Inspection on 14/04/09 for Oak Lodge

This inspection was carried out on 14th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oak Lodge 15/10/08

Oak Lodge 04/12/06

Oak Lodge 31/01/06

Oak Lodge 04/10/05

Oak Lodge 17/01/05

Oak Lodge 23/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Oak Lodge 213 Eastbourne Road Polegate East Sussex BN26 5DU     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: Jo Mohammed     Date: 1 4 0 4 2 0 0 9 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. that people have said are important to them: They reflect the things 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.cqc.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 Lodge 213 Eastbourne Road Polegate East Sussex BN26 5DU 01323488616 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Regard Partnership Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Oak Lodge is a purpose built bungalow, situated just off the main A22 Polegate/Eastbourne Road. The home shares the same site as Hillview, another service owned by this organisation. Local shops and public transport links are a short walk away. The home is registered to accommodate six younger adults with learning disabilities. Resident accommodation provides six single bedrooms and a communal lounge. The Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 6 1 5 1 0 2 0 0 8 Brief description of the care home bathrooms are fitted with the necessary adaptations. The site provides ample car parking. There is a garden but it is currently inaccessible to residents. The Registered Providers of the service are The Regard Partnership. This organisation owns a large number of homes across England and Wales. More detailed information about the services provided at Oak Lodge can be found in the homes Statement of Purpose and Service User Guide - copies of these documents can be obtained directly from The Regard Partnership. Latest CQC inspection reports are available on request from the home. 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 report reflects a key inspection based on the collation of information received since the last inspection, a review of the homes Annual Quality Assurance Assessment [AQAA], improvement plan and requirements, recommendations made at the last inspection on 15th October 2008. Two Inspectors conducted an unannounced site visit on Tuesday 14th April 2009 between 10am and 5:30pm. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care home settings. For the purpose of this report, those living at Oak Lodge are referred to as residents. Oak Lodge is an established home that provides residential care to six people with Learning Disabilities. There is currently one vacancy. The home is part of a larger Care Homes for Adults (18-65 years) Page 6 of 34 group of homes owned by The Regard Partnership Ltd. The site visit included a tour of the premises to examine and ascertain progress made with the building problems identified at the last inspection. Examination of some care, medication, staffing, menus and general records. The visit also included meeting residents, the Manager and four members of staff. Surveys for residents were sent to the home prior to the inspection. Two were returned that had been filled in with staff support. What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Adults (18-65 years) Page 8 of 34 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representatives are now given clearer information about the home in order to make an informed choice about their accommodation. Following a more thorough assessment and review process would identify both individual and group compatibility issues in minimizing incompatibility that can affect residents living in the home and negatively impact on the outcome of the service they receive. Evidence: There have been no new admissions to the home since the last inspection in October 2008; this standard was not assessed on this occasion. There is currently one vacancy. At the last inspection, a requirement was made to clarify information in the homes Statement Of Purpose. Records showed this document had been updated in February 2009. Following examination of this, it was seen that specific staffing levels during the day and night had been identified including clarifying that the sleep-in person was shared by both homes: Oak Lodge and Hillview. It was identified that Oak Lodge share Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: a spacious lawn area and shaded seating area with Hillview, the home opposite Oak Lodge and that a good-sized patio is provided. The actual garden belonging to Oak Lodge remains inaccessible, however a new patio area has been added to the front of the property. It was discussed with the Manager that the age range of residents identified in this document should match with the homes certificate and conditions of registration. Each of the residents has been provided with a service user guide and terms and conditions of residence. Identified at the last inspection as a requirement was the need to ensure the home can meet the needs of residents both in terms of their individual needs and compatibility as a group. There are currently four male residents and one female in the home. The Manager advised that all residents had an individual review by the Local Authority in March and April 2009. However, there is no further development upon this and at these reviews residents compatibility as a group had not been adequately covered. Concerns remain about the compatibility of the residents accommodated. The home is advised to refer the matter back to Social Services for further consideration. 