Inspection on 13/11/08 for Oak House Short Term Breaks

This inspection was carried out on 13th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Oak House Short Term Breaks Brimble Hill Wroughton Swindon Wiltshire SN4 0RA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Malcolm Kippax     Date: 1 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Oak House Short Term Breaks Brimble Hill Wroughton Swindon Wiltshire SN4 0RA 01793814827 01793845782 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Oxfordshire Learning Disability NHS Trust care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 7. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: Learning Disability (Code LD) Date of last inspection Brief description of the care home Oak House Short Term Breaks is run by the Oxfordshire Learning Disability NHS Trust (O.L.D.T.). O.L.D.T. were registered in May 2008 to run the service, which was previously being provided by the Swindon Primary Care Trust. The service is designed to give people with learning disabilities and their families a break from their usual living arrangements. The service is predominately for people living in the Swindon area. The number of breaks available is agreed at the referral stage, being based on the needs of individuals, and their family situations. The service is provided at a property on the outskirts of Wroughton. This property has had a number of institutional type uses over the years, and there are plans for the service to move into new, purpose built accommodation during 2009. The people who stay at Oak House Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 7 Brief description of the care home receive support from a management and staff team, which consists of registered manager, team leader and support workers. Information about the service is provided in a Statement of Purpose and a Service Users guide. A report of this inspection will be available from the service. Inspection reports are also available on the Commissions website at www.csci.org.uk Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place six months after the Oxfordshire Learning Disability NHS Trust (O.L.D.T.) was registered to run the service. Before being registered, the O.L.D.T. had provided us with a plan, which showed the improvements that they would be making to the service and to the physical environment, before the end of September 2008. We have referred to this in the report. After the O.L.D.T. had been running the service for a few months, the manager completed an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how the service was performing. It also gave us information about what has happened since the service was registered in May 2008, and about their plans for the future. Care Homes for Adults (18-65 years) Page 6 of 34 We sent out surveys, so that we could get the views of the people who used the service, and of the people who work there. We received three surveys that had been completed by relatives, and three that were returned from staff members. We looked at all the information that we have received about the service, and then made an unannounced visit to Oak House on 13th November 2008. During our visit we met with the five people who were staying there at the time. We also spoke to staff members and to the manager, Ms Linda Dickie. We looked at some records and went around the accommodation. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. What the care home does well: What has improved since the last inspection? What they could do better: In their improvement plan, the Oxfordshire Learning Disability NHS Trust confirmed that visits would be made to the service, in compliance with Regulation 26 of the Care Homes Regulations 2001. The visits were also to be a way in which the Trust monitored the progress that was being made with implementing their improvement plan. We found that the plan has not been fully implemented in accordance with the timescales identified. The monitoring visits were not being made as required, and they need to be undertaken on a monthly, unannounced basis. This is to ensure that the Trust meets its statutory responsibilities, and the people who use the service can be confident that the standard of care and the conduct of the home are being appropriately monitored and reported on. In their improvement plan, the Oxfordshire Learning Disability NHS Trust stated that a plan of works had been identified for the current premises. A building project group was to feedback to the people who used the service and to their families by the end of July 2008, but we were told that this had not happened. We were also due to be sent a copy of a building audit report. We must receive a copy of the report, and confirmation of the action being taken in respect of items of work, including any relating to fire, that have been identified. This is to ensure that items of work are being appropriately identified and actioned, and that people who use the service stay in accommodation that is safe and meets their needs. A system for evaluating the quality of services provided at the service must be established and maintained. The system must provide for consultation with the people who use the service, and with their representatives. This is to ensure that the Oxfordshire Learning Disability NHS Trust is making the improvements that are needed, and that the views of the people who use the service, and of their representatives, are being taken into account and acted on. Care Homes for Adults (18-65 years) Page 8 of 34 Peoples individual support plans and the associated assessments must be reviewed and updated where necessary. This is to ensure that the individual plans contain up to date information about peoples needs, and are fully completed in accordance with the services intentions. Controlled drugs must be stored in a cupboard that meets