Inspection on 08/11/05 for Oak House

This inspection was carried out on 8th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 27 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oak House 21/11/06

Oak House 21/06/06

Oak House 20/03/06

Oak House 13/02/05

Oak House 03/08/04

Oak House 01/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Oak House Newland Nr Coleford Glos GL16 8NJ Lead Inspector Mr Paul Chapman Announced Inspection 8th November 2005 10:00 Oak House DS0000016516.V257914.R01.S.doc Version 5.0 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 DS0000016516.V257914.R01.S.doc Version 5.0 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 DS0000016516.V257914.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Oak House Address Newland Nr Coleford Glos GL16 8NJ 01594 832218 01594 810374 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) Oak House Trust Limited Mr Stephen Horne Care Home 16 Category(ies) of Learning disability (16), Learning disability over registration, with number 65 years of age (3), Sensory Impairment over of places 65 years of age (1) Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13/02/05 Brief Description of the Service: Oak House is a large detached property in the village of Newland, near Coleford. The home is registered to provide accommodation for up to 16 adults with learning disabilities; currently there are 12 male residents. The home has extensive grounds with grassed areas, vegetable plots and outbuildings. The service users are extensively involved in the up keep of the garden and growing vegetables. In addition to this they also make birdhouses and other similar items in the workshops. The home is staffed at all times. There are domestic and care staff. The manager and his family live in flats in the property and provide the majority of the care. The registered manager and his family were present throughout the inspection. One of the registered manager’s sons is the deputy manager. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced visit was carried out by two inspectors Paul Chapman and Tanya Harding and lasted over six hours. The registered manager and his family, who form part of the staff team supported the inspection. All of the service users and staff were met. The environment was inspected and a number of records were examined. These included care plans and risk assessments, health records and records of service users expenditure. The main purpose of this inspection was to assess whether the home is operating in line with the National Minimum Standards for Adults and the Care Homes Regulations 2001. A large number of requirements made in this report present evidence of significant shortfalls in the service provision. A meeting has taken place between the Commission and the registered providers on 22nd September 2005 to discuss a number of concerns and the unannounced inspection which was attempted but not completed in August 2005. What the service does well: What has improved since the last inspection? What they could do better: Care plans and other care guidance in the home are below the required standards and do not provide satisfactory information about the needs and aspirations of the service users. There are shortfalls in systems for monitoring people’s health and welfare. The home has a number of limitations on service users’ daily routines and this provides little scope for people to develop and follow a lifestyle of their choice. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 6 New service users coming into the home are expected to conform to the longstanding routines in order to fit in with the service. People have no control over their finances, other than when they are given spending money on request. A number of practices in the home, such as ringing the bell to indicate time for a drink, are seen as controlling and prevent flexibility of routines. There is an expectation on people living at Oak House to exist as a cohesive family type group, without evidence of due consideration being given to looking at people as individuals with diverse needs. The environment compromises people’s privacy, dignity and individuality. 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. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 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 DS0000016516.V257914.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Prospective service users are provided with appropriate information in the home’s Service User’s Guide although some additions to this document and to the Statement of Purpose are needed to provide a more detailed picture of the service provided. EVIDENCE: A requirement of the previous inspection report was to ensure that the Service User’s Guide included a summary of the complaints procedure and this has been done. The inspectors did not check whether each service user has a copy of the document and this will be assessed at the next inspection. Some additional information needs to be included in the Statement of Purpose and Service Users Guide as described under the relevant standards. This includes issues around provision of snacks, contributions towards transport costs and information about bathroom facilities. Inspectors were able to examine an admissions assessment completed by the funding authority for one service user prior to admission. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Care guidance (care plans and risk assessments) does not provide a comprehensive overview of the needs and aspirations of the service users. Systems for managing of service users’ finances may potentially be denying people’s rights and exploiting their good will. Use of the advocacy service may empower the service users. EVIDENCE: Care plans viewed on files provided a very brief description about people’s assessed needs. People who live at Oak House have very diverse needs and aspirations. Care guidance seen did not provide a comprehensive overview of people’s lifestyles, health needs, social interests and future plans. The requirement to broaden the scope of care plans from the last inspection report is repeated. Staff responsible for writing care plans need to have the necessary skills and the relevant training must be accessed. The CSCI understands from previous discussions with the management team that a new comprehensive care-planning format is being introduced, although no evidence of this was seen at this inspection. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 10 Examination of one of the service users files showed that their funding authority had completed a care review within the last 12 months. There were no issues or agreed actions highlighted by this review. Service users files contained a document about communication and receptive cognition. There were a number of headings which were ticked to indicate for example whether the person can sign, verbalise or use symbols. There were no other details about how the person would actually make their views known. For example where the information showed that the person ‘can express needs’ – no specific information was provided on how the person would do this. There are some residents with complex communication needs. These documents may be more suitable for those people who have conventional rather than specialist communication needs. Previously recommendations have made for the home to approach the Community Learning Disabilities Team about providing guidance and support with regards to developing effective communication strategies for the service users. There was no evidence that this has been actioned. Finances: All money received for service users is paid into the Trust Account. Personal allowances are then transferred to a ‘social fund account’. The expenditure records are kept and cross-reference to the numbered receipts. The manager explained that the financial records are independently audited every year. The manager said that people do not hold / keep their own money and if they need any they have to ask for this. Personal money belonging to service users is held collectively in the home. In terms of good practice the service users should be enabled to manage their own finances. Any support which may be necessary for them to do this safely needs to be identified and provided. This support as well as any agreed limitations with regards to accessing personal money by service users must be documented in care plans. The home’s Service User’s Guide states that any prospective service users will be expected to contribute their mobility allowance to the cost of the home’s transport. The manager said that no one has a savings account or any other accounts where savings are kept. Recorded totals for personal moneys held for each person did not exceed £280.00. Some people had considerably less than this and one person was in arrears to the home because they took spending money on a holiday abroad. The manager explained that the person enjoys holidaying abroad. Care plans need to provide information about how people are supported with budgeting and possibility of people having savings accounts should be explored. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 11 Examination of expenditure records showed that service users all make a contribution towards each other’s birthday presents. The manager said that this is because people live as a big family. Residents also buy presents for staff. The inspectors did not examine the home’s policy in relation to staff receiving gifts from service users and this will be examined at the next inspection. However, it is felt that clear guidelines need to be agreed with regards to what contributions can be sought from the service users. These guidelines need to recognise that the service users may not be able to make a truly informed choice about paying for other people’s presents. The inspectors recommend that the home use the advocacy service to identify the service users feeling about buying presents for their peers. In view of the service users having very limited personal finances, it is required that the practice of buying presents for staff be reviewed by the Trustees. Consideration should also be given to consulting with the funding authorities. The inspectors noted on one occasion the records had stated “holiday money and toiletries”, these should have been recorded separately and it is recommended that this is done in future. Expenses incurred by staff are paid out of the Trust Account. Risk assessments. Risk assessments seen on service users files are very brief and discussion took place with the management team on how these can be improved. One risk assessment said that the service user would be at risk of scalding if making a hot drink and as a strategy to reduce risk it said that the person ‘does not make hot drinks’. This strategy ensures that the service user is not put at risk by limiting the person’s options, but the inspectors feel that the more appropriate response would be for the staff to support them making a drink promoting the service users independence and choice. The standards talk about service users being supported to take risks as part of an independent lifestyle and this is not evidenced in the current approach. One risk assessment said that the service user requires staff supervision and support at meal times, and a programme of what support staff are expected to provide was also seen. This was about prompting the person to slow down to ensure safer eating practices. This support was not observed during lunch. Staff did not share a table with the service users. It is recommended that a referral be made to the speech and language therapist to assess the person’s eating and drinking in view of perceived concerns about choking. Risk assessments seen were dated 27/06/04 and would need to be reviewed. As identified later in this report none of the management team have completed training in risk assessment and this needs to be addressed. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 12 Information seen on service users files included ‘teaching programmes’. The idea of these is thought to be useful in identifying a particular issue and putting a programme of support in place. One such teaching programme was about road safety. This was dated July 2004 and said that it will be reviewed monthly. It was not clear from the information how and when this programme would be implemented and there was no evidence of monthly reviews. The inspectors were advised that the ‘teaching programmes’ are being used as a trial. Regular review of these would be essential to identify service users progress in achieving goals. The home has become a member of an organisation called Care Aware that will provide service users with advocates for different situations. The inspector asked whether they could be involved in the assessment/care planning with service users. It is recognised that the majority of the service users have lived at the home for many years and this may influence their ability to make an informed choice or voice their dissatisfaction with any aspect of the service to the home manager or their family. Use of independent advocacy service is seen as very important and needs to be facilitated by the home. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 16 and 17 Service users may have limited opportunities to pursue their interests other than horticulture and may not have regular access to the community. Service users rights may not always be respected. The meals served in the home are varied and enjoyed by the residents, although better clarity needs to be established about the provision of snacks. EVIDENCE: Daily records are not kept for service users. This made it difficult to make an assessment of whether people are offered options for how they would like to spend their time. The service users spend the majority of their time working in the gardens throughout the year. The manager explained that most service users enjoyed horticulture, and with many of them living there for up to 30 years they have always been involved in maintaining and developing the grounds. The inspectors visited one of the outbuildings where member of staff was supporting the service users in a woodwork session. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 14 The manager explained that they are planning to install a “poly” tunnel in the garden to enable the service users to grow vegetables and flowers from seed. It is hoped that this will be erected in the spring. Days are structured with the service users having breaks at different times; these are signalled by staff ringing a bell. On the morning of the visit one person wanted to show the inspectors their room, but was told to have their drink as the bell had rang. Staff explained that a range of snacks are available at all times including hot and cold beverages, fruit, crisps, cakes and biscuits. The menus were examined by the inspectors and seen to provide the service users with a wide range of meals that are prepared by a cook. Inspectors sat with the service users during lunch and the comments made by them included that they thought the “food was nice” and “there was always plenty of it”. The home uses a lot of the vegetables and fruit grown on site. In conversation with service users they stated that they recently went to the pictures. The games room has a darts board and a pool table. Some people were observed enjoying colouring and making puzzles. There is a large TV lounge on the first floor. On the day of the visit, the pool table was covered and people were peeling and chopping large quantities of carrots ready for the meal and some for the freezer. One person was doing some colouring and another service user was cleaning the bedrooms. This service user also enjoys painting and showed the inspectors some of his work. One service user attends an Adult Opportunity Centre in Cinderford two days a week. Comments are made in the last report about rigid routines in the home. Care files examined during this visit did not have information about people’s preferences as to their daily routines. It was observed that breaks and meals were served for all at the same time and during lunch service users said they would be getting back to work when they finish eating and clearing up. In the afternoon, as people were coming in from working in the garden and workshops, staff said most people would have baths/ showers as part of their routine. One person was helping in the kitchen. Service users are not enabled to have lockable bedrooms and manage a key. One of the service users helps with the cleaning and enters other peoples’ bedrooms regularly. The manager has produced a written statement which the service users have signed to say that they are happy with this. There was also a statement to say people were happy with their clothes being stored collectively in the laundry room. Staff advised that the service users didn’t mind for their clothes to be put out for them. It must be acknowledged that Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 15 the service users who have lived in the home for so long, may have got used to these practices and may not be making a fully informed choice. The practices described above do not promote independence, restrict individual choice and deny some people the right to privacy and autonomy. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 19 Shortfalls in monitoring of aspects of healthcare may put service users at unnecessary risk of harm. EVIDENCE: Records relating to people’s health and well-being were examined for several service users. Visits to GP’s are logged on individual sheets. Daily records are not kept. Records of weights were examined. The manager said that people are weighed every six months or if there are concerns, every month. Generally people’s weight showed some fluctuations. One person appeared to be very thin and their weight charts indicated that since 2002 the person’s weight went down from 8 stone to 6 stone 12 lb (the last entry), which the manager confirmed to have been made on 30th March 2005. On admission to the home in 1983 the person weighted over 10 stone. The logs for the person showed that sometimes they had diarrhoea and would vomit their food. The manager said this was discussed with the GP and recommendations made have been followed. The person was said to have stopped vomiting and has no diarrhoea and is generally eating better. There were plans to weigh all the residents around Christmas time. Since the inspection the manager informed that the service user weights 7 stone 5lb. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 17 Another person has been loosing weight and the inspectors were informed that anxiety was one of the reasons given for this by the GP. One person has gained weight and looked well on the day of the visit. Service users weights must be monitored more regularly and significant weight loss must be investigated in consultation with medical professionals. Records of any such consultation and information about any health issues must be kept and available for inspection. One service user has been receiving extensive support from physiotherapists following a hip operation. The deputy manager has been instructed by the physiotherapist on the exercises the person must complete to improve their mobility and there was evidence that these exercises have been completed. Handrails have been put in some places to help the person with mobility around the home and a raised toilet seat and chair supports have been provided by the Community Learning Disabilities Team to aid rehabilitation. Since the operation the service user had moved from the second to first floor so that they would need to manage fewer stairs. The raised toilet seat has been placed in a toilet close to the person’s new bedroom. One person has regular seizures and experienced one on the day of the visit. Staff said this happens about once a month and the person has medication to manage their epilepsy. Another service user also has epilepsy, and staff felt this is well controlled. The person has not had a seizure for over 20 years. The deputy manager said that all staff have been briefed about how to support the service user in case of a seizure. The inspectors have also been told that staff have received training in this area. There was no information about what support is required on the persons’ file. Occurrences of seizures are not being recorded. A requirement of this report is that all of this person’s seizures must be recorded, and that guidelines are developed that enable staff to support the person consistently when they have a seizure. Guidelines will also enable the home to monitor whether the person’s seizure characteristics remain the same or change over a period of time. One person has continence needs and staff explained how these are managed. The person is prompted to use the toilet and given a bath and a change of clothes if they are incontinent. Staff explained that the person had some clothes stored in their bedroom whilst their other clothes were being stored and accessed from the laundry room on the ground floor, see also Standard 16. In June 05 there were notes about a fall one person had in the garden during which they had hurt their leg and advice was sought from the GP. This accident was not recorded in the accident book. The home must ensure that all accidents are recorded and the CSCI are informed of any events which may adversely affect the wellbeing of the residents in line with Regulation 37. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 18 Records for the same person showed that every 2-3 years there is contact with Orthotics for special footwear. The person was wearing slippers at the time of the visit. The manager must ensure that guidelines are available in the person’s file that identify whether they should wear the special footwear all day, or whether it only needs to be worn for a specific length of time each day. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users view of their care may be based on loyalty and familiarity and they may find it difficult to voice concerns. Service users are subject to controlling and institutionalised practices which may potentially undermine their self-determination and freedom of choice. EVIDENCE: No complaints have been made since the previous inspection. Concerns are expressed in this report about rigid and controlling routines in the home. It is important to acknowledge that service users who have had long-term placements at Oak House may not have the ability to challenge the longstanding custom practice of restrictive routines and limitations and may see these as the norm. For new service users coming into the home there appears to be an expectation to conform to the same routines. There are a number of practices which are very dated, inward looking and do not embrace the ethos of the National Minimum Standards for Adults (18-65). This includes lack of privacy in bedrooms and bathrooms, restrictions for service users to access their clothes and money, limited opportunities for service users to develop diverse lifestyles and emphasis on group living. All service users but one have no access to day care outside of the home. One person does access an Adult Opportunity Centre on one day a week. There has been some involvement from the CLDT team to support a service user post operation. Gloucestershire Social Services have carried out needs reviews in early part of 2005 in response to a request to increase fees. Care and support Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 20 is provided to the service users by the manager and his family and care staff who have been working in the home for a long time. It is felt that the way this support is delivered is outdated and does not meet the National Minimum Standards in many areas. As identified earlier in this report service users will have access to an advocacy service in the future. This should be independent of the home and the Trust. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 and 30 The home is clean, hygienic and maintained to a high standard throughout minimising risk to service users. However, aspects of the environment compromise people’s privacy and dignity. EVIDENCE: The inspectors completed a tour of the building and the surrounding grounds. The building is maintained to a high standard throughout and provides the service users with ample communal space. On the ground floor there is a large lounge with a television, DVD player, stereo and games computer. There is a separate dining room sited near the kitchen. There is a games room that the manager stated was used regularly by the service users. At the time of this inspection the service users were being supported by a staff member to prepare vegetables for freezing. On the first floor there is another lounge with a television. The furniture provided in the communal areas is of good quality and in a good state of repair. The service users bedrooms are situated over two floors. All of the service users’ bedrooms were seen. The previous report identified one bedroom that did not have a window to the outside. This was discussed with the manager and he proposed that a large skylight/window would be fitted in the roof to provide natural light for the service user. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 22 The same room has two entrances – one into an adjacent bedroom and another to a corridor with a toilet. The door to the other bedroom is unlocked and the two residents in the adjacent room use this single room as a walk way to the toilet and the landing, rather than going through the lounge. Despite attempts by the home manager to encourage the service users not to use this room as a thoroughfare, the practice still continues. The home must now take steps to ensure that this room is only accessible to the service user whose bedroom it is. The connecting door must be secured to prevent the thoroughfare. The home may want to consult with the Fire Officer about suitable emergency locks which can be fitted on the connecting door, to leave this usable as a fire escape route if necessary. Unlike other establishments that have solid partition walls this home has a number of bedrooms that have window frames, with no glass (but curtains) between adjoining bedrooms and into communal corridors/ hallways. None of the curtains were pulled shut on the day of the inspection. This is not seen as acceptable as it clearly compromises the privacy and dignity of the service users. The manager agreed to fit frosted glass into all internal windows. This need to be of sufficient density to ensure privacy. The long-term solution should be for the walls to be made solid and the CSCI will require the home to provide a timescale for when this can be achieved. One bedroom has not had a door for a period of time and the manager explained that this is due to the physical needs of the service user. The manager said he has investigated various other styles of doors but to no avail. The service user’s physical needs have changed and the manager said that a door would now be fitted. The other bedrooms seen by the inspectors were clean and tidy and decorated to the same standard in magnolia. Service users have put some pictures up and other personal possessions were present. In one bedroom a personal possession was seen in a frame on the wall. The manager advised that this was given to the person by a family member. Consideration should be given about this and other items which may be valued by the residents to be added to the inventory of personal possessions where necessary. Records of valuables and any furniture which belongs to the service users must be kept. There are several bedrooms which are shared by two service users. None of these rooms had a privacy screen. Many of the bedrooms did not have wardrobes. All rooms had a chest of drawers, beds, and chairs. There were limited number of personal possessions, uniform decoration, lack of adequate storage facilities, lack of mirrors and few bedside lamps. One room was very bare and very small. None of the bedrooms were lockable and no lockable storage has been provided for service users to keep their valuable possessions. A requirement is made for the home to Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 23 provide the service users with adequate furniture (as described in Standard 26.2), privacy screens and any other equipment which may be required. The manager advised the inspectors that one of the vacant bedrooms maybe used to enable family members to stay over. The home has a number of toilets and one main bathroom, all of which were seen by the inspectors. The “main” bathroom is situated on the second floor and is a large communal bathroom with two shower units side by side, two sinks, a toilet, and three partition walled baths (one with an adapted shower) and all were fitted with lockable doors. Service users keep their towels, flannels and toothbrushes in named spaces on one wall. The manager stated that this practice was to ensure that wet towels, etc are not left in bedrooms. There are shelves next to the sinks which the manager said were for people’s toiletries. He said some people liked to keep these here and some in their rooms. He said items are not labelled individually and people mainly don’t mind sharing. It is felt that the bathroom and shower set up in the home does not offer service users sufficient privacy. The Statement of Purpose must be clear that the bathroom facility in the home is communal and all bathrooms and showers are situated side by side, not in separate parts of the house. There are extensive grounds around the house and the manager shared his plans for improving the outside facilities, including making stepped access to the growing areas safer and redeveloping the barns and storage sheds into holiday lets. The manager said that a donation has been received following one person passing away some time ago and this was going to be used to provide a patio area overlooking the lower garden and orchards. In the grounds there are grassed areas, vegetable patches, chickens, ducks and geese. A basic toilet facility of wooden construction is provided outside near the barbeque area. A member of staff who has worked at the home for 27 years manages the laundry. She said the ‘boys’ keep stocks of clothes here. Shelves were provided for many of the clothing items with people’s trousers being placed in a row on a hanging rail. Close to the laundry and the kitchen there is ‘boot room’ with shelves for boots / and slippers for all service users who work outside. Freezers and a washing machine are stored here. Staff advised that to prevent cross infection, soiled laundry is washed in a separate washing machine. The provider states that they are committed to promoting the service users rights, privacy, dignity, choice and independence. The CSCI support these principles and a number of requirements are made in this report to change the current practices which could be interpreted as institutional. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 Risks to service users are minimised by the home obtaining all the information required by these regulations when recruiting staff. EVIDENCE: A requirement of the previous inspection was for the home to ensure that all the information required by the regulations for the employment of staff is obtained. The inspectors examined the records for the last person employed by the home (the registered manager’s 2nd son). All the required records had been obtained and met the criteria of these regulations. No new staff members have been recruited since the last inspection. There are six care staff in addition to the cook, two cleaners and the laundry lady. At the next inspection the inspectors will wish to examine how the staff rota to assess how holidays are covered throughout the year. In addition to this the inspectors will examine the staff training records. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The home is not run in the way which promotes people’s rights, autonomy and choice. Shortfalls in some health and safety procedures may potentially compromise people’s safety and welfare. EVIDENCE: This report provides many examples of practices and routines which fall short of the National Minimum Standards and the Care Homes Regulations 2001. Previous reports demonstrate lack of acknowledgement from the providers that the service has not kept up with current good practice in supporting people with learning disabilities. There are concerns about the way the service users are managed and controlled and lack of integration of the home with the wider society. Issues have been raised about the ability of the registered manager to implement a more person centred and individualised approach to delivering Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 26 care and support to the service users and his willingness to take up appropriate training. The registered manager has recently met with the CSCI and agreed to supply them with a document detailing his experience and qualifications. At the inspection he stated that he will have completed this by December 2005 and will then send it to the CSCI. The inspectors spoke to the deputy manager about completing his registered manager’s award. He explained that he has not started it as yet, but wishes to. The registered manager is the deputy manager’s father and has made it clear that he wishes to retire in the next few years. The deputy manager wishes to become the registered manager. The inspector recommended to them that they start the award before they apply for registration. The deputy manager agreed that they will start it next year. Service users’ feedback about living at Oak House had been noted on a questionnaire on one file. It was in a written format and the inspectors would question whether all of the service users could understand it. But the CSCI look on the use of the questionnaire as good practice and would recommend that the home asks the service users to complete one regularly with the support of the independent advocates. Inspectors examined some of the environmental risk assessments completed by the management team at the home. None of the management team has completed risk assessment training, and it is a requirement of this report that this is completed. The risk assessments seen by the inspectors require more detail, and completion of training should achieve this. In addition the inspectors explained that the assessments should be reviewed a minimum of twice in a twelve month period. During this inspection the power (electricity) supply to the house and workshops was interrupted several times and at one point to power stayed off for over an hour. The registered manager explained that this is a recurrent problem, which is why the home has a generator that provides the necessary power if the main supply is off. However, on the day of the inspection there were problems with the generator and this contributed to the electricity going on/ off several times. Service users remained in the workshops with the support of the staff. One workshop was in considerable darkness. Towards the end of the inspection the problem with the generator was rectified. In view of the problems described being recurrent, the home must compile a robust risk assessment and action plan for ensuring the service users remain safe in the dark (especially in high risk areas such as workshops or when using the stairs). One person has moved from the home as their needs could no longer be met there. The person suffered an accident in the home and injured their hip. It was assessed that Oak House would not be the best place for the person in Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 27 view of their increased physical needs. The accident book was examined and the entry for this incident made reference to whether a notification should be made under RIDDOR. It is recommended by the CSCI that any future incidents of this nature are reported to RIDDOR. Fire safety checks and fire drills are completed regularly by the staff. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X X Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 1 X 1 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 X 1 3 X 3 LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 X 16 1 17 Standard No 31 32 33 34 35 36 Score X X X 3 X X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Oak House Score 2 1 X X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 2 X DS0000016516.V257914.R01.S.doc Version 5.0 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4, 5 Requirement Timescale for action 31/03/06 2. YA6 12, 15, 16 and 17 The manager must ensure that the Service User’s Guide and the Statement of Purpose identify that service users are expected to contribute their mobility allowance to fund the home’s transport and that there may also be additional transport costs. 