Inspection on 17/07/07 for Oakdene Care Providers

This inspection was carried out on 17th July 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oakdene Care Providers 11/11/08

Oakdene Care Providers 09/01/07

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

CARE HOME ADULTS 18-65 Oakdene Care Providers Oakdene 6 Berwick Road Shrewsbury Shropshire SY1 2LN Lead Inspector Deborah Sharman KEY Unannounced Inspection 17th July 2007 09:30 Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakdene Care Providers Address Oakdene 6 Berwick Road Shrewsbury Shropshire SY1 2LN 07855 795 239 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) carolineedge@hotmail.co.uk Ms Caroline Edge Mr Stafford Andrew Jones Ms Caroline Edge Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2007 Brief Description of the Service: Oakdene is a five bedroom Edwardian town house within walking distance of Shrewsbury town centre. The property has been completely renovated to provide modern and homely domestic style accommodation for mobile young female service users with mental health needs. The Provider took the decision to offer single sex care and accommodation in order to meet the specific needs and vulnerabilities of this client group which may be compromised by the admission of a mixed gender group. Each bedroom has en-suite shower facilities. A bath is not available. The property has a rear garden. The property is a no smoking area although there are plans to provide a smoking shelter in the garden. Double yellow lines are on Berwick Street therefore parking is restricted. Following a successful planning application parking at the front of the property has increased and two cars can now park off road with space for a further one small car to park at the rear of the property. A range of community facilities are available in the immediate local area including the Gateway centre for education and recreation, two GP surgeries one within walking distance, a main library, the park or ‘Quarry’, Post office, mini supermarket and three local pubs. Current fees range from £1900 to £2400 per week per service user. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was Oakdene’s second inspection since registering as a care home. As at the last inspection one service user is currently accommodated. The service user who had recently moved in at the time of the last inspection has now moved out into more independent accommodation shortly following a successful stay. A second service user moved in two weeks before this inspection. The inspection was unannounced meaning that no one associated with the home received prior notification and were therefore unable to prepare. The inspection was a key inspection meaning that it was planned to assess all national minimum standards defined by the Commission for Social Care Inspection (CSCI) as being ‘key’ standards. One Inspector carried out the inspection over seven hours, beginning at 11.30am and finishing at 6.30 pm. Evidence to support judgements made about Oakdene’s performance has been obtained in a number of ways. The service user, her relative and a health professional upon request provided CSCI with written feedback about their experiences and impressions of the service prior to the inspection. The Manager also provided written information to the home pre-inspection. These sources of information were used in part to plan the inspection. The Inspector was able to interview the Manager, a new staff member and a new staff member supplied by an agency. The Inspector was not able to speak to the service user, as she decided not to take part in the inspection process. The Inspector looked at this and the previous service user’s care in detail using evidence in written documentation and discussion with a staff member and the Manager. Other documentation was viewed to assess recruitment processes, protection, complaints, training and the safety of the premises. The Inspector was also able to tour the premises. This inspection found that whilst some improvements are needed every effort was being made to meet service users’ needs. Direct outcomes for the service user are considered to be good. There are significant omissions in other aspects of managing the care home and requirements made by CSCI to ensure improvement following the last inspection have mostly not been met. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There are a significant number of outstanding requirements from the previous inspection that were made to ensure that action was taken in areas identified as needing improvement. The majority of previous requirements have not been complied with and have been brought forward. The Manager’s previous experience is as a social worker. This has prepared her to assess needs, engage with service users, develop and review care plans and work towards meeting need. The Manager is aware that her previous Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 7 experience has not prepared her to meet National Minimum Standards relating particularly to Staffing and Management. Staff speak highly of her, feel supported and observed that the home is being managed on a day to day basis in an organised way. The Manager however who is also the joint provider is not receiving sufficient support. The need to obtain professional supervision discussed at the last inspection has not materialised and the Manager has not taken steps to meet the gaps in her knowledge and experience. However it is vital that the Manager develops a plan to ensure that she meets the National Standards that she is not familiar with. These relate particularly to the management of recruitment and the development and management of health and safety systems that relate to the premises. Improvements required by the Environmental Health Department have also not been met. This means there is the potential for service users and staff to be put at risk. CSCI has since this inspection liaised with Environmental Health and the Fire Service and they have both provide additional guidance and support. The Manager reported having difficulty in recruiting staff although people are responding to the adverts that she places. Four of her six staff are agency staff and whilst they have become regulars this does not provide maximum stability for service users. The Manager is working many hours as a support worker, sometimes without a break, to reduce costs and this is failing to provide her with sufficient supernumerary time to manage the service effectively and to develop the systems needed. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5. Quality in this outcome area is adequate. Service users can be assured that their needs will be assessed and that they will only be admitted to the home if the Manager is confident that their needs can be met. The Manager must however ensure that more information about the home is provided to service users pre admission and that it is accurate so that they are able to make an informed decision about using the service This judgement has been made using available evidence including a visit to this service. EVIDENCE: The purpose of care home brochures is to provide prospective service users with information about the home and support their informed choice pre admission. The Manager feels that these brochures ‘could be more professional’. None of the requirements made at the last inspection to support the development of these documents to ensure that they provide service users with sufficient information have been met. The contract issued between the home and the service user is insufficient and does not comply with Standard 5. It disadvantages service users as instead of stating the rights and responsibilities of both parties it is a list of rules with which the service user must comply (smoking, alcohol, behaviour and family visits). Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 10 A service user confirmed that she did not receive sufficient information pre admission and information has not been provided to the second service user. Copies of assessment of need have not been obtained from an independent third party such as the placing authority but the Manager did carry out her own assessment pre-admission and did obtain copies of others risk assessments. The Manager carried out up to date appropriate risk assessments on the day of admission and the following week. The Manager had written confirming that following assessment, Oakdene would offer the service user referred a 12 week trial visit. A service user’s parents wrote ‘X’s needs are met very well at Oakdene’. A health professional wrote ‘‘only had experience of them in dealing with one resident but they have met her needs sensitively and appropriately” A service user’s health and confidence has improved whilst at Oakdene and this has prepared her to move on after 6 months into more independent accommodation. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. Some omissions were identified but care plans generally offer staff sufficient guidance and staff understand and respond to service user needs and rights well. Service users are encouraged to make choices about their lives and the routines are service user lead. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A service user wrote ‘I ‘usually’ make decisions about what do each day. Care records demonstrate that there is a culture of facilitating service user choice within the home. Records demonstrate that ‘X made her own tea’, ‘ X declined to go back to bed’, ‘X ate pot noodle and a chocolate bar for breakfast’, ‘X chose to eat alone later and went on her own to the shop’. The Manager stated they had supported a service user to begin to access the community independently. This was achieved by offering encouragement and a stepped approach which enabled the service user to gain in confidence. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 12 This decision was supported by a risk assessment that was reviewed. This is a good example of how the home is supporting positive risk taking. This service user has since moved into her own flat and achieved her goal to live more independently. This demonstrates that in practice service users goals and progress are being reviewed. Multi agency review meetings supported the service user’s move from Oakdene into more independent accommodation. Prior to inspection the manager stated that a planned improvement is to ‘ensure our in house reviewing system is completed on a monthly basis’. Inspection would support this goal as valid as currently there is no system to demonstrate that care plans are being reviewed. It is important to show even where there is no change that the plan of care is reviewed as a change in intervention might be needed. The care plan for the new service user is in draft as it is being negotiated with the service user and progress is slow. The Manager however feels that there is sufficient within it to guide staff and staff in discussion were aware of the service user’s needs. One identified need is ‘sufficient staffing levels’ and the plan for this was vague and insufficient. Similarly there is no guidance in place for the administration of a controlled drug prescribed as ‘as required’ to manage behaviour. This is important to ensure a consistent staff approach that is in the interests of the service user. Other required care interventions were described well and provide sufficient guidance for staff. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is good. The home has worked creatively to ensure that the service user has been supported to enjoy a very wide range of community facilities that meet her expectation and preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A service user wrote ‘I sometimes go to the cinema or out for a meal with staff and go to college during term time to do LEAP courses. I visit my daughter twice a week and I go to the pub once a week to have a J2O or one alcoholic drink. I don’t have a job but I am training with Learn Direct with computers. I might make my own web site.’ A relative wrote ‘we always feel welcome when visiting and she comes home twice a week to see her daughter. Phone calls keep in touch otherwise’. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 14 ‘She has been well supervised throughout her stay, taking part in various activities and therapy sessions although hampered by physical side effects of the medication she takes’. Also ‘X has taken part in the available activities and been very well and closely supervised’. Records demonstrate that prior to leaving Oakdene, a service user had an exceptionally busy activity programme that had been designed around her individual interests. A sample from one week shows that on Monday she attended a computer course and visited family. On Tuesday she attended Tai Chi, art at a local college and then cookery at a different college. On Wednesday she attended a project for people with mental health needs and a drop in centre followed by a GP appointment. Thursday saw her have a lie in, go shopping with staff in town and then do some cooking at home. On Friday she had a free trial at a local gym, cooked lunch, played dominoes and watched TV. The