the current storage regulations: the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007. This is to ensure that controlled drugs are stored safely. Arrangements must be made for the safe handling and recording of medication that is received into the home. This means ensuring that the services procedures for dealing with medication are adhered to, and appropriate records are maintained. This is to ensure that medication is safely managed and the people who use the service are not at risk because the appropriate procedures are not being followed. There was a lack of evidence of a robust recruitment procedure. Records must be available, which show what information was obtained during the recruitment process, including details of the checks that were undertaken and when these were completed. This is so that there is evidence of a robust recruitment procedure being implemented, which protects people who use the service from being supported by unsuitable staff. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed, to ensure that the service will be suitable for them. Evidence: Details about the eligibility criteria for using the service were included in the services Statement of Purpose. The service could only be accessed via a care manager. The service worked in conjunction with the care managers to assess peoples needs and to decide whether the service could meet these. Each person who stayed at Oak House had an individual file, with their personal information. We looked at examples of peoples files, which contained details of their backgrounds and individual needs. Before using Oak House, people had an initial assessment by the service, which was carried out at the persons home. People who were new to Oak House had a Community Care Assessment, although these were not available for everybody who used the service. Some people had been Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: using the service for a number of years and did not have an up to date assessment. Ms Dickie reported in the AQAA that one thing that the service could do better was to ensure that all the current users of the service had a Community Care Assessment. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have individual plans, which reflect their main needs. The service is seeking to promote a person centred approach, although this is not yet fully reflected in peoples plans. Assessments are undertaken to help to ensure that people are not at risk during their stays. However a lack of consistency in the process reduces the benefits for people and could compromise their safety. Evidence: We looked at five peoples individual files and at some other peoples records in less detail. The files contained a range of care and support plans, and risk assessments. We had discussed the content and format of the plans and assessments at the time of the services registration. A system of care planning and assessing had been in place, but it was acknowledged that further work was needed to ensure that the plans and assessments were up to date and person centred. The Oxfordshire Learning Disability Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: NHS Trust was going to undertake this work over a period of time. In the improvement plan that we received from the service we were told that a range of information would be available in a person centred plan for each person. This included, for example, copies of assessments and other information about peoples needs. The process was to be completed by the end of September 2008. The records that we looked at did not contain all this information. It was reported in the AQAA that the service had started to personalise peoples personal files and care plans. There was varied documentation on peoples files, relating to their support plans and risk assessments. These included older style plans, which referred, for example to people having a named nurse. This was not an appropriate or accurate statement to include. Sometimes, review dates had not been recorded and the appropriate people had not signed the plans. When review dates were shown, it was not always clear whether the review had taken place and what the outcome had been. In their surveys, two staff members reported that they felt that they usually had the right support, experiences and knowledge to meet the different needs of the people who used the service. One staff member reported that they sometimes felt that they did. We also saw examples of where the information about peoples basic needs had been added to with more personal details, for example about their likes and dislikes and the type of meals that they enjoyed. We saw information recorded which reflected peoples diversity, such as how they expressed their sexuality, and whether they attended a church regularly. The service had started to complete Listen to Me booklets with the people who stayed at Oak House, and with their families. These were designed to help in the development of person centred plans. We agreed a date with Ms Dickie for completing the process, to ensure that the plans and assessments were up to date and reflected a person centred approach. We were given examples of how people made choices and decisions during their stays. These included people being able to choose their favourite bedroom to stay in. The service also had information about peoples favourite foods, so that these could be taken into account when the menus were planned. Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will benefit from the developments that are taking place, and being planned, to ensure that the lifestyle that they experience in the home meets their needs. Evidence: As a provider of short breaks, the service did not have the primary role in setting up and supporting people with their main day occupation and their social networks. People tended to already have established arrangements, and the service sought to maintain these for the duration of a persons stay. We were told about the arrangements that had been made for somebody to stay at Oak House at short notice, following a family bereavement. It was reported by the manager that, by working alongside other providers and professionals, the service was able to support this person successfully. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: It was reported in the AQAA that the service had developed a good honest relationship with families and carers. Ms Dickie said that she was keen to work in partnership with families, and had sought relatives views about the best way of achieving this. In the entrance hall to Oak House, there was a lot of information available about the service, which would be of interest to relatives and carers. Staff from Oak House had contact with peoples day activities, for example by attending a team meeting at one of the day services that people went to. This helped staff to understand the needs of the people they supported, and to learn about their preferred routines. It was reported in the AQAA that it was planned to meet regularly with day services, so that any issues could be discussed, with the aim of improving the way that people were supported at both services. Peoples individual files included copies of weekly timetables showing the day services that they attended. We saw that peoples files included details about their usual routines and activities, so that staff would have information about what people had done during the day and how they might be feeling. We were told in the AQAA that the service was aiming to maintain friendships by booking people in together and planning stays for people that were compatible. When we arrived at Oak House, the people staying there were attending their various day activities. People then returned, or started their stays, during the afternoon. A staff member later prepared the tea meal, and one of the people who was staying helped with some washing up and clearing away. We were told that people used not to help out in this way, and that there used to be a stair gate at the entrance to the kitchen. Another person had come back to Oak House feeling hungry, and they wanted to have something to eat before the main meal was ready. This person had a meal prepared especially for them. The communal space included a lounge, a dining room and a sensory room. One relative commented in their survey that people went out for walks, weather permitting. The relative also told us that television was readily available. They thought that more could be done to provide stimulating activities for people, particularly at the weekends. We were told in the AQAA that more information was being obtained about peoples preferred activities, which would be included in their person centred plans. This should help ensure that activities are on offer to people which meet their individual needs. It was reported in the AQAA that varied and nutritious meals were offered at Oak House, with individualised options available. We saw in peoples files that there was information about their likes and dislikes and their particular dietary needs. A menu was displayed in the kitchen, which identified the people who were staying at the time. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: Staff could then check peoples files for information about peoples diets and individual preferences. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples main personal and health care needs are met. People will be better protected when further health related information is obtained, and changes are made to the medication practices. Evidence: Peoples individual plans included information about their care needs, and guidance about the ways in which they wished to be supported. People required assistance with a range of personal care tasks, and with the administration of their medication. Some information about how a person liked to be supported was also recorded in the form of a Quick Guide, for staff. Risk assessments had been undertaken in connection with particular activities, such as moving and handling and eating. As reported under the section, Individual Needs and Choices, some assessment forms did not show a review date, or it was not always clear whether the review had taken place and what the outcome had been. There was no consistent method of cross referencing being used between the support plans and the risk assessments. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: There were written guidelines for staff, which provided additional information in areas such as diet and medication. One of the files we looked at included a care plan for epilepsy. The files we saw did not include copies of health action plans, and we thought that these would be useful in providing an overview of peoples health needs and how these were to be met. In the improvement plan that we received from the service we were told that a range of health related information would be available in peoples individual plans. The records that we looked at did not contain all this information. For example the files did not include copies of health action plans, letters from GPs confirming peoples medication details, or signed forms giving consent to the administration of medication. There was a procedure for staff to follow when receiving medication, and for its return at the end of a persons stay. We looked at the medication that was being kept in the home and saw that one persons medication had not been signed in. We were told that this was to be administered at the persons day centre. We confirmed that this medication should have been recorded as having been received by the service, in accordance with the services written procedure. The medication had also not been appropriately labelled. Guidelines