Inspection on 15/10/08 for Oak Lodge

This inspection was carried out on 15th October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oak Lodge 14/04/09

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 27/02/2009.

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:   zero star poor 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: Caroline Johnson     Date: 1 5 1 0 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 Lodge 213 Eastbourne Road Polegate East Sussex BN26 5DU 01323488616 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Teresa Murphy 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 bathrooms are fitted with the necessary adaptations. The site provides ample car parking. There is a large garden but it is not currently accessible to residents. The Registered Providers of the service are The Regard Partnership. This Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 6 Brief description of the care home organisation owns a large number of homes across England and Wales. For information regarding the fees, please see the summary section of this report. 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 CSCI 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: zero star poor 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: 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 OakLodge are referred to as ‘residents’. This report reflects a key inspection based on the collation of information received since the last inspection and an unannounced site visit on Wednesday 15 October 2008, which lasted from 10.30am until 5.30pm. Two inspectors conducted the inspection. As part of the inspection time was spent with the appointed manager, with the deputy Care Homes for Adults (18-65 years) Page 6 of 34 manager from the sister home, Hillview, which is next to Oaklodge and with three staff members in private. There were opportunities to meet with four of the residents and to spend time observing a mealtime. A wide range of documentation was examined including a care plan, menus, staff training and recruitment records, policies and procedures, health and safety and quality assurance and complaints. Due to the complex needs of the residents at Oak Lodge, verbal feedback was only able to be obtained from one resident. The Inspectors therefore made judgments about the quality of care received by the other residents based on observation and feedback from the staff team. In advance of the inspection comment cards were sent to the home for distribution to residents, staff and any visiting professionals. At the time of the inspection the manager had yet to distribute the cards. Following the last inspection of the home the appointed manager at that time went on to become the registered manager but subsequently went on maternity leave in November 2007. The Commission was advised of the temporary management arrangements. However, we were then advised in June 2008 that there was a different temporary manager in post. This manager is still in post and she advised the inspectors that the registered manager would no longer be returning to her position. The new manager has been in post for six months, as a temporary manager, but became the appointed manager in September. She advised that she would apply for registration as soon as possible. The Commission has not formally been advised of the appointment of the current manager. Two requirements made at the last inspection of the home on 4 December 2006 remain unmet. These requirements are now subject to consideration for further enforcement action. Fees at the time of the last inspection were 1,277 pounds per week and this was based on a block contract. 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. 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 8 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 9 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 poor 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 not given clear information about the home in order to make an informed choice about accommodation. A more thorough assessment process would identify both individual and group compatibility issues. Evidence: There is a detailed statement of purpose in place, which includes information about the recent management changes. It was noted that the statement says that ‘Hillview and Oaklodge share a spacious garden laid to lawn with flowerbeds and a good size patio area for service users to enjoy’. However, whilst Hillview has a garden area, Oaklodge does not currently have a garden area that is accessible to the residents. It is the Commission’s understanding that both of the homes have a separate staff team, however it was noted in staff meeting minutes that staff were advised that they would have to work in both homes. Each of the residents has been provided with a service user guide and a terms and Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: conditions of residence. There has been one new admission to the home since the last inspection. There was no pre admission assessment on file. The manager advised that this had probably been archived. In relation to this resident there was a detailed social care assessment and a care plan that had been started in September 2006 when there had been no particular placement in mind. Issues of compatibility were discussed as one resident is twenty years old, one resident is in his forties, one in their fifties and two in their sixties. The 20 year old was described in their assessment as ‘lively, with capacity to build upon existing communication and skills’. The manager advised that residents get on well and the twenty-year old resident has ample opportunities to spend time with a female resident from Hillview. Evidence outlined in other sections of this report indicates that this needs to be reviewed to ensure that individual needs are met. Care Homes for Adults (18-65 years) Page 11 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. Improved care planning and record keeping would better promote residents’ health and welfare. Evidence: The manager advised that emphasis has been placed on updating the care plans using a more person centred approach. This was evident for the care plan examined but there were three folders