway. On the day of the site visit, the registered manager told us that the current weekly fees range Care Homes for Adults (18-65 years) Page 4 of 36 Brief description of the care home from 1300 pounds to 1600 pounds. People pay extra for personal toiletries, clothing, personal effects, some leisure activities, and contributions towards holidays. Before people arrive we were told that they would be provided with a copy of the service users guide and the homes brochure. People are also welcome to visit and have a look around. The inspection report will be made available to people on request. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since it became registered in February 2008. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Comment cards sent to all people living at the home (five returned), and staff (five Care Homes for Adults (18-65 years) Page 6 of 36 returned). A site visit to the home carried out by one inspector lasting 6.5 hours on 26 February 2009. During the visit to the home, some people who live there, three care staff, the registered manager and deputy were spoken with. Two peoples care plans were looked at in detail, as well as two staff recruitment files, and some records about health and safety. Some time was also spent with people, and watching the general activity where appropriate, to get an idea about what it is like to live at Oak House. The deputy manager was available all day. The registered manager was available in the afternoon. Both were provided with detailed feedback at the end. What the care home does well: What has improved since the last inspection? What they could do better: In future, the staff could assess people before they move in. They could keep this information and use it when reviewing the care, so everyone can see how it has changed over time, and where changes need to be made. Peoples care plans could be updated and reviewed, so staff have up to date information about their current strengths, abilities, risks to them, and also where they need support to maintain their wellbeing and independence. Better records could be kept to show what people have eaten, so it is easier to confirm they have received a nutritious, well balanced diet which meets their dietary requirements. Improvements could be made to the way the medication people get is recorded, reviewed and audited so it can be confirmed that they get this as the doctor prescribed it. Staff could be provided with more information about the professionals they can report to if they ever needed to pass on their concerns about abuse. This would make sure that there were no delays in these professionals taking the right action to protect Care Homes for Adults (18-65 years) Page 8 of 36 people quickly. More information could be made available for authorised people to look at, to confirm that the company have taken the right steps to properly vet staff before they are allowed to provide care to the people living at The Oaks. Also to show when they have completed training about how to work in a safe way. Better observation by staff of some health and safety matters could be made so it can be assured that people are kept safe from unnecessary harm. Advice could be sought from the Environmental Health department to check the kitchen is being run to meet their standards, and that the correct procedures are being followed with regards to good, safe housekeeping. Ways of seeking the views of people who use the service, their families, and other professional who support them could be established, and their comments taken into consideration, to make sure that the home is run in peoples best interests. 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 set out 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. Care Homes for Adults (18-65 years) Page 9 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager knows the right procedure to follow should a new referral be made to the home, and assures that people will be properly assessed before they are admitted, to make sure their needs can be met. Evidence: Two care plans were looked at in detail after asking the people to whom they belonged if this was alright, to see what information had been collected about their needs and wishes before they came to live at Oak House. There was no pre admission assessment information in either file. The deputy manager explained that this is because the people had been either transferred from another service belonging to the Trust, or had received respite care there, so their needs were already known. The deputy manager said that staff had worked closely with these people in the run up to Oak House opening. This means they had the chance to get to know the staff who Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: would be providing their care in the future. Four out of five surveys returned on peoples behalf confirmed that they had received enough information about the service before they moved in, so they could decide if it was the right place for them to live. Completing an assessment before the person is admitted allows staff to have a better understanding about what the current needs of each individual are, areas in which they are independent, and whether the home is the right place to meet these needs. The registered manager gave assurance that, should anyone be admitted to Oak House in the future, she would make sure that she or a chosen staff member does this. The assessment should always include gathering information from health professionals and care managers, where appropriate, before deciding whether Oak House will be able to offer the person a place. The assessment should also consider what gender of staff the person would prefer to receive care from. At the moment, there are only female staff employed there. This may not be acceptable to some people, who may wish to receive their care from a male. Although it is the aim of the service to keep paperwork stored at the home to a minimum, the assessment should be kept with the persons plan, rather than be stored at head office, as we were told would be the case. This assessment helps to develop the persons plan of care, and can be used to reflect upon how needs change over time. Five out of six surveys returned identified that people have not received a contract. These need to be arranged, so they and their families are aware of the terms and conditions of their stay, and their rights and obligations. Although in normal print, there was a copy of the service users guide in the reception of each area of the home. This could be translated into other formats, such as easy read and pictorial, so it is useful to a wider audience. Some other documents in the home have been translated in this way, such as the complaints procedure. These examples could be followed. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples overall needs are met satisfactorily, but these needs, and risks to their wellbeing, are not always reflected in the care plan. Evidence: Two peoples files were looked at in detail to see how their care was described. The care plans that staff currently refer to were written before the people moved from one establishment owned by the Trust to this one when it opened. They were completed in 2007, and had not been formally reviewed since. These care plans are designed to explain peoples areas of ability and independence, as well as where they need assistance. Some of the information was not very person centred, and it would not have been easy to distinguish to whom the plan belonged. The registered manager agreed that staff now need to focus on updating these plans to reflect the knowledge they have about people, and include more information about what support people need both socially and psychologically. When doing so, staff need to make sure that the informaton is dated, so it is clear when changes to a persons health and welfare have Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: happened, and why. The plans need to be regularly reviewed, especially when peoples care changes. Staff also need to make sure that there are completed risk assessments and care plans, for people who may experience risks in their daily lives. For example, how staff are to manage behaviour which can change quickly and challenge others, or where a persons medical condition may need immediate staff attention to maintain their safety. This way, people can be assured that staff will work consistently and safely in meeting their needs, because they are all following the same plan. However, the staff have been working hard to make sure people settle in to their new home, and despite the above shortfalls, the daily records reflected that they know them well. Many of their comments were very individual, and really focused on what makes one person different to the next. Staff demonstrated, throughout the day, ways in which people are provided with opportunities to make choices and decisions in their lives. It was clear that these are respected. Staff get a handover before each shift. They agreed that they are always or usually given up to date information about peoples need. They said that the way information is passed on either usually or sometimes works well. The home does not have an office. One survey said that better confidentiality would be an area for improvement. This was not observed to be an issue on the day of the site visit. However, the registered manager and staff must remain aware of the need to maintain peoples confidentiality. Nobody at the home manages their own finances, but the records seen showed that any money belonging to them and managed by staff was properly accounted for, and accessible to people when they wanted it. People do not have locked facilities in their rooms, but the registered manager said that she would make sure these were supplied if needed. Care Homes for Adults (18-65 years) Page 14 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care is taken to make peoples lives more fulfilled. Evidence: People living at Oak House attend a range of activities and education opportunities to help make their lives more fulfilled. They can carry on attending activities they enjoyed before moving to the home, even if this involves some extra travelling, if this is what the person wants. Some people attend college classes in art, baking and computing. Other interests include horse riding and rebound which involves exercising on a trampoline. Transport provided by the home makes it easier for people to access these activities, which they attend with staff support. Of the surveys returned on peoples behalf, one replied that there were always activities for them to join. The remaining four said that this was usually or sometimes Care Homes for Adults (18-65 years) Page 15 of 36 Evidence: the case. Now that people have settled in, the registered manager told us that she intends to see what facilities that the local community provides, so they can have better access to these. One person, for instance, has said they would like to go to the theatre. Another has already enjoyed bowling sessions. Three people have enjoyed a holiday with staff. Two of these went abroad in a specially adapted villa. Staff accompanied them on their break. And people are encouraged to keep in contact with their families and friends. Visitors are welcome, and often people go home at the weekend. This helps to maintain links with those who are important to them. The routines at the home are flexible. Staff respected the time people chose to spend in their own room, and always knocked before entering. This allows people the right to have time on their own, away from others, when they want. There was a lot of good interaction and laughter between people and staff, and the environment was relaxed. One staff member said thats how it should be, because it is a proper home where people live. There was mixed response when people were asked if they liked the meals at the home. However, nobody replied that they did not like them. One survey completed on a persons behalf said prepared on the premises - just like being at home. People choose at each meal what they want. Staff were heard asking what they would like to eat for lunch. This gives people the opportunity to look forward to a meal which they know they will enjoy. Assistance was given sensitively, and the mealtime was