31/03/06 Care plans must describe in detail how each service user’s needs are to be met in respect of health and welfare. Include consideration of each person’s activity programme as part of care planning. Include also details of any specialist communication needs and any methods of communication that may be appropriate to the person and details of support required from staff. (Timescale of 31/05/05 not met). Staff responsible for writing care 31/03/06 plans must access the relevant DS0000016516.V257914.R01.S.doc Version 5.0 3. YA6 18 Oak House Page 30 training. 4. YA7 12 and 15 Identify the support which individuals may require with managing their own money. This support and any agreed limitations with regards to accessing personal money by service users must be documented in care plans. 5. YA7 13(6) Develop written guidance on what contributions can be sought from the service users. This guidance must recognise that the service users may not be able to make a truly informed choice about paying for other people’s presents. 6. YA7 13(6) The practice of service users buying presents for staff must be reviewed by the registered providers. 31/03/06 31/03/06 31/03/06 7. YA9 13(4)(b)(c) Risk assessments must be revised to ensure that the strategies minimise risks while still empowering service users and that all risk assessments are up-to-date. 13(4) 12 12 and 16 Agreed risk assessments must be adhered to. Service users must have easy access to their clothes in their own rooms. People must be given the option of being able to lock their rooms. Use of independent advocacy service is seen as very important and must be facilitated by the home. DS0000016516.V257914.R01.S.doc 31/03/06 8. 9. 10. YA9 YA16 YA16 31/01/06 28/02/06 31/03/06 11. YA16 12 31/03/06 Oak House Version 5.0 Page 31 12. YA17 16(2)(i) 13. YA17 16(2)(i) and 4,5 The manager must ensure that the service users have the freedom of choice as to when they have snacks and drinks. The manager must review service users’ contracts to identify whether the service users, or the home are responsible for providing snacks. If it is the service users responsibility to provide their own snacks this must be reflected in the Statement of Purpose and Service User’s Guide and communicated to the placing authorities. Service users weights must be monitored more regularly and any significant weight loss must be investigated in consultation with the medical professionals. Records of any such consultation and any other health issues must be kept and available for inspection. The manager must maintain a record of any seizures and guidelines must be developed for staff to follow when managing a service user’s seizures. A record of all accidents in the home must be kept. The Commission must be informed of any events which may adversely affect the wellbeing of the residents in line with Regulation 37. Provide written guidance about one person needing to wear the specialist footwear. The home is required to keep a record of any furniture brought by a service user into the room DS0000016516.V257914.R01.S.doc 31/01/06 28/02/06 14. YA18 12 and 17 31/01/06 15. YA18 12, 15, 17 28/02/06 16. 17. YA19 YA19 12 37 31/01/06 31/01/06 18. 19. YA19 YA26 12 17(2), Sch4 (9,10) 28/02/06 31/03/06 Oak House Version 5.0 Page 32 occupied by them and a record of valuables. 20. 21. YA26 YA26 23(2) (p) 23(1) (a) Provide a skylight window in the bedroom which has no external windows. Improvements must be made to the environment as follows: a) Frosted glass to be fitted in all internal window openings between bedrooms and communal passage ways (this is a short-term measure only. See Requirement 10.) b) A door must be installed to the bedroom without one. c) Additional furniture and effects must be provided in service users’ bedrooms as detailed in the report. 22. YA26 12 Provide an action plan with timescales for when the home intends to block internal window openings in bedrooms. Ensure that the room with a door interconnecting with another bedroom is only accessible to the service user whose bedroom it is. The connecting door must be secured to prevent the thoroughfare. The home needs to consult with the Fire Officer about suitable emergency locks which can be fitted on the connecting door, to leave this usable as a fire escape route if necessary. The Statement of Purpose must be clear that the bathroom facility in the home is communal DS0000016516.V257914.R01.S.doc 31/05/06 31/03/06 31/03/06 23. YA26 23(1) (b) 28/02/06 24. YA27 12, 4, 5 28/02/06 Oak House Version 5.0 Page 33 25. YA27 12 and all bathrooms and showers are situated side by side, not it separate parts of the house. (This is because it is felt that the bathroom ad shower set up in the home does not offer service users sufficient privacy.) Ensure service users are able to keep their personal toiletries separately from others and are not required to share these. Storage of toothbrushes and towels all in a row must be reviewed with consideration being given to service users keeping these items in their rooms until they need them. 28/02/06 26. 27. YA35 YA42 18(c)(i), 13(4) (c) 13(6) and 23 The management team must complete risk assessment training. A robust risk assessment and action plan must be implemented for ensuring that the service users remain safe in case of a power cut. 31/03/06 28/02/06 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. Refer to Standard YA7 YA17 YA6 Good Practice Recommendations The manager should use the advocacy service to talk to service users about their views of purchasing presents for their peers. A referral should be made to the speech and language therapist to assess the person’s eating and drinking in view of perceived concerns about choking. There should be regular review and evaluation of the ‘teaching programmes’ to identify service users’ progress in achieving their goals. DS0000016516.V257914.R01.S.doc Version 5.0 Page 34 Oak House 4. YA7 The service users should be enabled to manage their own finances. The possibility of people having savings accounts should be explored. 5. 6. YA23 YA42 Advocacy support offered to service users should be independent of the home and the Trust. Procedure for notifying RIDDOR of accidents/ incidents should be clarified and followed when necessary. Oak House DS0000016516.V257914.R01.S.doc Version 5.0 Page 35 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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