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Inspection on 16/08/06 for Oak House Residential Care Home

Also see our care home review for Oak House Residential Care Home for more information

This inspection was carried out on 16th August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 26 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Oak House is a well managed care home that is staffed by a caring and experienced staff team who have developed good working relationships with residents. The majority of residents have lived at the home for a number of years and the current compatibility of the residents accommodated is good. Residents are well supported to maintain contact with friends and relatives, who are always made to feel welcome at the home, whilst the staff team support residents to lead varied and fulfilling lifestyles. Their comments include: `I love it here, it`s my home.` `My relative has never been happier. I visit the home every week and everyone seems happy. Staff are always friendly and welcoming`.

What has improved since the last inspection?

Since the last inspection the weekly menus have been adjusted according to the preferences of residents. One person commented: `Fish and chips on Fridays are my favourite`. The Registered Manager has undertaken specific training in all aspects of the supervision of staff, which is now taking place on a regular basis. Staff commented that they found this to be useful particularly in relation to identifying and planning for any future training needs.

What the care home could do better:

The home`s Statement of Purpose and Service Users` Guide is in need of updating in order to provide prospective residents and their relatives/significant others with information that is current and reflective of the home at this time. Care plans are outdated particularly in relation to supporting staff to meet the healthcare needs of residents. These must be reviewed to ensure that they are up to date, reflect the current needs of residents and include written detailed guidance for staff to follow. It is an outstanding requirement for the home to ensure that individual risk assessments are undertaken on a regular basis, particularly in relation toensuring the health, safety and welfare of residents whilst out in the community. Medication policies, procedures and practices are in need of tightening up to ensure that residents` medical needs are met and that the appropriate action is taken in the event of a medication error occurring. In order to ensure that residents and any visitors to the home are enabled and supported to raise any concerns that they may have, the home is required to implement a clear and accessible complaints procedure, which details the stages and timescales for the process to ensure that all complaints will be dealt with promptly and effectively. Albeit that there is an Adult Protection policy and procedure in place to ensure that residents are protected from potential harm, neglect and abuse, it is required that training regarding this is provided to all staff. The home will need to ensure through their assessment and reviewing processes that either suitable adaptations and equipment are provided for residents with increased needs or alternative placements are found, as stairs and other access arrangements would make it unsuitable for residents with significantly restricted mobility.

CARE HOME ADULTS 18-65 Oak House 56 Surrenden Road Brighton East Sussex BN1 6PS Lead Inspector Niki Palmer Key Announced Inspection 16 & 17th August 2006 15:00 th Oak House DS0000014215.V300370.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 DS0000014215.V300370.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 DS0000014215.V300370.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak House Address 56 Surrenden Road Brighton East Sussex BN1 6PS 01273 500785 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) managerjan@btconnect.com Mr Anthony David Sargent Janice Ford Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is fourteen (14). Service users must be aged between eighteen (18) and sixty-five (65) years on admission. Service users with a learning disability only to be accommodated. That one named service user may be over sixty-five (65) years on admission. 27th September 2005 Date of last inspection Brief Description of the Service: Oak House is a privately owned, three storey Victorian semi-detached house providing residential care for up to fourteen adults who have mild to moderate learning disabilities. The providers have owned the home for 24 years. The home is located in a residential area on the outskirts of Brighton, close to Preston Park, local amenities and bus routes into Brighton. Placements are generally long term, with most residents having lived at the home for many years. The home works closely with the Grace Eyre Foundation and accesses many of the services offered by them including day care provision. Accommodation is provided over three floors and consists of nine single and three shared bedrooms. Communal facilities include a sitting room, lounge/diner and rear garden. There are two bathrooms located on the first and second floor and two shower facilities on the ground and first floor. Stairs and other access arrangements would make it unsuitable for residents with significantly restricted mobility. The home provides personal care and support to residents who are funded by Social Services. The home’s fees as of 27 June 2006 range between £610.00 £689.00 per person per week. Additional costs are charged for hairdressing, chiropody, toiletries, holidays and transport. Prospective residents and their relatives are provided with written information regarding the services and facilities provided at the home prior to admission. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Oak House will be referred to as ‘residents’. This announced inspection took place on Wednesday 16 August 2006 between 3pm and 9pm, which enabled the Inspector to spend time with residents and observe the evening routine. The Inspector returned to the home the following day to meet with the Registered Manager and one of the Providers of the home to give verbal feedback on the findings of the inspection. 13 residents were accommodated on the day of the inspection, 12 female and one male aged between 42 and 84 years of age. In order to gather evidence on how the home is performing, individual discussions took place with three residents, whilst others commented on their care during the evening meal, the Inspector having been invited to join and eat with them. In depth discussions took place with the Registered Manager and three members of care staff. Three care records were examined in some detail for the purpose of monitoring care. Other records and documentation inspected included: the home’s Statement of Purpose and Service Users’ Guide, medication practices, the provision of activities, quality assurance systems, the home’s complaints procedure and the systems in place to safeguard residents from harm. The Inspector was shown all communal areas and most individual rooms by three of the residents. A pre-inspection questionnaire was received prior to the visit to the home. This provided the Inspector with information relating to the premises, maintenance and associated records, details of the homes policies and procedures, staffing details and relevant training. 14 residents’ survey questionnaires were sent to the home prior to the inspection, 13 of which were returned. Most had been completed with the help from a Support Worker. In addition, written feedback was received by five relatives/advocates/friends. All feedback and views received are reflected throughout this report. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home’s Statement of Purpose and Service Users’ Guide is in need of updating in order to provide prospective residents and their relatives/significant others with information that is current and reflective of the home at this time. Care plans are outdated particularly in relation to supporting staff to meet the healthcare needs of residents. These must be reviewed to ensure that they are up to date, reflect the current needs of residents and include written detailed guidance for staff to follow. It is an outstanding requirement for the home to ensure that individual risk assessments are undertaken on a regular basis, particularly in relation to Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 7 ensuring the health, safety and welfare of residents whilst out in the community. Medication policies, procedures and practices are in need of tightening up to ensure that residents’ medical needs are met and that the appropriate action is taken in the event of a medication error occurring. In order to ensure that residents and any visitors to the home are enabled and supported to raise any concerns that they may have, the home is required to implement a clear and accessible complaints procedure, which details the stages and timescales for the process to ensure that all complaints will be dealt with promptly and effectively. Albeit that there is an Adult Protection policy and procedure in place to ensure that residents are protected from potential harm, neglect and abuse, it is required that training regarding this is provided to all staff. The home will need to ensure through their assessment and reviewing processes that either suitable adaptations and equipment are provided for residents with increased needs or alternative placements are found, as stairs and other access arrangements would make it unsuitable for residents with significantly restricted mobility. 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 DS0000014215.V300370.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst sufficient information is provided to prospective residents and their relatives in order to support their decision of where to live, it is in need of updating to ensure that it is current and reflects the home’s conditions of registration. Good systems are in place to ensure that no one is admitted to the home, whose needs cannot be met. EVIDENCE: The Inspector was provided with a copy of the home’s Statement of Purpose and Service Users’ Guide, both of which are kept on display in the main entrance area of the home. The Manager confirmed that all residents are provided with a copy of both documents prior to admission in order to support their decision of where to live. All of the survey questionnaires that were returned by residents and their relatives confirmed that they feel they received enough information prior to admission in order to help them to make a decision about where to live. The Statement of Purpose provides the reader with information relating to the services and facilities provided in the home, details of the Registered Providers and Manager, the organisational structure of the home, the age range of the residents accommodated, the arrangements in place for accepting new admissions and a copy of the home’s complaints procedure. It was noted Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 10 however, that the information given is in some instances misleading, for example the Registered Manager has only been in post for the last three years not 25 years as suggested and the current age range of residents is between 42 and 84, not 18-65 years. The home is required to update its Statement of Purpose in order to provide prospective residents and their relatives/significant others with information that is current and reflective of the home at this time. The Service Users’ Guide is presented in a reasonably easy to understand format for residents, although it is not at this time available for those who