provided and it was difficult to know which contained the most up to date information. It was reported that the new care plans would not be signed until they are fully completed. The deputies have updated the care plans and once completed they will be handed back to the keyworkers to keep updated. The resident’s needs were clearly identified along with the action required by staff to ensure that they were met. However, there was a statement that a resident suffered Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: from psychosis but not how this presented. In relation to this resident there was evidence that at least one keyworker meeting had been held and that a review had been held. Daily records show that this resident chooses what they wear each day. There was no evidence that they use their walking frame. Residents’ meetings are held periodically. Records seen showed that residents had raised objections to the excessive vocalisations made by one resident stating that it gave them headaches. On the day of inspection the noise level was apparent and it was noted that the resident appeared to be very distressed for long periods throughout the day. Staff were supporting this resident in an attempt to calm them. The care plan shows that when this resident is distressed staff should offer music. However records showed a very heavy reliance on music. Daily records do not currently show the extent of the issue in terms of how often it is occurring, how long it is lasting, possible triggers and how it is managed. Daily records for another resident showed that they have become increasingly withdrawn opting to spend time in their room either watching television or listening to music. Care Homes for Adults (18-65 years) Page 13 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 poor 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 their community for activities. Revised menus would ensure that residents could be offered a more balanced and varied diet. Evidence: The manager advised that residents often join in with Hillview and the other homes for activities particularly for seasonal entertainment at Halloween and Christmas. Residents also attend a club on Friday night every other week. Residents have the opportunity to have an annual holiday and it was reported that holidays this year included trips to Blackpool, the New Forest and a luxury weekend in London. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: One resident attends a college placement two days a week. At the time of inspection there had been a problem with this resident’s wheelchair so they were unable to access activities outside of the home. As a result, additional staff support had been put in place for this resident on a temporary basis and activities were being provided inhouse. The resident had an aromatherapy session in the morning of the inspection followed by time spent on a keyboard. In the afternoon they spent time on their bed watching a DVD. Another resident was at a day centre on the day of inspection and a physiotherapist visited the home to see another resident. Records for the days prior to the inspection were either blank or showed a heavy reliance on DVDs, music and free time. Staff spoken with stated that the range of activities that can be provided in the community is affected by the staffing levels and the fact that a number of residents require a high level of support in the community. It was reported that menu planning is decided each week with the residents and that residents are shown a pictorial guide to assist them in making choices. Staff spoken with during the inspection stated that they had been due to go shopping on the day of inspection but that there was no money available. The plan for the week of the inspection was on display in the dining room and showed which resident had chosen which dinner and the alternatives to be offered. In respect of lunch it stated that residents would be given the opportunity to choose their own lunch and there is no set meal recorded in menu book. It was noted that in one week chips had been served on three occasions and there appeared to be a heavy reliance on ready meals. It was noted that alternative to a main meal served for one resident was noodles and there was no reference to any vegetables, fish or meat. On the day of inspection the picture displayed was for jacket potato and quiche, however, the meal served was beans and quiche. It was noted that two of the four people at the table required assistance with their meal. One resident was very vocal throughout the meal. Staff advised that the fifth resident had been called to his lunch but had chosen not to come and preferred to wait until later. Staff stated that he is fixated with magazines. However it was noted that in one-week period, he had refused his main evening meal for four evenings in a row. There was no record that he had had an alternative and records showed that he either had toast or sandwiches at lunchtime. A staff member advised that sometimes he chooses to have his meal in his room, as he does not like noise. He has been referred to a dietitian for advice and support. Care Homes for Adults (18-65 years) Page 15 of 34 Care Homes for Adults (18-65 years) Page 16 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. Recent improvements to the medication procedures should minimise the risk of errors occurring. Evidence: Each of the residents has a health action plan in place detailing their individual health needs. There was evidence that residents receive some specialist advice and support as required to meet their individual needs. It was reported that referrals were being made to dietitians for two residents and one resident had been referred to have a mental health assessment. Records showed that residents are supported to attend healthcare appointments such as dental, opticians and chiropody. In relation to the care plan seen there was no record that the resident’s weight had been monitored. Records seen in relation to medication were in order. It was noted that two medications errors had been reported to the Commission within the past few months. The manager advised that staff involved in each incident had received further training Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: on the subject and were not permitted to administer medication until they had been assessed as competent. The home’s policy on the administration of medication was last updated in 2003. The manager advised that this policy is now being updated. Discussion was held regarding the need for a local policy and the manager agreed to draw up guidelines. However, it was later found that there were guidelines in the medication room that were dated May 2008. It was unclear if the manager was aware of the updated guidelines. There were individual risk assessments in place for each resident detailing how they take their medication. There was also a protocol in place for as required medication. Weekly audits of medicines were carried out and there is a medication returns book showing all medication returned to the local pharmacy. Staff observed working with the residents over the course of the inspection showed patience and understanding and were seen to treat residents with respect and dignity. There was evidence that the psychological health of some of the residents may be affected due to compatibility issues identified. Requirements will be made elsewhere in this report. Care Homes for Adults (18-65 years) Page 18 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to enable anyone wishing to make a complaint to do so. However, record keeping in relation to the management of complaints are inadequate. The procedures in place for the management of residents’ finances are inadequate. Evidence: Records showed that two complaints had been received since the last inspection. One related to a broken fence that had been broken for several months. Records did not show if the problem had been resolved. The second complaint dated April 2007 referred to 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 also advised that they would be kept informed. No further information is documented and the issue remains outstanding. There is a record detailing all adult protection alerts and regulation 37 notifications. The file was disorganised and the outcome of adult protection issues were not always documented. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: The systems in place to manage residents’ finances were chaotic. The appointed manager asked the deputy manager to assist in explaining the problems with the system. A problem had occurred when the three signatories for residents’ accounts had either left or were on sick leave. As a result residents had no access to their accounts and staff had no access to petty cash. For a period of time staff were taking residents to the office in London to pick up petty cash. Records up until August 2008 showed that residents were owed large amounts of money. The deputy manager advised that as of the day prior to the inspection a new system had been put in place which meant that the home would be able to access a certain amount of money on a daily basis. Inspectors advised that the situation needed to be resolved as a matter of urgency. The manager confirmed by the end of the inspection that the situation had been resolved and residents would be given all monies owed to them. The Commission has been advised that Social Services are aware of this issue that that the organisation has been given three months to resolve the issue. Care Homes for Adults (18-65 years) Page 20 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 poor 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 to repair to ensure that it remains fit for purpose. Residents would benefit from having access to a garden area. Evidence: Communal areas consist of a large lounge area and a separate dining room. These areas are decorated to a good standard. However, there were large cracks visible in the ceiling throughout the property but this was especially evident in the lounge and corridor areas. The appointed manager advised that a structural engineer visited the property to rule out subsidence. He advised that that building is safe. The manager stated that there are three options to address the problem but she was not able to expand upon this, or to advise of a timescale for dealing with the problem. There has been a long-standing issue over the garden for the property. A requirement made at previous inspections has been repeated on a number of occasions and remains outstanding. The requirement states that ‘action must be taken to provide level access to the garden’. The appointed manager advised that for some time now there has been a disagreement over who has responsibility for paying for the garden. She stated that quotes have been obtained and submitted to the head office to have a post rail fence, which would effectively divide part of the driveway to the front of Oak Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: Lodge and Hillview in two and reduce the car park area but would give a secure patio area for the residents of Oak Lodge. Again there is no timescale for completion of this work. She said that although there have been previous plans relating to a garden at the rear of the property she was not sure if they were being considered at present. As this requirement remains unmet it will now be subject to consideration for enforcement action. Bedrooms seen had been personalised and were homely and reflected individual residents’ hobbies and interests. Staff advised that a relative of a resident had also had input into the choice of décor for her relative’s room. There was a very strong odour in one bedroom. It was reported that this room is due for redecoration. Some of the furniture had had to be removed from this room temporarily. The fish tank in this room was also due to be cleaned. Bathrooms seen were in need of redecoration. In one bathroom there were some broken tiles and in a second bathroom the toilet seat was loose. There were cobwebs to be seen in many areas around the building. At the time of inspection the tumble drier was not working and an engineer had been called. There was a cleaning rota in place detailing the cleaning works to be carried out by staff at night and through the day. Staff training records showed that only one staff member has received training on infection control. Care Homes for