relaxed. The care staff cook the meals each day. The staff who prepared the meal on the day knew that some people had special dietary needs. They also knew that they could refer to this information in the care plan. Staff were also aware of peoples cultural and religious preferences in relation to the food they would not wish to eat. We were told that, although there is no set menu, people also decide between them what they would like for their main meal, which is provided in the evening, and which includes a selection of fresh vegetables. One staff member said they always try to provide sufficient fruit and vegetables so people get their allowance of five a day. A record is kept in peoples files to show what they have eaten. Staff need to keep an overall record of what meals have been provided so they can make sure that the menu over time is sufficiently varied, balanced and nutritious. It would also be good practice to complete a nutritional assessment for everyone, including when they are first admitted, and to review this along with the care plan. Problems with nutrition can often impact on other areas of care, for example good skin integrity. Having an Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: assessment in place would warn staff early if problems were arising which needed more attention from the professionals who support the home. Care Homes for Adults (18-65 years) Page 17 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff take care to meet peoples health needs. But improvements could be made to the medication system to reduce the risk from errors. Evidence: Out of five surveys returned on behalf of people living at the service, four of these agreed that they get the care and support that the need. One person thought this was sometimes the case. A comment was made that staff try really hard to understand and anticipate the persons needs and that staff cant do enough for all of the residents. All but one response, which stated not always, was positive when asked if staff listen and act on what people say. Someone said The staff are very caring and professional and always keep us informed at all times. Three surveys agreed that people always get the medical support that they need, with the remaining two stating that this was usually or sometimes the case. Once the home starts to circulate satisfaction surveys, this is the sort of valuable Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: information which will help the registered manager to make improvements to the service based on peoples views, and to be clear where the home does things well when providing their support. On the day, peoples care was provided in a flexible, personal way, depending upon their needs, and also upon what their plans were for the day. Personal care was provided in private, and staff did not discuss this in public areas. The daily records showed how people make choices about their care. A physiotherapist provides regular support to the home. She stated that the staff follow her instructions when she is not there, which means that people get the right support at all times. Other professionals also visit, and give support and advice depending upon need. This includes the doctor, district nurse and professionals from the hospital, such as the speech and language therapist. None of the people living at the home manage their own medication. This is looked after by staff, all but one of whom have completed safe handling of medication training. The final staff member will soon attend this training, but we were told that, in the interim, they have received in house training to make sure they know how to work in a safe way. Peoples medication is recorded in their care plan. It is prescribed by their doctor, and dispensed by the chemist. On arrival, staff check and count the medication to make sure it is correct. There were some areas which need to be improved upon: Staff do not record how much medication they have given when the dose prescribed is variable. It is good practice to do this so the doctor can see how much the person has been having, and how effective the medication has been over time. Staff who apply creams prescribed by the doctor do not sign to say they have done so. They need to, as a true record that the doctors orders have been followed. Some medications which had been discontinued by the doctor were still included on the medication chart produced by the chemist. These need to be removed where they are no longer prescribed, to save duplication, and to reduce the risk from error. One persons medication needed to be reviewed, to make sure that the doctor was clear about the way in which the medication was being administered. The care plan and record sheets must when be updated to reflect clearly the instructions for staff to follow. The registered manager has informed us this has now been done. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: Some equipment used for testing urine was out of date, and may have been no longer be effective. The deputy manager was told that this needs to be reordered. Care Homes for Adults (18-65 years) Page 20 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by staff who will pass on concerns, but who need more training about the different roles of those who are responsible for investigating these. Evidence: Of those who returned their survey, all said that they know how to make a complaint. All staff said they know they must always report concerns raised about the home. The deputy manager confirmed that there have been no complaints made direct to the home. The Commission for Social Care Inspection has received no complaints or concerns since the home opened in February 2008. Each area of the home has a pictorial complaints format which gives people with limited communication an alternative way to express their concerns. This is good, and if used will help staff to iron out problems early should they arise. Staff receive training in abuse awareness, during which time they are told what to do if they ever believed that anyone living at the home was being mistreated. This is first discussed at induction, and further training is given thereafter. Staff