may have some level of difficulty in reading written words. It provides residents with a summary of the Statement of Purpose, the home’s aims and objectives, the terms and conditions of contract, information in relation to what residents can expect from the home on and shortly after admission, the arrangements in place for meeting their personal and healthcare needs, a copy of the home’s complaints procedure and contact details of the CSCI. The home is required to update the Service Users’ Guide in respect of the current fees payable as provided to the CSCI on 27 June 2006. Many of the residents have lived at Oak House for a number of years, most of which have moved to Brighton from other areas in order to be nearer to friends and family. Although there have been no new admissions to the home since the last inspection, discussions took place with the Manager of the home in respect of how new admissions are assessed. When a vacancy arises, any interested people are requested to complete an application form. They are then invited to visit and have a look around the home on an informal basis in order to meet with other residents and determine whether or not the home can meet their expectations. Planned overnight stays can be arranged if requested. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning procedures do not reflect the current personal and healthcare needs of residents. Residents are being placed at risk of potential harm through the home’s failure to identify and take the appropriate action to ensure their safety whilst out in the community. EVIDENCE: Three individual plans of care were examined in some detail. In 2004 the Registered Manager introduced ‘Person Centred Planning’ for each of the residents. This format is based on placing the individual at the centre of their care in relation to assessment, planning and implementation. Albeit that separate care plans are mostly updated as individuals’ needs change and develop, it was disappointing to note that minimal work has been carried out to ensure that their person centred plans remain person centred. In addition there is inadequate identification and guidance for staff to follow in relation to meeting personal healthcare needs. The home is required to update all person centred plans to reflect individuals’ current needs and aspirations in order to support care staff in meeting personal and healthcare needs. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 12 All of the returned residents’ questionnaires confirmed that all of the residents feel that they are usually supported to make their own decisions about what that would like to do each day. Throughout the duration of the inspection care staff were observed to do most things for the residents e.g. cooking, laundry, cleaning and tidying and making drinks. This was discussed in detail with staff and residents. The staff commented that many of the residents are older and in some cases unwilling to want to do more for themselves, whilst others said that many have become accustomed to having staff do everything for them. When residents were asked if they would like to become more involved in the running of the home, for example helping to prepare their packed lunch for the following day, their replies were rather mixed. Most residents said that they are not allowed into the kitchen when care staff are preparing meals as the oven may be hot and there may be other associated dangers. It is recommended that the home consider different ways in which residents can be supported to become more involved in participating in all aspects of life in the home based on individual risk assessments. Details of this must be recorded within individual plans of care. All residents have core risk assessment forms in their plans of care, which cover all areas of daily living. Whilst there was evidence to show that they had been reviewed by care staff and in most instances remain unchanged, the examination of a number of areas for example in relation to eating and drinking and going out alone in the community (see below) identified that they were outdated, inaccurate and failed to identify and provide detailed guidance for staff to follow in order to minimise any potential risks. The home’s failure to identify and take appropriate action in order to prevent any unnecessary risks to residents has been a cause for concern since 22 April 2005. The home is required to ensure that individual risk assessments are undertaken in relation to any risks faced by residents. These must be reviewed frequently and the apporiate action taken. A serious matter was raised on the day of the inspection in relation to a resident who had not returned home from day services as expected. The Inspector was informed that this was not the first time this had happened. Whilst the home’s missing persons procedures were adequately followed and the resident returned home safely that evening, their plan of care and risk assessment failed to identify and minimise any potential risks to support the person to go out unsupervised. This is particularly concerning as the person is considered to be vulnerable. The home is required to ensure that suitable and safe procedures are in place as a matter of priority, based on a thorough risk assessment for residents to go out alone. These must be completed in agreement and shared with day services and/or others as appropriate. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lead a varied and fulfilling lifestyle, which encourages them to develop life skills and maintain relationships with family and friends. EVIDENCE: The majority of residents continue to attend local day centres, which specialise in the needs of older people and where they are offered a range of opportunities for informal education and occupation. Where residents have made a choice not to attend day services this has been respected by the home and alternative arrangements made for personal development and stimulation. In addition to this, many residents participate in evening and weekend activities. These include advocacy meetings, discos, going to the local pub and shopping. Additional staff are rostered to work during these times to facilitate this. Residents spoke about how much they enjoyed their recent annual holiday to a nearby resort that is equipped to cater for people with learning disabilities. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 14 Each of the returned relatives’ questionnaires, residents and conversations with staff confirmed that visitors are always made to feel welcome to the home and there are no restrictions placed on visiting times. The arrangements in place to support residents in maintaining close relationships with others were discussed, however there were no written guidelines in place to ensure that this is managed safely, whilst respecting the wishes of the person. The home is required to ensure that written guidelines are in place within individual plans of care based on a thorough risk assessment to ensure that residents are supported to maintain close relationships with others, whilst at the same time protected from potential harm. Throughout the duration of the inspection all staff were observed to knock on residents’ bedroom doors prior to entering and address them by their preferred term. Two residents currently have appointed advocates in order to support them with exercising their rights and choices, whilst others are supported by their relatives and care staff. All meals are prepared within the home by care staff that have obtained a certificate in Food Hygiene based on a four weekly rotational menu. Specialist diets are appropriately catered for including low sugar alternatives. All residents dine together in the pleasantly decorated dining room. Some residents were observed to lay the tables prior to each meal and clear the plates way afterwards. The main evening meal served on the day of the inspection looked appetising and plentiful with fresh vegetables available. Care staff were observed to be attentive to residents’ needs and offer discreet support where needed. Residents spoke highly of the variety and taste of the food provided, fish and chips being the most popular. Two of the residents have developed diabetes and require high in fibre, low sugar alternatives. Written information sourced from the Internet is on display in the kitchen area to advise staff on catering for specialist diets, however individuals’ care plans are in need of updating in relation to this; for example: what the person’s likes and dislikes are and what the preferred alternatives are. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. This home fails to ensure that all personal and healthcare needs of residents are identified and met. Inadequate policies and procedures for the administration of medicines potentially place residents at risk. EVIDENCE: All residents are registered with a local GP and dentist and are supported to all healthcare appointments as necessary. Specialist advice from the CLDT is requested on an individual basis. Three individual plans of care were examined in some detail for the purposes of monitoring care. Care staff spoken with confirmed that they are responsible for updating the care plans for the individuals that they keywork. In addition to the Person Centred Plans, separate care plans are in place to provide care staff with the action that is required in order to meet individuals’ needs. Whilst on the whole there was evidence to suggest that they are being regularly reviewed by staff, some concerns were raised in respect of how the home is meeting the personal and healthcare needs of residents. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 16 Many of the residents are older and are therefore more susceptible to developing additional healthcare needs for example, diabetes, reduced mobility, eating and drinking difficulties and early onset dementia associated with Downs Syndrome. It was concerning to note that in many instances, care plans were insufficiently detailed in the above mentioned areas e.g. how often a persons blood sugar levels should be monitored and the action that staff need to take in the event of an abnormally high or low reading. The Manager informed the Inspector that diabetes training for all staff is planned for October 2006. The home is required to gain specialist advice through the GP prior to this training in relation to the action that care staff need to take in order to meet the individuals’ assessed needs. Care plans must be updated accordingly. In addition to this the home is required to purchase a ‘sharps bin’ for the safe disposal of blood sugar monitoring equipment. A number of daily entries written by care staff identified that one person’s cognitive and mental state has been deteriorating over recent months, yet their care plan had not been updated to reflect what action had been taken (if any), or what care staff were required to do in order to support the person. Through discussions with staff, the Manager and reading assessments which have previously been completed by the CLDT, it would appear that this person is possibly experiencing early onset dementia, which the home is currently not registered to provide for. The home is required to undertake a comprehensive assessment of need alongside health and Social Care professionals in order to identify whether or not the home can continue to meet their needs in accordance with their conditions of registration. This must take into account the layout of the building and future care needs as the dementia progresses. During the evening meal, one person was noted to have had their food liquidised. Through discussions with care staff and the Manager it emerged that the