had been produced about the administration of medication. This included the need for two staff to sign the record when medication was administered to people. The records we saw showed that this was not happening consistently. We saw that controlled drugs had been administered on occasions, although there were no controlled drugs being kept at the time of our visit. The storage arrangements for controlled medication were discussed with Ms Dickie. The cabinet did not meet the current standard for controlled medication and a timescale for the fitting of an appropriate cabinet was agreed. Care Homes for Adults (18-65 years) Page 19 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff members receive training and guidance, which helps to ensure that people who use the service are protected from harm. Evidence: The organisation had produced a procedure by which people could make a formal complaint. This was also available in an accessible version. A copy of the procedure was on display in the front hall. This included the role of the Commission, although the contact details needed to be updated. Many of the people who used the service needed support with making a complaint. Ms Dickie told us that she was keen to work with peoples families and to obtain their views of the service. In their surveys, the relatives confirmed that they knew how to make a complaint, and who to talk to if they were not happy with something. One relative commented: any complaints are dealt with very quickly and resolved to our satisfaction. An easy read version of the procedures for safeguarding vulnerable adults was displayed in the front hall. There were leaflets about a local advocacy service. Copies of the local safeguarding procedures were also available to staff in the office. The staff we spoke to confirmed that they were aware of the procedures and that they had received training in abuse awareness and how to report an allegation. Ms Dickie had Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: attended a one day course about the procedures for safeguarding vulnerable adults. We were told in the AQAA that there had been no incidents that had involved restraint. We were told that people received support with the safekeeping of the personal money that they would need during the course of their stay. A staff member told us about the procedure for this and we looked at an example of one persons records. These showed that the details of transactions were being appropriately recorded. Care Homes for Adults (18-65 years) Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation is not fully meeting peoples needs, or the aims of the service. Evidence: The improvement plan that we received from the service at the time of registration, set out the action that the Oxfordshire Learning Disability NHS Trust was going to take in respect of the premises. This included the move to new accommodation in the second half of 2009. We were told in the AQAA that the new building would provide a more conducive environment, enabling us to meet the diverse needs and wishes for the people we support. The current accommodation had a history of institutional use. The building did not lend itself to the creation of a home from home, which was the services philosophy, as reported in the AQAA. In their surveys, one relative stated that the condition of the premises was one of the factors that undermined their confidence in the service. Staff members also commented on the state of the building. They commented on the need for more mod cons and for central heating that could be controlled. One staff member also reported in their survey that a larger bath was needed. We talked to a staff member about this during our visit and we were told that the design Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: of the baths and showers meant that they were not suitable for a few of the people who used the service. Staff members said that a walk-in shower would be beneficial for people, although one was not available. We were told that there had been a feasibility study to look at this. We were shown around the accommodation. The accommodation was all on the ground floor of the building. There were no en-suite facilities in peoples rooms. The bathrooms looked functional, rather than homely, and one of the baths we saw had a cracked side panel. We brought this to Ms Dickies attention. Bedrooms did not have locks fitted to the doors, although there were latch type locks fitted on the doors to the lounge. We were told that these were not in use and we confirmed that they should be removed. All the rooms were off a central corridor. The bedrooms had been personalised to varying degrees; overall we thought that more could be done, for example through redecoration, to enhance the environment. In their improvement plan, the Oxfordshire Learning Disability NHS Trust stated that a meeting had taken place and a plan of works identified. A building project group was to feedback to the people who used the service and to their families by the end of July 2008. Ms Dickie reported that this had not happened. The commission was also to be sent a copy of a building audit report, but we have not received this. Ms Dickie reported on some works that had taken place, such as a deep clean, and the fitting of blinds and net curtains. One of the bedroom doors had an automatic fire door notice on it, but no working door closure. A staff member said that none of the bedroom doors had had self closing devices fitted in the years that they had worked there. We saw that a fire risk assessment had been undertaken in May 2008. This confirmed that self closing devices were not fitted to the doors. There was also guidance which stated that fire doors should automatically close unless on magnetic release. It was not clear what the outcome of the assessment was in the light of