Adults (18-65 years) Page 22 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. Insufficient staff levels could compromise the safety of residents and the quality of the care that can be provided. The planned training opportunities should ensure that the needs of the residents are met. Staff would benefit from regular supervision. Evidence: Recruitment records were seen in relation to two staff appointed since the last inspection of the home. In relation to one there was a detailed application form and two references had been requested and obtained. There was also a record that a full CRB had been obtained. The staff member had completed the home’s in-house induction but had yet to start the Common Induction Standards despite having been in post for three months. Records held in relation to the second staff member showed this staff member had transferred from another home within the group. As a result no new references were sought. The manager advised that this staff member was completing the Common Induction Standards. The rota’s provided show that there are normally three staff on duty but on the day of inspection there were four staff as one staff member was providing one to one support for one resident to meet their changed needs. This is a temporary arrangement in respect of this individual. The manager advised that they often have a fourth staff Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: member on duty to assist with activities. However, staff spoken with stated that the activity chart is based on there being a fourth staff member and the majority of the time there is three staff so this means that the number of activities that can be provided is affected. Staff advised that the rota is kept in the office and that they have no access to it. It was noted that three of the residents require a staff ratio of two to one for personal care and toileting. All of the residents require one to one support for activities outside of the home. The service user guide states that there are two waking night staff and one sleep in. However, this staff compliment at night is for both Oaklodge and Hillview. There were a number of shortfalls in relation to staff training but records showed that arrangements had been made for this to be rectified as a number of staff had been booked to receive training during October and December. The manager’s name was not on the staff-training matrix, so it was not clear if she is up to date with training. There was some confusion in the information provided in advance of the inspection about the number of staff employed to work in the home. The manager confirmed that there are nine staff excluding her working in the home. In addition to this there are three night support workers but it was not clear from the record provided which home they are designated to work in. One staff member has completed NVQ level three and three staff had completed level two. A further two staff are due to commence level two and one of the staff members who has level two is in the process of doing level three. Records showed that dates had been set to carry out staff appraisals throughout the month of October. It was noted that some of the staff team had received regular supervision but that other staff had received only one or two supervision sessions this year. Care Homes for Adults (18-65 years) Page 24 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The operation of this home does not fully safeguard residents. Evidence: Following the last inspection of the home the appointed manager at that time went on to become the registered manager but subsequently went on maternity leave in November 2007. The Commission was then informed in March 2008 of the appointment of a temporary manager who would be covering the maternity leave. However, we were then advised in June 2008 that there was a different temporary manager in post. This manager is still in post and she advised the inspectors that the registered manager would no longer be returning to her position. The new manager has been in post for six months, as a temporary manager but became the appointed manager in September. She advised that she would apply for registration as soon as possible. The Commission has not formally been advised of the appointment of the current manager. The appointed manager has completed NVQ level four, the RMA (Registered Manager’s Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: Award) and the D32/33 Assessor’s Award. She has held a registered manager’s position previously. Staff spoken with stated that the past year has been a difficult time for the home. There have been difficulties with having access to money for residents and for the house. Shopping was due to be done on the day of inspection but there was no money available. In addition, having only three staff on duty also affects the numbers of activities that can be provided. Staff stated that the morale in the home is very low and there is a tense atmosphere. Feedback from staff and evidence seen in the communication book showed that some entries were abrupt and harsh. Staff have not had regular supervision and they stated that they don’t feel supported. This was discussed at the time of inspection and it was recommended that the manager review the dynamics of the staff team and look into positive team building exercises. A requirement was made at the last inspection to ‘introduce a system of obtaining formal feedback from all relevant stakeholders’. The manager advised that satisfaction questionnaires were sent out to relatives, two were returned and both respondents were satisfied with the care provided. The manager then said that the residents or staff questionnaires had not been sent out yet. She was however, referring to the CSCI questionnaires sent to the home for distribution as part of the inspection process and not to their own organisation’s quality assurance system. She went on to advise that she would devise a format for satisfaction questionnaires for the home. Later in the inspection a format for carrying out service user questionnaires was found in the medication room. However, the format would need to be adapted if it were to be considered for use with the residents. As this requirement