spoken with were clear about their responsibilities in reporting potential abusive situations, and knew that they could not keep such information to themselves. However, not all were clear about the role of the local authority as lead investigators. They need to be reminded of Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: this so they can pass on their concerns to the right professionals if for any reason they did not feel that they could go to a representative of the Trust. This will make sure that the right people are always told quickly. Care Homes for Adults (18-65 years) Page 22 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The internal design of the building meets peoples needs in a comfortable way. However, failing to act according to peoples assessment where risks are identified increases the chance of accidents happening. Evidence: The home is situated near to local amenities, transport links, cinemas, pubs and shops. We were told there are places of worship within reasonable travelling distance. Transport is provided by the home to assist people should they wish to attend any of these facilities. The premises looked clean and tidy. The cleaning duties are carried out by the care staff, often at night, although the registered manager has plans to employ cleaners. This would be good, because it would mean that staff have extra time to spend with people. In their surveys, people said that the environment was either always or usually fresh and clean. The accomodation provided is on ground floor level. The building has been specially adapted so that people who use wheelchairs can get around it more easily. Four people live in The Oaks. Two people live in The Acorns, which is designed to accommodate Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: people who are more independent. The two buildings are separate. However, there is a call bell system throughout, and we were told there are always staff in attendance when the areas are occupied by people. There is a small raised kerb leading from the road onto the pavement which leads to the building called The Acorns. The manager was advised to see if this could be made more level, so that people entering the building can do so more easily, and reduce the risk from wheelchairs tipping. A risk assessment was seen to address this, which said that two staff should be in attendance when the person negotiated the kerb. However, on the day, only one staff was with them when doing so. This risk assessment must be followed if this is the safest way of managing the situation, and keeping the person safe. The Oaks has a large sitting area, a communal bathroom and toilet and a dining area. There is also seating in the kitchen area. The Acorns has two large bedrooms and a sitting area. There is also a kitchen area there, where people are assisted by staff, depending upon their abilities, and risks to their safety, with cooking. One person intimated that they enjoyed this. Everyone has their own room, which is fitted with ceiling track hoists so they can be assisted easily when they are unable to manage alone. Everyone also have a shower facility. We were told that people have chosen their own colour schemes for their rooms. Those seen were individual to the person, and contained their own belongings. The laundry is situated in an annexe off the kitchen area. Care staff complete the laundry tasks, as well as the cleaning. There was protective clothing such as gloves and aprons available for staff to use, and the deputy manager explained that special bags are provided to keep soiled linen separate so it does not have to be handled unnecessarily. This reduces the risk from cross infection. We have been given assurance that staff use the side door to enter the laundry, and that they never transport soiled linen through the kitchen area, which would not be safe practice. Care Homes for Adults (18-65 years) Page 24 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff get training to help them provide good, safe care. However, insufficient records are available to confirm, other than through staff consultation, that these staff are thoroughly vetted before they begin to provide care. Evidence: Four surveys returned on behalf of people living at the service agreed that staff were always available when needed. The fifth said this was sometimes the case. We were told that a minimum of four staff are provided during the day to meet the needs of the six people who live at Oak House. The numbers are higher during the week, when up to six staff are available. This is to allow for escort duties to the many activities that people attend. At the weekend there are less activities, and sometimes people are away on leave. At night, there is one waking staff, who works in Oak House, and one sleeping carer on call who is based in The Acorns. They work together when people need the care of two staff. People can ring for assistance. Staff spoken with said that this works satisfactorily. Staff comments varied about staff availability. Whilst some though there were always sufficient, others said this was usually or sometimes the case. One comment was made that there are sometimes not enough staff left in the house when people are Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: escorted to their various activities. Based on this mixed feedback, the registered manager should keep staffing levels under review, as staff are needed in both the main house and the annexe when both areas are occupied by people. There were not enough records kept in the two staff recruitment files looked at to confirm that the necessary checks had been carried out before they were allowed to provide care. For instance, there was no application form, so it was not clear whether any gaps in employment they may have recorded had been explored. The references received were not dated, so it was not clear whether they had arrived before the staff member had been deployed. In one case, neither reference was from their previous employer. In one file, the staff member had been deployed to provide care after the Trust had checked that they had not been barred from providing care, but before