Inspection on 27/09/05 for Oak House Residential Care Home

This inspection was carried out on 27th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Oak House Residential Care Home 21/10/09

Oak House Residential Care Home 03/05/07

Oak House Residential Care Home 16/08/06

Oak House Residential Care Home 22/04/05

Oak House Residential Care Home 22/11/04

Oak House Residential Care Home 05/05/04

Oak House Residential Care Home 23/07/02

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

CARE HOME ADULTS 18-65 Oak House 56 Surrenden Road Brighton East Sussex BN1 6PS Lead Inspector Nigel Thompson Unannounced Inspection 27th September 2005 09:30 Oak House DS0000014215.V250754.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 DS0000014215.V250754.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 DS0000014215.V250754.R01.S.doc Version 5.0 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.V250754.R01.S.doc Version 5.0 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. 22nd April 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 25 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 many 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. Service users’ accommodation consists of ten single and two shared bedrooms. Communal facilities include a sitting room, lounge diner and rear garden. Stairs and other access arrangements would make it unsuitable for residents with significantly restricted mobility. The homes literature states that one of its aims is to provide residents with a comfortable and happy home suited to residents own special requirements. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours in September 2005. It found that all of the National Minimum Standards that were assessed had been met or partially met and the overall quality of care provided was good. Service users spoken to during the inspection expressed satisfaction with the home, the staff and the service provided. On the day of the inspection there were thirteen residents living at the home. The inspection involved a tour of the premises, examination of the homes records, discussion with management and consultation with three staff and five residents. The focus of the inspection was on the quality of life for people who live at the home. In order that a balanced and thorough view of the home is obtained, this inspection report should to be read in conjunction with the previous inspection reports. What the service does well: What has improved since the last inspection? The majority of requirements and recommendations from the previous inspection have been addressed, including the reviewing and improving of the staff training programme. The manager has recently completed the Registered Manager’s Award (RMA). Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 6 Improvements to the physical environment include the tasteful redecoration of the lounge and dining room and new carpets fitted in several service users’ rooms. What they could do better: 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.V250754.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 DS0000014215.V250754.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): 2&4 The thorough admission policy and procedure ensures that service users are admitted only on the basis of a full needs assessment, undertaken by people competent to do so. EVIDENCE: Following a referral to the home, the manager will visit the prospective service user and carry out a pre-admission needs assessment, including any personal care needs, mobility issues, social and cultural needs and family involvement. As part of this process, advice is also sought from health care professionals and others, including family members who are aware of and understand the specific care and support needs of the individual. Following admission, the home carries out continuous assessments over the first three months, which forms the basis for the service user’s care plan. There have been no new admissions to the home since the last inspection. However, the pre-admission needs assessments that were examined were found to be detailed and comprehensive. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 9 In addition to establishing whether the individual’s care and support needs can be met within the home, the manager also stressed the importance of ensuring compatibility with existing service users. As well as being invited to visit the home to look around and meet with existing residents and staff, prospective service users have the opportunity to stop overnight or occasionally for a weekend stay, before moving in. The manager confirmed that new service users undergo a three month trial period at the home, during which time their suitability and compatibility are fully assessed and it is established whether their identified care and support needs are able to be met. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 10 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 & 9 Service users’ care plans are developed from a comprehensive assessment of an individual’s needs and enable staff to meet such needs in a structured and consistent manner. Service users are encouraged and supported to make decisions about their day to day living and benefit from effective consultation systems. EVIDENCE: Detailed and comprehensive care plans have been developed for each service user at Oak House and are clearly linked to the individual’s assessed needs. Plans that were examined were found to be accurate, generally well maintained and up to date. It was evident that care plans have been discussed with individual service users and have been signed to that effect. Service users or, where appropriate, a relative or representative are also directly involved in an annual care plan review. It was noted that these reviews Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 11 are recorded and plans are amended appropriately to reflect changing needs or circumstances. The manager confirmed that service users continue to be consulted regarding many aspects of their day-to-day living, including choosing colour schemes for their room and communal areas, menu planning and recreational and leisure activities. This was evidenced through discussions with service users during the inspection. The home continues to balance the rights of service users, who may at times present risk to themselves or others. Core risk assessments are undertaken which cover areas of potential risk, including: hot water, challenging behaviour and the environment. It was evident that, despite a previous requirement, risk assessments are not routinely being reviewed and updated. However it was noted that a personal risk assessment has now been completed in relation to a service user who smokes. The manager confirmed that, despite efforts to access additional external advocates, the level of advocacy remains low, with only two service users currently being supported through a local advocacy service. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 12 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): 13, 15 & 17 Family and community links are good and support and enrich service users’ social opportunities. Service users do not currently benefit from meals that are balanced and nutritious and reflect their individual likes and preferences. EVIDENCE: The manager confirmed that contact between service users and their family is variable, with some people having daily visits while others have no contact at all. However, where appropriate, service users’ family links are encouraged and supported. Visiting to the home is largely unrestricted and relatives and friends are made welcome any time. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 13 The majority of service users 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 occupation. Staff have clearly developed awareness and a sound understanding of the changing needs of older residents regarding, amongst other things, mobility issues, relaxation time and age appropriate leisure and recreational activities. A four week rolling menu has been developed, reflecting the choices and preferences of the service users. However it was noted that the actual meals provided did not correspond to the agreed menu. This is clearly poor practice and defeats the object of residents’ choice. The manager, having just returned from annual leave, was unaware of this inconsistency and is to discuss the matter with the staff concerned. A lack of fresh vegetables in the home was evident during the inspection. Following discussion with the manager, this issue is also to be addressed in a general review of menu planning, to ensure service users are provided with a healthy, balanced and nutritious diet. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 14 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 & 21 Staff have developed positive relationships with service users and demonstrate a sound understanding of their care and support needs. Environmental adaptations and specialist equipment currently available does not reflect the changing physical and personal care needs of service users. EVIDENCE: All service users are registered with local GPs and have access to and regular input from other health care professionals, including District Nurses, chiropodists, opticians and dentists. All health related appointments are recorded for individual service users. It was noted that specific records, including ‘headache’ charts are maintained, as appropriate. The individual level of support required with personal care is variable. The manager, a registered nurse, and the two senior staff have extensive experience, awareness and a sound understanding of the care and support needs of older people. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 15 The mobility of ageing service users is currently closely monitored, particularly in relation to stairs. The manager confirmed that an Occupational Therapist is to visit the home in the near future to advise on providing improved access to the front of the building. In view of the changing needs of service users, it is recommended that an assessment of the premises will also be carried out regarding the need for further adaptations or specialist equipment. Staff spoken to during the inspection confirmed the importance of routine in the lives of service users and this is clearly reflected in the individual care plans and structured daily routines for how personal care is provided. The manager also confirmed that the established and experienced staff work closely and consistently with service users. Knowing each of them well and having a sound understanding of their individual support needs, staff are aware of any changes in a resident’s mood or manner and are therefore able to respond swiftly and effectively. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 16 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 & 23 The open and inclusive atmosphere within the home enables service users, staff and visitors to feel able to express any concerns, confident that they will be listened to. Service users are safeguarded from abuse through robust policies, procedures and relevant staff training. EVIDENCE: A clear and accessible complaints procedure is in place, however, as discussed it is recommended that it be reviewed and amended to include updated contact details of the CSCI. Service users and members of staff spoken with during the inspection confirmed that they would have no hesitation in speaking to the manager or in making a complaint if necessary. Each person was also confident that they would be listened to. The home has a copy of the East Sussex guidance notes on the Protection of Vulnerable Adults and has produced its own policies, including ‘whistle blowing’ for the advice and guidance of staff. Policies and procedures relating to abuse were found to be up to date and well maintained. The manager confirmed that training relating to the Protection of Vulnerable Adults (POVA) is provided for all staff and this was evidenced by training records in staff files and confirmed by members of staff themselves. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 17 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): EVIDENCE: These standards were not assessed on this occasion. All key standards were assessed during the previous inspection carried out on 22 April 2005. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 & 36 There are sufficient trained and competent staff on duty at all times to meet the assessed needs of the service users. Formal staff supervision has still to be introduced at Oak House. EVIDENCE: The stable and dedicated staff team is clearly able to meet the assessed, individual and collective needs of service users within the home. All new employees are provided with a comprehensive job description and staff spoken to had a sound understanding of their individual role and responsibilities. A rota is in place, showing which staff are on duty at any time and their designation. 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. Mandatory training is ongoing and is recorded in individual staff files. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 19 Formal staff supervision is yet to be introduced, however the manager confirmed that, following our discussion, she now has a clearer understanding of what is required. However, to ensure compliance with this standard and for formal supervision to be effective, it is essential that the manager is both confident and competent to provide it and therefore further research and specific training may be necessary. An appropriate recording format for the supervision sessions is also to be developed. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Staff are aware of and adhere to up to date policies and procedures relating to health and safety, ensuring the health, safety and welfare of service users and staff. Service users benefit from continuous quality assurance and self-monitoring that takes place at Oak House. EVIDENCE: The registered manager has been in post for two years. As previously documented, she has many years experience in the management of care services, particularly in relation to older people. She is a Registered General Nurse and has recently completed the Registered Managers Award (RMA). Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 21 The atmosphere in the home was relaxed, friendly and welcoming. Staff, spoken to during the inspection felt valued and supported by the manager and confirmed her open and approachable style of leadership and clear and positive sense of direction. The health, safety and welfare of service users and staff remains of paramount importance within the home and staff training is provided in many aspects of safe working practices, including moving and handling; food hygiene; fire safety and first aid. COSHH assessments and guidelines are in place. Temperature regulators are fitted to all hot water outlets, accessible to service users. All accidents, incidents and injuries are recorded and reported, as required. The home operates effective quality monitoring systems, including regular residents’ meetings and satisfaction questionnaires for both service users and relatives. Responses from these surveys indicate a high level of satisfaction with the care and services provided: ‘This home is one of the most caring I have known’. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score 3 X X X 3 2 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Oak House Score 3 3 X 2 Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X 3 x DS0000014215.V250754.R01.S.doc Version 5.0 Page 23 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 9 Regulation 13(4)© Requirement It is required that individual risk assessments are undertaken on risks faced by residents and that these are reviewed frequently and recorded as having been reviewed.(Previous timescale of 22.04.2005 not met). It is required that meals provided are varied, nutritious and balanced and reflect service users’ individual dietary needs and preferences. It is required that the physical layout of the premises, including accessibility, adaptations and any specialist equipment, meet the changing needs of servcis users. It is required that all care staff receive formal supervision at least six times a year and that these sessions are recorded appropriately. Timescale for action 31/10/05 2 17 16 (2) (i) 31/10/05 2 21 23 (2) (a & n) 31/10/05 3 36 18 (2) 31/10/05 Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard 36 21 Good Practice Recommendations It is recommended that the registered manager undertakes specific training in all aspects of supervision. In view of the changing needs of service users, it is recommended that an updated assessment of the premises be carried out, regarding the need for further adaptations or specialist equipment. Oak House DS0000014215.V250754.R01.S.doc Version 5.0 Page 25 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.V250754.R01.S.doc Version 5.0 Page 26 - 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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