remains unmet it is now subject to consideration for enforcement action. The organisation carries out a quality assurance visit, which is like a mock inspection and the last visit was dated June 2008. Forty-two areas were identified. There is an action plan in place saying what will be done, what the home is doing and what has been completed. A manager from another home within the organisation visits monthly to report on the conduct of the home. Records were seen for the visit carried out in August 2008. Records refer to some but not all of the areas identified in this report. Information provided in advance of the inspection showed that a number of policies and procedures are either not in place or are in need of updating. In relation to health and safety, there were certificates in place showing that portable appliances had been tested in April and that a gas safety check had been carried out in February. A series of weekly, monthly and annual checks are carried out in relation to water Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: temperatures, fire safety and equipment checks. All were up to date with the exception of a weekly vehicle check. Records showed that the vehicle had last been checked on 9 August 2008. Care Homes for Adults (18-65 years) Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 24 23(1)(a) That action must be taken to 01/02/2007 provide level access to the garden. (Previous timescales of 01/04/06 and 01/04/06 not met) Care Homes for Adults (18-65 years) Page 28 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 1 4 The Registered Provider must clarify within the home’s statement of purpose the position regarding the garden for Oaklodge. In addition the staffing arrangements for the home must be clarified. The practice of sharing staff between both homes must be reviewed. Prospective residents need to have clear information to assist them in making an informed choice about accommodation. 30/01/2009 2 3 14 The registered person must ensure that they can meet the needs of the residents both in terms of their individual needs and in terms of their compatibility as a group. 27/02/2009 Care Homes for Adults (18-65 years) Page 29 of 34 Prospective residents need to know that the home will meet their needs and aspirations. 3 6 15 The Registered Person must ensure that the updating of care plans is completed. Care plans should include the assessed and changing needs of residents. 4 12 16 A review of the day care arrangements for each resident must be carried out to ensure that each resident is receiving a programme of meaningful activities. Residents must have access to age, peer and culturally appropriate activities. 5 17 16 The Registered person must ensure that a review of the menus is carried out to ensure that it is balanced and nutritious. Residents must be offered a healthy diet and enjoy their meals and mealtimes. 6 19 13 The Registered person must confirm that they have sought additional professional guidance in relation to the management of the health care needs of residents identified during the inspection. Residents physical and emotional needs must be met. 04/02/2009 16/01/2009 30/01/2009 27/02/2009 Care Homes for Adults (18-65 years) Page 30 of 34 7 22 17 The registered person must ensure that detailed records are kept of all complaints made to the home and the action taken as a result. Complainants views must be listened to and acted on. 15/01/2009 8 23 17 The registered person must 27/02/2009 ensure that individual care managers are advised of the problems identified with accessing individual residents’ finances and the action taken to resolve the issue. The home must confirm with the Commission that this has been carried out. Residents need to be protected from abuse. 9 24 23 The registered provider must ensure that the building is of sound construction and kept in a good state of repair internally and externally. Residents have a right to live in a homely, comfortable an safe environment. 27/02/2009 10 30 16 The registered person must 14/01/2009 ensure that all areas of the home be kept clean and free from any offensive odours. The home must be kept clean and hygienic. Care Homes for Adults (18-65 years) Page 31 of 34 11 33 18 The registered person must 30/01/2009 ensure that a review is carried out of the staff levels to ensure that residents’ individual needs can be met. Residents must be supported by an effective staff team. 12 35 18 The registered person must ensure that all staff receive an induction to the home. Residents individual and joint needs must be met by appropriately trained staff. 30/01/2009 13 36 18 The registered person must ensure that all staff receive regular supervision. Residents benefit from well supported and supervised staff. 30/01/2009 14 37 8 The registered provider must clarify the management arrangements for the home. Residents benefit from a well run home. 16/01/2009 15 43 25 The registered provider must ensure that the home has sufficient money available to provide for the residents accommodated. Residents benefit from competent and accountable management of the home. 09/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards Care Homes for Adults (18-65 years) Page 32 of 34 and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Daily records should show information about how often particular behaviours are occurring, if there are any triggers, how long they last and how they were managed. In relation to residents’ meetings, where residents are raising concerns, the concerns should be treated as part of the complaint process and a record should be made of any action taken to resolve the issues raised. The home should ensure that the picture menu board matches up with the food served on a given day so as to avoid confusion for the residents and to encourage them to make a more informed choice about the food on offer. Mealtimes should be relaxed and unrushed. Work should be undertaken in an attempt to improve relationships between management and the staff team. The registered provider should ensure that the policies and procedures manual is updated. 2 7 3 17 4 5 6 17 38 40 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. 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