person had gradually been losing weight and experiencing difficulty in chewing and swallowing solid food. Albeit that significant improvements had been noted in respect of maintaining nutrition since the food was being prepared to a softer consistency and their weight was being regularly checked and recorded, the staff team had taken it upon themselves to liquidise all foods without the specialist advice or assessment from healthcare professionals. Such decisions being made without specialist advice and knowledge could potentially place residents at risk of aspirating (inhaling food into the windpipe). The home is required to ensure that residents’ nutritional needs are suitably assessed by a person trained to do so. Care plans must be amended as necessary. The home’s medication records and storage systems were inspected. The home uses a pre-packed blister pack issued by the local pharmacy, which is easy to use and monitor. Only five members of staff who have received training and been assessed as competent in the administration of medicines are able to carry out this task. Senior members of staff are responsible for the reordering and returning of medicines to the pharmacy. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 17 Whilst it was pleasing to note that records were mostly maintained and there were clear guidelines in place for all medicines that are prescribed on an ‘as and when’ basis (PRN), a medication error was identified in a persons daily records whereby a resident was administered an additional dose of medicine (used in the management of diabetes). This indicates that staff are dispensing and administering from the blister pack prior to reading the medication administration records. Not withstanding that a written record was maintained in the daily records, the home failed to take the appropriate action e.g. contact the GP for advice, monitor the person’s blood sugar levels, make a note of the error on the medication administration record, complete an incident report and notify the CSCI in writing. Through discussions with staff and on a closer examination of the home’s policies and procedures it became evident that staff are unaware of the procedures that are to be followed in the event of a medication error occurring. The home is required to have a drug error policy in place. This should encourage staff to report any errors no matter how minor. This will help to support the home to identify any faults in their current procedures and training needs for staff. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 18 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are unaware of how to make a complaint. Albeit that written information is in place to support staff in protecting residents from harm, neglect and abuse, staffs’ lack of understanding and knowledge in this area has the potential to place residents at risk. EVIDENCE: The Service Users’ Guide and Statement of Purpose contain a copy of the home’s complaints procedure, however this is not a procedure for residents or visitors to the home, it is primarily aimed at providing guidance to care staff when receiving a complaint. Not surprisingly, most of the returned residents’ and relatives’ questionnaires indicated that they are unsure of how to raise any concerns, who to raise them to, or how they can expect any concerns or complaints to be dealt with. The home is required to produce a simple, clear and accessible complaints procedure for residents and visitors to the home, which details the stages and timescales for the process to ensure that all complaints will be dealt with promptly and effectively. The Service Users’ Guide and Statement of Purpose must be amended accordingly. No concerns or complaints have been raised to either the home or the CSCI since the last inspection. Albeit that the home has suitable Adult Protection and whistle-blowing policies and procedures in place, which are on display in the staff room in an easy to read and follow format, not one of the care staff spoken with during the inspection were able to discuss the different types of abuse, who the lead agency is and the action that they would take in the event of suspecting abuse, Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 19 harm or neglect. The home is required to ensure that all staff undertake training in this area including the Protection of Vulnerable Adults (PoVA). No Adult Protection alerts have been raised since the last inspection. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 20 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, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Oak House presents as a clean, well-maintained and homely place to live, however consideration must be given to environmental adaptations and specialist equipment to reflect the changing physical and personal care needs of residents. EVIDENCE: Oak House is a privately owned, three storey Victorian semi-detached house. Accommodation is provided over three floors and consists of nine single and three shared bedrooms. Residents’ bedrooms were found to be nicely decorated and reflective of residents’ personalities and individual preferences. All rooms contained personal photographs, certificates that have been achieved and personal belongings and furnishings. Communal facilities include a sitting room, lounge/diner and rear garden. There are two bathrooms located on the first and second floor and two shower facilities on the ground and first floor. The majority of residents choose to use the ground floor shower, as due their restricted mobility (in some cases, not all) they are unable to get into and out of any of the baths, as additional Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 21 bathing equipment is not available. The showering facilities are small raised cubicles, which are enclosed with a plastic door. Care staff commented