the full police check had been returned. The registered manager gave assurance that this person was supervised at all times. In the second file, the full enhanced Criminal Records Bureau check had been returned, but the result of the check against the POVA list, which shows whether people have been barred from providing care, was not available. There must be enough information available for the regulatory body to be able to confirm that people have been safely recruited. Despite thisshortfall, two staff spoken to were clear that the correct information was asked during the interview period about previous gaps in employment, based on the information given in their application form. And those who returned their surveys also agreed that the necessary employment checks were carried out, such as the full police check and references, before they started working there. Staff inductions were not available. Again, we were told that these were kept at the Trust offices. However, staff confirmed that they had received an induction, which covered everything they needed to know about the job either very well or mostly. And they all agreed that, since then, they have been provided with suitable training. Two staff spoken with said their induction had lasted for four weeks. One said their induction had improved their understanding of people with a learning disability, and had covered health related problems such as epilepsy and nutrition, and also other issues such as privacy and dignity, and equality and diversity. Since starting, they have been given occasional supervision to help them in their work. Future opportunities for staff includes training on how to manage behaviour which challenges others. This will help to make sure the care people get is consistent, and will help staff to take the right action should such instances occur. Some of the staff have attended training in special communication methods. One of these is called Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: MAKATON. This will help them to communicate effectively with people who use this form of communication. Other training includes aromatherapy and relaxation techniques. We were told that training is also provided by health professionals. For instance, the dietitian has provided training on managing peoples special feeding regimes, such as gastronomy feeds. Staff are completing National Vocational Qualifications in Care at Level 2 and 3. Staff at a more senior level are also undertaking Level 4 in Management. This collective training will mean people are cared for by a well informed workforce. The registered manager does not keep a record of when staff have received training. And some of the staff files did not contain copies of certificates to confirm training that staff said they have attended. It would be good practice for the manager to keep her own record of training so she can plan training sessions dependent upon individual need and following supervision sessions. Care Homes for Adults (18-65 years) Page 27 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is lead by an enthusiastic manager who wants it to run in peoples best interests. Improvements could be made to some matters which affect peoples health and safety in order to help achieve this. Evidence: The registered manager has worked in the care profession for a number of years. She is undertaking a management qualification, and said she gets lots of support from the regional manager, who visits the home regularly to check that good standards are being maintained. She gets opportunities through the Trust to update her skills. This will help her to keep staff up to date with current good practice. Staff on the day said things like The management are very supportive, The managers are good - they support us and listen, and a comment was made that the registered manager and her deputy were fabulous. She wants the home to run well and in the best interests of the people who live there. She and her staff want people to have a good quality of life. In order to help achieve Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: this it is important that the home establishes a way of seeking the views of people. There are currently no residents or relatives meetings. And the home is yet to establish a quality review programme. However, there are very good pictorial satisfaction questionnaires available which could be used so that people get the opportunity to say what they think about their home. Surveys could also be given to peoples families and other professionals who play a part in their care. This would show the registered manager what they think the service does well, and where it could do better. It would help her to develop the service, and would ensure that the home is run according to their best interests and wishes. Staff told us that they have attended a range of training to help them work in a safe way. This includes training in fire safety, moving and handling, infection control and food hygiene. And we were told that the majority of staff have completed first aid training, to ensure that there is always a first aid qualified person on duty in case of an emergency. The registered manager does not keep a record of when staff have received this training, because head office alert her whenever it is due. As stated in the previous section, it would be good practice to do so, to be certain that nobodys mandatory training is accidentally overlooked. The following matters which affect peoples health and safety were discussed: There were no records kept in the kitchen except for fridge and freezer temperatures. Staff do not wear aprons when preparing meals. As they may have previously been providing care, they need to do this to reduce the risk from cross infection. The registered manager has been advised to seek further advice about what records the home is required to keep to evidence that they are providing a safe food service. The Environmental Health Officer would be able to provide up to date guidance. The registered manager said in her AQAA that the number of fire drills provided for night staff could be improved upon. This has not been done yet. This should be