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. Care plans are in place containing some good detail about residents support needs. However, these need to be fully completed and implemented in a person centred way to enable residents the opportunities to fulfill their individual needs, goals and aspirations. Some choice and decision making is affected that can have an impact upon residents personal growth, development and empowerment. Evidence: The home had started the process of introducing a new format for care planning. The Manager advised that the task for completing this work had been delegated to a senior carer from another home within the organisation who had updated three residents care records and the Manager had done one. There was no obvious auditing of the care plans in place and the Manager was not entirely clear which care plans had been completed. We tracked the care of two residents and one partially that included examination of their care records, discussions with the Manager, staff and meeting these residents Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: during the course of the inspection. Two of these residents had a new care planning format in place that had recently been introduced, one had nearly been completed in full, and one was in the process of being done. A third residents care records examined were still in the old format with some out of date information that required updating. The Manager advised that each residents care folder was going to be completely rewritten with as much involvement from residents as possible. Contained within residents care records are risk assessments that are either in the old format or being compiled in line with the new care planning format. A new requirement to ensure that meaningful, person centred and accurate care plans are developed and completed will be made. We had a discussion with the Manager around residents choice and decision making being fully respected and promoted. This was in respect of how one resident requires two staff when going out with their relative each week due to their health care needs. In order to facilitate this outing, another person and only ambulant resident in the home would be included in this activity otherwise the outing would not be possible. It was explained this was because one member of staff could not be left in the home with four residents. Also linked to this is the organisations protocol whereby some staff who are drivers are only to take one person in a wheelchair and one person who can walk when going out. Examination of residents monthly meetings revealed insufficient evidence of residents views being sought and although issues were identified, the actions to follow these through are not recorded. A meeting held on 25th March 2009 involved two residents with the other residents declining. A previous meeting date to this was recorded as 24th February 2008. A review of practices relating to both of these matters is recommended. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inadequate staffing levels mean that residents are not currently able to make good use of the community. Menus devised should ensure that residents receive a balanced, healthy and varied diet. Evidence: During the course of the inspection two residents went out for a walk to a local cafe. Another resident was being assisted to go out with their relative. Two residents remained in the house, one person was in the dining room playing music on their keyboard;another resident appeared playing a radio in the same dining area. This activity continued for the duration whilst the tour of the home took place. An Occupational Therapist was visiting one of the residents at the time of the inspection to review their current activities. It was identified by the Manager that some residents would refuse to go out and there were lots of in house activities. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: Future plans being looked into included to initially take one resident swimming. One resident has an interest in the police and a community support police officer visits this resident as well as this person visiting the police station. Three residents attend a music group on separate occasions. The Manager advised she had been to a show on living pictures and was hoping to introduce this into the home. Two staff are to attend training in the provision of residents activities. It was identified that once an appropriate wheelchair harness was obtained for one resident which was to happen on the day of the inspection, they would be able to go to back to college the week following the inspection. During discussions with staff it was said this persons wheelchair had broken again since the last inspection. That they had a temporary chair and since 14th February 2009 they had not been going to college as the wheelchair was only suitable for indoors. It was identified how sketch books were being developed for each resident with photos relating to activities, outings and a new Karaoke machine had been purchased which all residents enjoyed. We examined the activity timetables for two residents: these included a number of in house activities such as snooker, board games, music, reading magazines, menu and meal preparation, DVD night, weekly clean, aromatherapy, looking at photos and personal time. Some examples of external activities included pub visit, gym, drives, cafes, Friday night club where residents meet up with other people living in homes run by the organisation, visiting Hillview the home opposite for coffee and house shopping. The care plan for one of these residents identifies this person has chosen not to attend college or access day centre. Comments made by staff during the inspection identified a need for increased staffing levels due to residents dependency needs in and outside of the home. It was said all residents need one to one staff support when going out. That for most of the time residents timetables were achieved although having insufficient staff or drivers on duty without the right qualifications can cause a problem. Other comments made was there was too much to do in respect of care, cleaning, cooking, activities and staffing levels were inadequate. The outcome for residents was described as being looked after and staff do their best but suspect residents pick up on low staff morale. It was said that an extra member of staff would be possible if there were special events going on, although this could be affected by the homes medication protocol whereby two trained staff are required to do residents medication together and because of this outings can be affected. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: Information recorded in the homes Annual Quality Assurance Assessment under what the home does well identifies that residents are able to access the community and leisure places as they so desire and are given the opportunity to attend college either full or part-time. It also identifies that residents are supported to maintain contact with their families and friends. Based on information shared and examined at the inspection, there is an inbalance between external and in house activities available to residents and this should be addressed. There has been a review of the homes menu. The main daily pictorial menu board in the kitchen matched the food that was to be prepared and served on the day. It was explained that weekly meetings are held with residents to decide the menu for the next week, although not all the residents attend. Pictures relating to different foods and meals are used to assist residents in making choices. Two residents like to participate in the cooking and three observe. On a Saturday, it was noted there is always a takeaway and a roast on Sunday. A staff member said this is discussed with residents however examination of the record of weekly menu meetings shows this discussion occurring between Monday to Friday and not at weekends. Since the inspection, the Responsible Individual of the organisation has clarified that residents weekly menu meetings are chosen and planned for over seven days. That Takeaway meals are not a regular occurrence and staff sit with residents on a Saturday to show them the choice of take away menus. Roast dinners are always offered on a Sunday along with the choice of another alternative. There were some gaps in recording meals that had been served. Also noted was the frequency of fish and chips in close proximity on the 17th, 20th, 27th and 28th March 2009. It was said that shopping days for food were on Wednesday and two residents would be involved in this. No monetary problems were identified. In order to ensure the menu is balanced and nutritious a requirement will be made to devise menus that reflect the dietary needs, choices and preferences of the residents. A recommendation made at the last inspection that mealtimes should be relaxed and unrushed was described as now being relaxed, with still a lot of vocalizing but happier occasions. Guidelines have been drawn up for a particular resident for staff to follow at these times. During the inspection, the Manager advised how she asked a staff member to give a resident some time out due to screaming at lunchtime. It is considered important these practices are regularly reviewed and evaluated to ensure they are effective and staff are actively following residents guidelines at meal times. 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. Residents health and personal care needs are now being actively assessed by other professionals and this should continue in order to promote their health and welfare. Some updating of records to ensure current medication protocols are followed will help to minimise risks to residents and assist safe medication practices within the home. Evidence: The homes Annual Quality Assurance Assessment identifies that all residents need staff support with dressing, bathing and washing. Four residents need two staff to support them with their care and two require staff support to eat their meals. Four have specialist communication needs. It identifies the frailty of some residents has increased, one resident has possible dementia. Following discussions with staff it was said that three to four residents need two staff for all their manual handling needs. Three residents have epilepsy and two staff are required at all times to administer medication. A previous requirement made at the last inspection to seek additional professional guidance in the management of residents health care needs is being achieved whereby an Occupational Therapist, Physiotherapist and Dieticians advice and support Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: has been sought for some residents according to individual needs. In respect of input from a Speech and Language specialist the Manager could not remember who had been seen. One resident has been seen by the organisations own Behavioural Therapist. Also confirmed was that eye tests for residents had been done and hearing tests were to be arranged. One resident at the last inspection was withdrawing into their bedroom. Since then the situation has improved as this person now has their desk in the lounge and we were advised this was working much better. Health action plans are in place, and it is recognised by the home that more information is needed to be added into them alongside the compilation of the new care planning documentation that has been introduced. At the time of the inspection it was evident that some progress is being made in documenting residents care needs within the new care planning format and this needs to continue. Once this is complete, residents will have two files. One of these examined contained a residents health action plan and new blank forms for recording contacts, appointments, and visits to other professionals. Two service users care records that were viewed showed the new care planning documentation was being completed for one of these residents containing a range of health care assessments and care plans that are being developed. It was noted that the health care plans had been drawn up by a staff member from another home within the organisation. Reference to this and other work undertaken by this member of staff has been identified in another section of this report. Examination of another residents records were found to be in the old format, with some information requiring updating to reflect current practice including how the GP will now be cutting this residents nails and elaborating upon a care plan in respect of their dietary needs. Following a partial examination of another residents records. It was identified their current wheelchair has been impossible to push and this person has not been able to fully access the community. More information about this matter is identified under the Lifestyles section of the report. Medication systems and practices were assessed by way of observation, records, storage and discussion. Residents do not self medicate and no controlled drugs are currently used. Medication recording sheets were found to be in order with medication securely stored. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: It was identified that it is the homes policy for two trained staff to do residents medication together. Blister packs are used. Medication was observed being given to one resident onto a spoon of Yogurt. Staff advised this practice had been agreed with the GP and recorded in the residents care plans. Examination of this residents medication care plan did not show evidence of this agreed practice. This should be followed up with the GP to seek approval and written guidelines identifying the reasons for this practice updated. It was identified that lots of staff have done a long distance training course in medication as well as yearly medication training and they receive medication supervision every six months with Managers. Medication guidelines held in the home were seen to be dated May 2008. As identified at the last inspection, the Manager needs to ensure this is the current version. The guidelines for the administration of Rectal Diazepam for one resident required updating as the last review was in June 2008. Care Homes for Adults (18-65 years) Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improved systems have been introduced to enable anyone wishing to make a complaint to do so, although close monitoring of this is necessary to ensure residents views are actively being listened to and acted upon so that they are fully valued and safeguarded. The procedures in place for the management of residents finances are inadequate. Evidence: Examination of records and discussions with the Manager confirm that no complaints or safeguarding alerts have been received since the last inspection in October 2008. It was identified that a complaint on behalf of a resident has been made to the wheelchair services due to ongoing issues that are identified in other sections of this report. After the last inspection, a complaint relating to a broken fence has been dealt with and this has been replaced. In respect of an old complaint dated April 2007 about concerns over cracks in the ceiling around Oaklodge, the response to the complainant advised that there had been some confusion over who had responsibility for repair of the property. The complainant was reassured that the matter would be given full attention, and the impression of a speedy solution. They went on to say that given the effect it has on service users and staff they were trying to resolve the problem and would hopefully be in a position to advance the present sticking point. The complainant was advised they Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: would be kept informed. There was no evidence to show this had been followed up with the complainant again to provide them with an update on the current situation. Therefore the homes own complaint protocols have not been followed through. Since the inspection, the Responsible Individual of the organisation has advised that a letter to all relatives will be compiled to inform them of the the organisations intentions and timescales in respect of environmental works to the home. A central record of complaints detailing complainant issues is kept on display in the home. It was recommended that as this may contain sensitive and confidential information it should be stored securely, although ensuring residents, staff or other interested parties have access to any documentation they may need to complete in the event of a complaint. There is a complaints notice on display in the home. The Manager advised that during keyworker meetings with residents, complaints would be recorded as necessary and the home is looking into introducing an audio complaint format. At the last inspection, the systems in place to manage residents finances were chaotic and a requirement was identified. Since then, some has progress has been made in respect of resolving the signatory issue and obtaining petty cash in a swifter manner. However, some financial issues do still remain as it was not clear what monies are held in residents banks, virtual accounts and some residents have bank accounts but cannot access them. Finances are generally unclear with no proper breakdown and no way of tracing some payments. During the inspection, we were shown information about the organisation being in contact with the Social Services finance department to advise them of current financial issues. This matter is on-going. A requirement to resolve these matters will be made. The Annual Quality Assurance Assessment [AQAA] identifies that all staff receive yearly refresher training in the Safeguarding of Vulnerable Adults and the home have current Multi agency procedures and guidelines. Care Homes for Adults (18-65 years) Page 22 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 building is in need of repair and decoration so that it is fit for purpose and a comfortable, safe home for residents to live in. Residents would benefit having access to their own garden. Evidence: Several areas of the home were seen including the lounge, dining room, kitchen, utility area, bathroom, shower-room and residents bedrooms. The home is a bungalow and can accommodate people in wheelchairs. There are overhead tracking hoists in the bedrooms of residents that require manual handling. Since the last inspection, fencing has been erected at the side of Oak Lodge to divide and separate the car parking area. The home now has a small patio area with tables and chairs available to residents by the front entrance of the home with plans to install raised flowerbeds and a water feature. No further development though has been achieved in providing level access to the homes main garden area that surrounds the property and remains inaccessible to residents. It was seen that areas around the home were showing signs of wear and tear, in need of decoration, with some repairs and replacements needed. It was identified that health and safety checks of the building are carried out weekly. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: It was seen that a radiator guard in the lounge needed repair. In the shower room were two rusty commode chairs that are currently being used to assist residents with their personal care that require replacement. The air vents in this room and the laundry were clogged up with dust. No hand-wash solution to prevent cross infection was available in the laundry room. There were big cobwebs in both bathrooms and general cleaning practices require improvement and monitoring. In one residents bedroom, the carpet was very stained and a bathroom cabinet door needed repair. Communal carpets were all stained. Residents bedrooms were personalised but were showing signs of wear and tear and in need of redecoration, as were both bathrooms. Structural cracks throughout the building remained visible in ceiling areas throughout the property particularly the lounge and corridor areas. The Manager was unable to give a clear account of the action to be taken in resolving this issue. Documentation found showed the matter was being monitored but it was not possible to establish the extent of the problem and how it was ultimately going to be addressed. A maintenance record is not kept in the home. It is recommended that a detailed maintenance plan be introduced. Since the inspection, the CQC and Responsible Individual from the organisation have met and an action plan with timescales regarding environmental matters that need to be addressed is to be forwarded to the CQC. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from the support of a dedicated team of staff, however greater protection would be afforded if there were sufficient staff employed in such numbers as to properly fulfill residents goals, aspirations. Ensuring staffs planned training and supervision sessions are kept up to date will benefit residents. Evidence: We met with the Manager and four staff members during the course of the inspection. It was identified that new staff rotas have been introduced and current staffing ratios comprise of three staff on duty throughout the day. Night arrangements comprise of one waking night staff. One sleep in person is also on duty who covers both homes; Oak Lodge and Hillview located on the same site. We were advised that when residents reviews were undertaken by the Local Authority between March and April 2009, it was identified by the reviewing officer that extra staffing is needed. Following discussions with staff, we were advised there were usually three staff on shift during the day and it was not a regular occurrence to have extra staffing. Residents dependency levels and needs have been identified in other sections of this report, that include all residents requiring one to one staff support when they go out and two to one staffing for residents requiring manual handling. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: Rotas examined showed regular levels of three staff on duty for the am shift and two staff for the pm shift. The Manager did advise that bank staff are used to cover shifts as well, however this was not always identified on the rota and plotted instead on the daily shift planners. Accurate and up to date rotas must be maintained. Following further discussions with staff it was identified there have been occasions when only two staff have been on shift. That an extra member of staff is needed for the afternoon and consideration has to be given to the staffing composition as to whether there are sufficient drivers on shift as well as it being the organisations protocol that two staff do medication. Also identified was there is too much to do with three staff on duty because of juggling care duties, activities, cooking, cleaning, taking residents out and overall staffing levels were inadequate. The Annual Quality Assurance Assessment identifies that five staff have a National Vocational Qualification in care at level 2 or above and that staff now appear to be working as a team. The organisation has introduced new E. learning training for staff. The Manager advised that all staff appointed since the last inspection have had a full induction and the E.learning induction method is to be used in the future. In respect of staff supervisions, we were advised that a senior from another home within the organisation supervised all the staff between February and March 2009 and the aim is to provide staff with supervision every month to six weeks. The matrix examined showed a record of some staff that had received supervision since the last inspection. The Manager advised she would be supervising senior staff and the deputy would supervise the rest of the staff team. Information received from the Responsible Individual of the organisation since the inspection clarifies the current position regarding training that staff have received. No staff other than the Manager have attended Deprivation Of Liberty Safeguarding [DOLS] training at the present time. It was noted that staff meetings take place with records kept. Recruitment records examined in relation to one member of staff who has been appointed since the last inspection of the home were satisfactory. 