Inspection on 31/07/07 for Oak House

This inspection was carried out on 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oak House 17/06/06

Oak House 16/01/06

Oak House 27/09/05

Oak House 21/02/05

Oak House 31/08/04

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Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Oak House 1 Draycot Road Surbiton Surrey KT6 7BL Lead Inspector Adrian Gordon Key Unannounced Inspection 31st July 2007 4:00pm Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak House Address 1 Draycot Road Surbiton Surrey KT6 7BL 020 8390 8206 020 8287 1950 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) The Fircroft Trust Mr Richard Weir Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th June 2006 Brief Description of the Service: Oak House is a care home provides accommodation for three adults with learning disabilities. It is located in a residential street close to facilities in Tolworth and Surbiton. Local bus and train routes are available nearby. The service is managed by The Fircroft Trust. Information about Oak House is available in a detailed Statement of Purpose and easy to read Service User Guide. Fees are £592.27 per week. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over the course of one afternoon by one inspector. It consisted of a tour of the premises, examination of records and observation of care practice. The inspector met with all the residents and two members of staff. Feedback questionnaires were received from all three residents. What the service does well: What has improved since the last inspection? What they could do better: Training must be provided on a more regular basis to ensure staff have all the core skills necessary to carry out their jobs. Although most of the environment is of a good standard, residents would benefit from the bathroom being refurbished. Outstanding health and safety checks must be carried out to make sure residents are fully protected from all unnecessary risks. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 7 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 House DS0000013425.V346434.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are given an opportunity to spend time in the home. They are given understandable information about rights and responsibilities if they choose to live there. EVIDENCE: All residents have an assessment before moving in to make sure that the service can meet their needs. There has been one new admission over the past year. This resident said that they came to visit and had a trial stay before moving in permanently. The resident now sees it as home and said they are ‘very happy here’. A copy of the three month placement review was seen in their file. Each resident has a contract which includes information about the fees for the service and terms and conditions. Residents are also given a Service User Agreement which outlines responsibilities while living there, for example domestic chores and looking after their rooms. Copies of these are signed by the resident and kept in their files. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are involved in developing good support plans which are person centred and easy to read. EVIDENCE: Each resident has a detailed person centred Support Plan which includes photographs and symbols to make it easier to understand. These are clearly written and show how individual needs are best met by staff support. Areas covered include personal hygiene, health, social relationships and leisure. Other information includes a personal profile which gives a history of each resident. Goals are identified and reviewed. One resident showed their Personal Planning Book which they keep themselves. This is a colourful, easy to read book which gives lots of information about life history, likes and dislikes. The use of family pictures and other photographs makes it a very personal document. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 10 Residents are regularly asked for their opinion about life in the home. Either formally, through monthly keyworker meetings and resident meetings, or informally on a daily basis. For example during the inspection staff asked residents what they wanted to eat, and talked to one person about what they wanted to do that evening. Risk assessments are up to date and regularly reviewed. These support residents to stay as safe as possible whilst encouraging independence. Risk assessments cover areas such as personal safety, travel, hot water and mental health. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good range of activities available for residents to enjoy and they are encouraged to pursue individual interests. EVIDENCE: Residents are able to take part in a range of activities which they choose to do. One resident talked about doing a computer/internet course at college and showed a pictorial work book that had been completed. It would be a great benefit if there was access to the internet in the home. Other activities enjoyed include bowling, going out to pubs and cafes and visiting friends. One resident likes to watch Chelsea play football. Another resident has just got a season ticket to watch Arsenal. There are local shops in Surbiton and Tolworth and sometimes residents go into London for a day out. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 12 Visitors are made welcome and residents talked about their friends and family that either come and visit or who they go out to see. There is little information about sexuality in care plans and where it is mentioned it is about ‘inappropriate behaviour’. More thought should go into what is written to show sexuality as a positive part of someone’s identity rather than inappropriate. The rights and responsibilities of residents are detailed in service user agreements. It was clear that residents are able to choose what they want to do and understand their responsibilities for living in a communal house. For example one person talked about it being their turn to do the hovering which is shared on a rota basis. One resident’s file contained a behaviour agreement which had been signed by them. This stated that if they misbehaved they would get no treats. Although this was trying to get the resident to be responsible for their behaviour it was negative and did not respect them as an adult. Residents confirmed that they go out shopping for food and that they enjoy the meals. Fresh fruit was available in the lounge. Menus showed that ‘takeaways’ are seen as a regular choice by residents. More should be done to promote healthy eating options as an alternative. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good support is in place from staff and specialists to ensure that health care needs are met. EVIDENCE: Information on health needs is detailed in Support Plans. Records show that residents go to routine health checks such as doctors appointments and the dentist. Specialist support is available from the Community Learning Disability Team if needed. Medication Administration Record (MAR) sheets showed no gaps and were completed correctly. The home uses a monitored dosage system from a pharmacist. Medication is checked in a weekly audit which helps to ensure there are no errors. However, the dosage instructions for one medication were unclear and could lead to a mistake. This was discussed with a member of staff who agreed to get it changed. The medication profile for this resident had also not been updated. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 14 A new document has been introduced called ‘When I Die’ which gives information about each residents preferences in the event of death. This is an excellent piece of information giving the views of residents about arrangements, including what they would like if they were dying, funeral music and what type of burial they want. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The clearly written complaints procedure is made available to all residents and ensures that they know what to do if they have any concerns. EVIDENCE: There is a detailed complaints procedure which has been made easier to read with pictures so that residents understand it. Residents confirmed that they knew how to complain and that the procedure had been given to them. It was also seen on the notice board in the dining room. There have been no recent complaints. The service has a copy of the local adult abuse procedures for the Royal Borough of Kingston. Staff were aware of the action to take in the event of any concerns. Not all staff have received training in the Protection of vulnerable Adults over the past year. This must be provided. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The layout and design of Oak House makes it a homely place for the residents to live in. EVIDENCE: Oak House is laid out over two floors. One the ground floor there is an open plan kitchen lounge area with a separate dining room with access to a rear garden. These rooms were clean, bright and nicely furnished. A homely feel was made with the use of plants, pictures and photo of residents. There is one bedroom downstairs and two upstairs. Two bedrooms were shown by residents. These were clean, well furnished and personalised with pictures and posters. Residents have equipment for personal use in their rooms such as DVD players, TV’s and CD players. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 17 There is a toilet downstairs and a bathroom upstairs. The bathroom had a damp smell and there were some tiles missing from the wall. The bath mat was dirty and stained. A member of staff said that the bathroom was due to be refurbished. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the support provided by an experienced staff team. EVIDENCE: There is a small but experienced staff team which consists of a house leader and support worker. Regular care bank staff are also used. The registered manager is based at another home. There is always one member of staff on duty and one person sleeps in overnight. Suitable on call arrangements are in place in case of emergency. The main recruitment files for staff are kept at Head Office. Records for bank staff were looked at during the inspection for another Fircroft home. These contained recruitment monitoring sheets which showed that all staff had the necessary checks before working. These include references, photograph, proof of identification and a Criminal Records Bureau check. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 19 Staff said that they get to go on useful training which helps them to do their job. Recent training includes ‘Understanding Behaviour that Challenges’ and ‘Empowering’. The registered manager has drawn up a training plan which identifies staff training needs over the next year. This includes core skills such as Health and Safety and Adult Protection. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good management and monitoring systems in place which ensures that the service runs effectively. EVIDENCE: The registered manager was not available at this inspection. He is based at a different home but provides suitable support and supervision to staff including monthly house meetings. There are good management systems to ensure that the home is run effectively. A house leader takes responsibility for the day to day running of the service. This person confirmed that they get the support they need from the manager. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 21 An annual development plan is in place for Oak House which includes aims and objectives for 2007. In addition, Fircroft sends out quality assurance questionnaires to residents and relatives every six months. Some of these were seen, however it is unclear what action is taken about some of the comments and suggestions made. These should feed in to the development plan. The Fircroft Trust carries out monthly monitoring visits and reports are kept at Oak House. Health and safety checks are mostly up to date and a monthly audit is carried out to ensure that the home is safe for residents. Checks on portable appliances and fire extinguishers were last done in June 2006. These are overdue and must be carried out. Staff received fire safety training in February 2007 and the fire alarms are tested weekly. An environmental risk assessment was updated in April 2007. Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 22 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 X 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 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 3 3 2 4 3 X 3 X X 2 X Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 YA20 Regulation 13(2) Requirement To ensure there are no medication errors, MAR sheets must be clear about the dose to be given and medication profiles must be updated whenever there is a change in medication. To further protect residents all staff must have refresher training in the Protection of Vulnerable Adults. So that residents have suitable facilities the bathroom must be refurbished and the stained bathmat replaced. So that staff have the necessary skills to carry out their jobs, core skills training must be provided. To make sure there are no unnecessary risks to the health and safety of residents, portable appliances and fire extinguishers must be tested. Timescale for action 24/08/07 2 YA23 13(6) 01/11/07 3 YA27 23(2)(b) 01/12/07 4 5 YA35 YA42 18(1)(c) 13(4)(c) 01/12/07 01/10/07 Oak House DS0000013425.V346434.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA11 YA15 YA17 YA39 Good Practice Recommendations Internet access should be provided for residents to enable them to develop their skills and improve communication. Sexual identity should be included in support plans to better enable staff to support and understand residents. To promote the health of residents a healthier range of meals should be considered. To show that the views of residents and relatives are taken into account, comments and suggestions in questionnaires should be included in the Annual Development Plan. 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