that this arrangement makes it quite difficult to support residents with showering without getting wet. It is recommended that consideration be given to converting one of the bathrooms into a walk in shower room in order to help improve the current facilities for both residents and staff. Following the last inspection advice was sought from an Occupational Therapist to advise on improving access to the front of the building. A summary of the report was seen on the day of the inspection, however it was concluded that little could be done to improve access for residents. Due to the age range of the residents currently accommodated it is unlikely that as their level of need increases, this environment will be suitable for them. The home will need to ensure through their assessment and reviewing processes that either suitable adaptations and equipment are provided or alternative placements are found, as stairs and other access arrangements would make it unsuitable for residents with significantly restricted mobility. Care staff informed the Inspector that they are responsible for undertaking the majority of cleaning duties including laundry, although some residents are encouraged to maintain their own bedrooms where possible. All areas were noted to be clean, tidy and well-maintained. The Registered Provider carries out most minor repairs, decorating and maintenance. Any areas that are in need of addressing are recorded in a maintenance book, which staff confirmed are usually promptly dealt with. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 22 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): 32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported and protected by the home’s robust recruitment procedures. Sufficient numbers of competent staff are employed to meet the assessed needs of residents. EVIDENCE: The home employs a total of nine female Support Workers, two of which are Senior Staff in addition to the Registered Manager. Only one person to date has achieved NVQ Level 2 in care although five are currently working towards this. Residents and staff confirmed that there is always a minimum of two staff on duty during the day and one waking person at night. Staffing levels are increased during weekends and some evenings. This is sufficient to meet the current needs of residents at this time. No agency staff are used. Staff vacancies are usually advertised through a local newspaper. The Registered Manager promptly sends out an information package and application form, prior to short-listing for interview. Four recently appointed staff recruitment files were checked. It was pleasing to note that all were found to contain the required checks including photograph identification, two written references, evidence of a PoVA First check and Criminal Record Bureau (CRB) check. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 23 All care staff are provided with a job description, which outlines their main roles and responsibilities. A comprehensive ‘Skills for Care’ induction and foundation training programme is provided for all new staff and is flexible, service specific and compatible with an individual’s level of relevant experience. Staff training courses over the past 12 months include: medication, manual handling, Food hygiene, First Aid, Fire training and understanding the neurological background of physical disabilities. Further training is planned for diabetes, Makaton, autism and aspergers and communication with people with learning disabilities. The home is required to ensure that Adult protection and PoVA training is provided to all staff. Since the last inspection the Manager has undertaken supervision and appraisal training for care staff. It was pleasing to note in individual staff files, that one to one supervision sessions are happening regularly, records of which are kept. Staff spoken with said that they found this to be helpful, particularly in relation to identifying and planning any future training needs. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 24 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 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Oak House is well managed service that is run in the best interests of residents. EVIDENCE: The Registered Manager has been in post for three years. She was a State Enrolled Nurse for many years working in both hospital and community settings. She has completed the Registered Managers Award (RMA) and more recently attended courses in refresher First Aid training, reducing staff turnover, assertiveness and dealing with conflict and aggression. All of the residents and care staff spoke positively of the way in which the home is managed. Annual questionnaires are given out to residents, their relatives and other visitors, three of which were seen all very positive. In addition to this care staff facilitate six weekly residents’ meetings, which are minuted. Topics Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 25 covered during the most recent meeting included the home’s annual barbecue, staff changes and the recent holiday. During the course of the inspection it was pleasing to observe a number of residents walk in to the Manager’s office to speak freely about what they had achieved that day, ask questions in relation to members of staff or just engage in general conversation. This indicates that residents find the Manager of the home approachable and open. A number of the home’s policies and procedures were inspected during the inspection. Not withstanding that the majority were considered adequate, concerns were noted in respect of care staffs knowledge and understanding of these, particularly in relation to medication and the Protection of Vulnerable Adults. The home is required to ensure that all policies and procedures are current, made available and known to all staff. Evidence provided within the home’s returned inspection questionnaire identified that all equipment is well-maintained and regularly serviced including: fire equipment, central heating system and emergency call system. Detailed discussions took place with the Registered Manager and Provider of the home in respect of keeping the CSCI notified of incidents that occur in the home in accordance with Regulation 37. The home is required to notify the CSCI in writing of any event in the care home which adversely affects the wellbeing or safety of any resident. This includes any admissions to hospital and medication errors and details of the action that was taken. Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 3 X 3 2 X 2 X Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes. 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(1)(a)(b) (c) Requirement Timescale for action 30/11/06 2. YA1 3. YA6 4. YA9 5. YA9 That the Statement of Purpose is reviewed and updated to provide prospective residents 4(2) & and their relatives/significant others with information that is Sch 1 current and reflective of the home at this time. A copy of this must be forwarded to the CSCI. 5(1)(b) That the Service Users’ Guide is updated to accurately reflect 4(2) the current amount and method of fees payable. A copy of this must be forwarded to the CSCI. 15(1)(2) That all person centred plans (a)(b)(c)(d) are updated to reflect individuals’ current needs and aspirations in order to support care staff in meeting personal and healthcare needs. 13(4)(b)(c) That individual risk assessments are undertaken in relation to any risks faced by residents. These must be reviewed frequently and the apporiate action taken [THIS IS OUTSTANDING FROM THE LAST 2 INSPECTION REPORTS]. 13(4)(b)(c) That suitable and safe procedures are in place based DS0000014215.V300370.R01.S.doc 30/11/06 30/11/06 30/08/06 30/08/06 Oak House Version 5.2 Page 28 6. YA15 16(2)(m) 7. YA17, YA18 & YA19 16(2)(i) 15(1) 8. YA18 & YA19 YA18 & YA19 YA18 & YA19 12(1)(a)(b) 15(1) 9. 10. 13(2)(3) 12(1)(a) (b) 13(1)(b) 11. YA18 & YA19 12(1)(a) 13(b) 12. YA20 13(2) on a thorough risk assessment for residents to go out alone. These must be completed in agreement and shared with day services and others as appropriate. That written guidelines are in place within individual plans of care based on a thorough risk assessment to ensure that residents are supported to maintain close relationships with others, whilst at the same time protected from potential harm. That individual care plans are updated for those residents with diabetes. This must include what the person’s likes and dislikes are and what the preferred alternatives are. That specialist advice regarding the management of diabetes is sought via the GP. Care plans must be updated accordingly. That a ‘sharps bin’ is acquired for the safe disposal of blood sugar monitoring equipment. That a comprehensive assessment for a person who has experienced a deterioration in their cognitive skills is undertaken alongside health and Social Care professionals in order to identify whether or not the home can meet their needs in accordance with their conditions of registration. This must take into account the layout of the building and future care needs as the dementia progresses. That residents’ nutritional needs are suitably assessed by a person trained to do so. Care plans must be amended as necessary. That safe procedures for the DS0000014215.V300370.R01.S.doc 30/11/06 30/09/06 30/09/06 30/09/06 31/10/06 30/08/06 30/08/06 Page 29 Oak House Version 5.2 17(1)(a) Schedule 3(i)(k) 13(2) 17(1)(a) Schedule 3(i)(k) 14. YA22 37 22(1) administration of medicines are adhered to at all times. That a medication error policy and procedure is devised and implemented. All staff must be aware of its contents. In the event of an error occurring, the CSCI must be notified in writing detailing the action that was taken. That a clear and accessible complaints procedure is produced for residents and visitors to the home, which details the stages and timescales for the process to ensure that all complaints will be dealt with promptly and effectively. The Statement of Purpose and Service Users’ Guide must be updated accordingly. That Adult Protection and PoVA training is provided to all staff. That the physical layout of the premises, including accessibility, adaptations and any specialist equipment, meet the changing needs of residents. That at least 50 of care staff are trained to NVQ Level 2 in care. That all policies and procedures are current, made available and known to all staff. That the CSCI are notified in writing of any event in the care home which adversely affects the well-being or safety of any resident. 30/09/06 13. YA20 30/11/06 15. 16. YA23 & YA35 YA29 13(6) 23(2)(a)(n) 30/10/06 30/11/06 17. 18. 19. YA32 YA40 YA42 12(1) 18(1) 17 37(1)(2) 28/02/07 30/09/06 30/08/06 Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 30 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. Refer to Standard YA1 YA7 & YA8 Good Practice Recommendations That the Service Users’ Guide is made available in an alternative format for residents who may have some level of difficulty with reading. That the home considers different ways in which residents can be supported to become more involved in participating in all aspects of life in the home based on individual risk assessments. Details of this must be recorded within individual plans of care. That consideration is given to converting one of the bathrooms into a walk in shower room in order to help improve the current facilities for both residents and staff. 3. YA27 Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. Extracts may not be used or reproduced without the express permission of CSCI Oak House DS0000014215.V300370.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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