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. The daily running of the home requires further improvement in order to fully meet its stated aims, objectives and purpose so that residents benefit from a well run home. Residents need to be supported by staff in sufficient numbers who in turn need to be supported by the organisation and management of the home in a way that empowers and values them. Evidence: The appointed Manager advised she has applied for her Criminal Record Bureau check [CRB] towards the Commissions application process in applying for the registered Managers position. The appointed Manager has completed National Vocational Qualification at level four, the RMA (Registered Managers Award) and the D32/33 Assessors Award. She has held a registered Managers position previously. At the last inspection, a recommendation was identified to improve relationships between the management and the staff team. The Manager explained how steps have been taken to do this in that a senior Manager within the organisation undertook staff supervisions in February 2009 and no issues were raised at that time. It was said Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: there is an open door policy and staff are praised. Also identified was for staff to come forward to discuss concerns by 24th December 2008, however it was said no one came forward, and this was not pursued. Four staff satisfaction questionnaires examined and completed in December 2008 showed unsatisfactory was recorded for most areas. Several staff met identified inadequate staffing levels and remain disconcerted with the organisation and management of the home. Identified in the homes Annual Quality Assurance Assessment is a new structure whereby the Manager can receive guidance and support from regional directors. Satisfaction surveys have been issued to obtain feedback from residents, staff, relatives and other interested parties. Examination of these showed positive comments received from professionals. It was noted in response from a relative that they answered no to there being sufficient staff on duty. A residents questionnaire completed in October 2008, identifies that an alternative format is needed and recognition that this is necessary to develop. The latest Regulation 26 report examined dated 25th March 2009, identified no issues with residents or staff. In addition the Manager was to do a business plan and to deal with some previous action points. The Deputy Manager advised he is given a list of things to by the Manager following the Regulation 26 visits. A Quality Audit tool used by the organisation dated 16th December 2008, showed that all standards were assessed and nearly all were met, however this does not concur with some matters identified within this report. There is a need for the Manager to actively audit work delegated. In respect of policies and procedures, the Manager advised that there was a new manual for staff to read located in the office. Health and safety records examined were found to be in order. 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 15 [1] [2] The Registered Person must ensure that meaningful, person centred care plans are developed and completed for all service users that clearly set out their aspirations and life goals. That care plans are person centred and include the assessed and changing needs of service users. 31/08/2009 2 17 16 16 [2] [i] The Registered Person must devise menus that reflect the dietary needs, choices and preferences of service users living in the home. To ensure service users receive a balanced, healthy and nutritious diet. 17/07/2009 3 20 13 13 [1] & [2] The Registered Person must ensure that they do not 17/07/2009 Care Homes for Adults (18-65 years) Page 30 of 34 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 covertly administer medication to service users unless this has been agreed with service users GP, risk assessed and the reasons documented within care plans. To ensure service users health and welfare is maintained. 4 23 17 17 [2] 17/07/2009 The Registered Person must ensure that service users have access to their monies at all reasonable times. There must be clear documentation available in the home to audit monies received and spent on behalf of service users. Service users need to be protected from abuse. 5 24 23 23 [2] [b] [c] [d] The Registered Person shall having regard to the number and needs of the service users ensure that[b] The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. 17/07/2009 Care Homes for Adults (18-65 years) Page 31 of 34 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 [c] Equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order. [d] All parts of the care home are kept clean and reasonably decorated. The Registered Person must produce a written action plan showing timescales for achieving the structural repairs throughout the home. The Registered Person must audit and produce a action plan including timescales for completion of repairs, replacements or cleaning of broken equipment, internal furniture, cupboard and carpets. The Registered Person must compile and audit a written action plan including timescales for completing all decorations and repairs identified in this report. Service users must be able to live in a home that is clean, homely, comfortable and safe. Care Homes for Adults (18-65 years) Page 32 of 34 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 6 33 18 18 [1] [a] 17/07/2009 The Registered Person must have regard to the assessed needs of service users and to the homes Statement of Purpose to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in sufficient numbers for the health and welfare of service users at all times. Service users must be supported by an effective staff team 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 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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. 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