organised, as the staffing arrangements and numbers at night mean that these staff need to be fully conversant with the fire routine, so they keep people safe should a fire break out. The registered manager agreed to action this. There were no records to confirm that the fire alarm has been serviced in the last year. The registered manager has confirmed that this service has been organised, and will be soon completed. One of the fire doors in The Acorns was held open in such a way that it would not shut should the fire alarm sound. The commission cannot give permission for doors to be held open in this way. The registered manager said she has ordered a hold open Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: device, which she was waiting to arrive. In the meantime, she said the wedge will not be used any more. This will keep people safer in the event of fire. She has been asked to contact the fire officer for further advice on the use of hold open devices. She has confirmed that she has done so, and that the right action has now been taken to protect people from the spread of fire. We were told that the water outlets accessible to people are fitted with fail safe valves which are pre set at a safe temperature. The water temperature is not checked periodically to make sure that the valves are still working. Doing so reduces the risk from scalds. The registered manager has agreed to make sure that this is done in the future. Care Homes for Adults (18-65 years) Page 30 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Peoples care plans must be updated, to explain their changing needs. The plans must be kept under review, and, where possible, agreed with the person or their representative. This is to make sure that all areas of personal, psychological and social care are understood and met consistently. 30/04/2009 2 9 13 Risks assessments which concern individuals health and welfare must be completed where risks to people have been identified by staff. This will make sure that these risks are not overlooked, and that staff take the correct, agreed action should an incident occur which affects the persons health or welfare. 31/03/2009 Care Homes for Adults (18-65 years) Page 32 of 36 3 20 13 As discussed at the site visit, 20/03/2009 all medication must be properly signed for and given as prescribed. This includes: Recording how much medication staff have given to the person when the dose is variable. Recording when creams prescribed by the doctor have been applied. Administering medication by the route agreed by the doctor. This ensures that proper records are maintained, allows the doctor to see how successful the treatment has been when they review the persons care, and ensures people receive their medication as intended. 4 34 19 Sufficient information about 31/03/2009 the staff recruitment process must be kept at the service for anyone with the authority to do so to check. This is so it can be checked that staff are recruited properly, so that people living there are protected from unsuitable workers. 5 42 16 Advice must be sought from 31/03/2009 the Environmental Health department to establish what records are required, and what protective clothing Care Homes for Adults (18-65 years) Page 33 of 36 staff should wear, when working in the kitchen area. This will make sure that correct and sufficient information is being kept, and procedures followed, to ensure that food preparation and storage is safe. 6 42 13 As stated at the site visit, fire doors must be kept shut, unless expressly agreed by the fire officer. This will keep people safe from the spread of fire. 20/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 In future admissions, the home should carry out a pre admission assessment, to include information from other professionals. This should be kept with the persons care plan, so it can be referred to when developing and reviewing the plan in the future. People should have a nutritional assessment completed on admission. This should be kept under review so that identified problems with their nutrition can be raised with the appropriate health professional quickly so that their nutritional wellbeing is maintained. Other than that kept in the care notes, a record should be kept of the menu provided for people. This is so sufficient detail is recorded of what meals people have been provided with over time. This would make is easier to confirm that their diet is nutritious, balanced, and that it meets peoples dietary requirements. Medication no longer prescribed for people should be removed from the medication administration record. This will reduce the risk from error. When auditing the medication, the stock should be closely checked to make sure that out of date items which may no 2 17 3 17 4 20 Care Homes for Adults (18-65 years) Page 34 of 36 longer be effective are removed and replaced. 5 23 Staff should be provided with more training about the role of the local authority as lead in safeguarding investigations, so they know that they can go to them at any time with any concerns about the people in their care. Staffing levels at the home should be kept under regular review, as the needs of people dictate, and to support the activities that they attend. The registered manager should keep a record of what training staff have attended, and when. This would help to focus training better according to staffs individual training needs, areas where they needs to develop, and would be helpful as part of their supervision. Ways of seeking the views of people who use the service, their families, and other professional who support them should be established. This will confirm what the home does well, where it could improve, and will give better information so that the service can be run in peoples best interests. A record should be kept to show that hot water outlets accessible to people living at the home are checked periodically to make sure that they are maintained at safe temperatures. This will reduce the risk from scalds to people should the pre set valves fail. 6 33 7 35 8 39 9 42 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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