this guidance. We were told that the Oxfordshire Learning Disability NHS Trust policy on infection control had been checked for compatibility with delivering the service provided at Oak House. The accommodation looked clean and tidy. It was reported in the AQAA that the cleanliness of the building was one of the improvements that had taken place during the last year. The relatives who completed surveys reported that the accommodation is kept clean. Care Homes for Adults (18-65 years) Page 23 of 34 Care Homes for Adults (18-65 years) Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are developing their skills and knowledge, so that the people who use the service benefit from staff who understand their needs and the aims of the service. There was a lack of evidence of a robust recruitment procedure, which is needed to ensure that the people who use the service are protected from unsuitable staff. Evidence: We were given information in the AQAA about the numbers of staff and the composition of the staff team. There were fourteen permanent care staff, of whom seven had achieved a National Vocational Qualification at Level 2 or above. Most of the staff were working at Oak House before the service was taken over by the Oxfordshire Learning Disability NHS Trust. In their surveys, staff told us they were being given training that was relevant to their role, kept them up to date with new ways of working, and helped them to understand and meet the individual needs of the people who used the service. One staff member commented that when they started work several years ago, the induction was not that good. They now felt that the induction was really good and that the mandatory courses they attended were necessary for the job. The staff members we spoke to during our visit said that Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: training opportunities had improved under the Oxfordshire Learning Disability NHS Trust. It was reported in the AQAA that staff had been given the opportunity to attend training in subjects such as Effective Communication and Understanding Challenging Behaviour. We received confirmation in the improvement plan that staff members had received training in a range of subjects since the Oxfordshire Learning Disability NHS Trust took over the running of the service. This training included moving and handling, fire awareness, and person centred support. Two staff had attended a course in Total Communication. It was reported in the AQAA that staff had completed training in Hygiene and Infection Control. We were also told that a clinical nurse specialist had provided training in specific areas of care relating to the people who used the service. We talked to Ms Dickie about a training plan for the staff team. Ms Dickie said that she was currently completing an overview of the training that staff had undertaken, and was updating the previous training records in order to identify training needs for the future. Ms Dickie said that training in first aid, POVA, and food hygiene was booked to take place in the coming months. Staff members confirmed in their surveys that their employer had carried out checks, such as a Criminal Records Bureau (CRB) disclosure and references, before they had started work. It was reported in the AQAA that staff were recruited in line with the Oxfordshire Learning Disability NHS Trusts recruitment policy. It was also reported that equal opportunities policies and procedures were followed in line with employment legislation. Ms Dickie said that records relating to the recruitment of staff were kept at the Trusts head office. A form was kept at the service which was designed to give details of the recruitment checks that had been undertaken and what documentation had been seen. We looked at forms for staff who had started during the last year. There were sections on the forms for the recording of CRB and POVA checks, references and proof of identity. However there was a lack of details and dates. This meant, for example that there was no clear record to show the chronology of the checks that had been undertaken, and whether these had all been completed before the applicant had started work. Care Homes for Adults (18-65 years) Page 26 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have benefited from some improvements in recent months, but they cannot be confident that the service is being appropriately monitored and developed in their best interests. Evidence: Ms Dickie was registered in May 2008 to be the manager of the service. This meant completing an application form and demonstrating that she was a fit person to manage the service. Ms Dickie has over twelve years of management experience with the Oxfordshire Learning Disability NHS Trust, and has managed other short break services. Ms Dickie has a National Vocational Qualification NVQ at level 3 in Management. During our visit, Ms Dickie said that she was currently undertaking NVQ at level 4 in Care, as well as the Registered Managers Award. Ms Dickie was expecting to have completed both these qualifications by Spring 2009. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: In their improvement plan, the Oxfordshire Learning Disability NHS Trust confirmed that monitoring visits would be made to the service, in compliance with Regulations 24 and 26 of the Care Homes Regulations 2001. Action reports were to be produced and linked to the improvement plan for the service. Under regulation 26, visits must be made to the service on an unannounced basis each month. A report of each visit has to be completed, and a copy of the report available for inspection. These visits are important because they should be a way in which the provider monitors standards in the service, for example by looking at the outcomes for people and whether policies and procedures are being implemented. When we visited the service we saw a report of a visit that was dated 27th June 2008. Another report was dated July 2008 and there were no reports of visits in August, September and October 2008. We thought that the reports did not give sufficient details about the conduct of the service and they did not refer to interviews with the users of the service or with staff. The visits were also to be a way in which the Oxfordshire Learning Disability NHS Trust monitored the progress that was being made with implementing the improvement plan. We found during our visit that the plan has not been fully implemented in accordance with the timescales identified. There was no procedure for quality assurance involving feedback from the people who used the service and their representatives. Ms Dickie said that she had sent surveys to relatives in order to get feedback about the service. Since we visited, Ms Dickie has reported that a new quality assurance and monitoring process has been developed, and that this is out for consultation prior to implementation. We were given information in the AQAA and that improvement plan about the action that was being taken in respect of health and safety. This included regular checks on fridge and freezer temperatures, a programme of regular checks for fire safety equipment, water temperatures, the boiler, electrical equipment, hoists and the vehicle. COSHH products were reported to be stored securely, and updated assessments kept at the service. During our visit we saw that there was a locked cabinet for the storage of COSHH products. We were also told that a health and safety audit had been completed. A report of this could not be located when we visited the service. Care Homes for Adults (18-65 years) Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Peoples individual support 31/01/2009 plans and the associated assessments must be reviewed and updated where necessary. This is to ensure that peoples individual plans contain up to date information about peoples needs, and are fully completed in accordance with the services intentions. 2 20 13 Controlled drugs must be stored in a cupboard that meets the current storage regulations: the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007. This is to ensure that controlled drugs are stored safely. 31/01/2009 3 20 13 Arrangements must be 04/12/2008 made for the safe handling and recording of medication received into the home. This Care Homes for Adults (18-65 years) Page 30 of 34 means ensuring that the services procedures for dealing with medication are adhered to, and appropriate records are maintained. This is to ensure that medication is safely managed and the people who use the service are not at risk because the appropriate procedures are not being followed. 4 24 23 That the premises are fit for 31/12/2008 the intended purpose, and meet the needs of the people who use the service. The commission must receive a copy of the building audit report, which includes confirmation of the action being taken in respect of items of work, including any relating to fire, that have been identified. This is to ensure that items of work are being appropriately identified and actioned, and that people who use the service stay in accommodation that is safe and meets their needs. 5 34 19 A person is not fit to work at 31/12/2008 the service unless certain information has been obtained about their background, charachter and fitness. Records must be available of the information obtained and when this was received. Care Homes for Adults (18-65 years) Page 31 of 34 This is so that there is evidence of a robust recruitment procedure being implemented, which protects people who use the service from being supported by unsuitable staff. 6 39 24 A system for evaluating the 31/01/2009 quality of services provided at the service must be established and maintained. The system must provide for consultation with the people who use the service, and with their representatives. This is to ensure that the Oxfordshire Learning Disability NHS Trust is making the improvements that are needed, and that the views of the people who use the service, and of their representatives, are being taken into account and acted on. 7 39 26 Monthly, unnannounced 04/12/2008 visits to the home must be undertaken in accordance with Regulation 26 of the Care Homes Regulations 2001. This is to ensure that the Oxfordshire Learning Disability NHS Trust meets its statutory responsibilities, and the people who use the service can be confident that the standard of care and the conduct of the home are being appropriately Care Homes for Adults (18-65 years) Page 32 of 34 monitored and reported on. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 That a community care assessement is obtained for each person who uses the service. This is so that the service has up to date information about the needs of the people who are being supported. Peoples individual plans and assessments should always be dated, and be signed by the appropriate people. This is to ensure that it is clear when the forms were completed, when they were reviewed, and that people are in agreement about the action being taken. That a system of cross-referencing is used between peoples support plans, risk assessment forms, and other guidance. This is so that all the relevant information relating to a particular task or activity is linked and can be clearly identified. That the information that is outstanding on peoples individual plans in relation to their health and medication is obtained without delay. This is so that there is good information about peoples health and medication, and about the supoprt that has been agreed in these areas. That a training plan is produced, which reflects the training needs of the staff team and shows how these are to be met. 2 6 3 18 4 19 5 35 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!