weekend was spent supermarket shopping and relaxing. The Manager and staff are aware of the difference in motivation towards activity between different service users and are demonstrating a different approach to activity accordingly. The Manager said that weekends were unstructured as the service user’s week was very busy. The new service user’s week currently is less busy and so the aim is to build weekend activity levels at the service user’s pace. To date the service user has been to the supermarket, attended medical appointments, been to the pub and gone independently to the shop to buy cigarettes. An introductory visit to local community mental health facilities was planned for the day after inspection. Staff confirmed that there is always plenty of fresh food available and that the service user chooses meals even when those choices might be unconventional. The longer term aim is to support healthy choices. Service users can help themselves to food from the kitchen at any time and the Inspector observed this. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. Staff are aware of the service user’s personal care and health needs and steps are underway to maintain health and wellbeing during this early transition period. Outcomes therefore for personal care and health are good. However, some aspects of medication management still require improvement to ensure that systems are robust, accountable and safe. This has reduced the overall judgement for this group of standards to adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A parent wrote ‘X’s needs are met very well at Oakdene – she is developing a routine of personal care and healthy life style despite complaining of unpleasant side effects from her medication’. The parent in feedback to CSCI recognised that staff have attempted to review their daughter’s medication with medics and that whilst the outcome had not been as they wished they understand that prescribing of medication is not Oakdene’s responsibility. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 16 In written feedback to CSCI a medical practitioner who had no concerns or complaints wrote that: • • • • • The care service always seeks advice and acts upon it to manage and improve individual’s health care needs. Individual’s health care needs are always met by the care service The care service always respects individual’s privacy and dignity The care service always support individuals to live the life they choose The care service always supports individuals to administer their own medication or manage it correctly where this is not possible. Records demonstrate prompt medical attention when changes in health arise. Records also demonstrate that service users are supported to attend women’s health screening appointments. In the six months she lived at Oakdene the service user did not receive any dental or optical screening but the Manager was aware of the need to arrange this had she resided for longer. There is evidence from records that service users are supported to attend very regular psychiatric review appointments, although these records are not as readily accessible as other medical appointment information. This does not best support the home to monitor these appointments, which will become more difficult as the service expands. The Inspector arrived at the premises initially at 9.30. On finding no one available to answer the door, a telephone call to the Manager confirmed that she and a staff member were escorting the service user to attend her weekly psychiatric review. The manager reported no medication errors and from perusal of medication stocks and records it appears that service users are receiving their medication appropriately. As at the previous inspection, medication systems require improvement to comply with good practice to minimise the risk of error. Two out of seven requirements issued by CSCI at the last inspection to ensure improvement have been met and two others have been deleted as they no longer apply. A detailed medication policy to guide practice is now in place and although the manager is aware that she will need to purchase a more suitable cabinet it has been secured to the wall. In addition to the outstanding action required from the last inspection, this inspection has identified further areas for improvement. These include the need to provide a written protocol in the care plan based upon medical guidance for the administration of medication prescribed ‘as required’. This will ensure that this medication designed to affect behaviour is only used as medically directed and only in the interests of the service user. A controlled drug is now in stock and although it is accounted for as such in records the manager is aware of the need for a controlled drug register that meets certain criteria and said she has ordered one. The practice of Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 17 recording drugs received in and out of the premises has stopped and needs to resume so drugs can be accounted for. Medication Administration Records (MAR) are handwritten and this increases the risk of human error. Steps to minimise this such as a second person checking and signing the handwritten entries have not been taken. Further direction for administration needs to be included on the MAR sheet if they are going to continue to be handwritten. The reason for non-administration is not being indicated on MAR sheets which are being left blank when for example a service user is admitted to hospital and as the MAR sheets are handwritten and home made there are no codes provided to account for the nonadministration. The Manager who said she has years of prior experience of administering medication still has not received medication training. The Manager who believes staff are trained was not able to evidence that any staff including agency staff have received medication training either. No systems are in place to assure the Manager of staff competency or ongoing competency to administer medication. A new staff member is not administering medication. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. There have been no complaints. Systems need to be improved so that people using the service know how to make complaints and both they and the staff know what action is taken when a complaint is made This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has not received any complaints and CSCI is not aware of any. There have been no allegations, adult protection investigations and no physical restraints. A medical practitioner closely associated with the home has no concerns or complaints. Prior to inspection a relative confirmed that they know how to complain but that there has been ‘no reason to raise concern’. Similarly the service user was comfortable that she would know who to speak to but like at the last inspection didn’t know how to complain. Since the last inspection a brief complaints policy has been written that states complaints are welcome. Complaints information is now more accessible to service users as this is available in the kitchen. However it does not inform service users what they can expect following making a complaint such as how long they can expect to wait for a response. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 19 Likewise there are insufficient policies in place to guide and advise the manager and staff. It is important that policies are in place in advance as this will provide a framework for good practice and if known to staff will serve to protect them and service users. Since the last inspection a policy of no restraint has been implemented. This clearly tells staff what is and is not expected of them and helps to promote a culture where there are rules and boundaries. Guidance in respect of the following however is not available – whistle blowing, bullying, racial harassment, staff disciplinary and managing service users money. The manager explained that they are not currently holding service users’ money but inspection later found that there is some limited involvement. On this basis when on one of two occasions the service user lost money, the manager felt some responsibility and reimbursed her. Policy and procedure would better set the parameters. The Manager must not assume that staff will know what is expected of them. Incident records that detail where professional boundaries were breached almost leading to disciplinary action underlines this. The manager did however take steps to address this when positively another staff member brought it to her attention. Adult protection training has not been provided. Records show that one of the two permanent staff has undertaken this training with a previous employer and the Manager has applied for training for her second permanent staff member. The Manager was not able to provide evidence that agency staff have undertaken adult protection training. Discussion with a new agency staff member on the day of inspection confirmed she had received this training. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 30. Quality in this outcome area is good. Premise are refurbished and renovated to a high specification and provide homely, clean and modern accommodation that meets the current service user’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user was reclining on the sofa watching TV and appeared to be comfortable and relaxed. The rear garden, which is visible from the lounge, is beautifully tended with an array of colourful flowers providing a pleasant and valuing environment for people to live in. A tour of the premises shows it to be bright, light, clean and fresh. It is very tidy with no immediately obvious hazards that are likely to cause obstructions or slips and trips. Cleaning products were left in the toilet room and a low first floor toilet window is unrestricted. Based on what is known of current service Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 21 user need these are not evident immediate risks but there are no premises risk assessments based on service users’ vulnerabilities. The amount of parking available to staff and visitors has increased. Apart from this there have been no changes to the premises since the last inspection. Although formal systems for infection control management have not been implemented i.e. no infection control policy, written protocols or risk assessment, the Manager has informed staff of ways of minimising risk from having to take soiled clothes through the food preparation area to the washing facilities. Staff demonstrated that they were aware of the advice given to them and also confirmed the availability of hand washing facilities and protective clothing. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is poor overall. Staff present as interested, motivated and committed. Some training courses have been booked for staff but a training plan is needed to help manage the training programme as the home grows. Two thirds of the homes staff ‘team’ are agency staff which does not provide stability. Recruitment practice remains poor overall and does not sufficiently assure the Manager or service users of applicants’ suitability or competence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Outcomes for service users at the point of delivery are good and apart from one incident where a staff member breached professional boundaries, no concerns are known. A service user wrote ‘staff ‘always’ treat me well. ‘They are quite friendly’. Carers ‘always’ listen and act.’ Her parents agreed commenting that ‘Oakdene has given excellent support and care to X during her stay by attentive staff and good facilities’. ‘Each staff member I have met has been experienced and responsive to X’s needs’. ‘She has been well supervised throughout her stay’. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 23 The Manager has not taken sufficient steps to assure herself of the suitability and competence of staff supplied to her by the agency. The Manager is satisfied with the calibre of staff supplied by the agency and assumed that they are supplying appropriately qualified staff. There are no records of their checks or training. The file of a staff member recruited since the last inspection was assessed. Criminal Record Bureau checks had been obtained in a timely way and discussion with another new staff member confirmed this. A completed application form was available showing no gaps in employment and this is an improvement. The application form shows that the applicant had provided details of two referees but only one reference has been obtained. A second staff member confirmed completing an application form and also confirmed being interviewed for the position. On file there was also evidence of prior training and qualifications. However there was confusion at inspection. This was because there was no evidence that a staff member recruited on the basis of being qualified was appropriately qualified, as the Manager had thought. The Manager has investigated this since inspection and confirmed the qualification as appropriate. The confusion arose from a short fall in record keeping. Records show that this staff member who whilst being unqualified is also under 21, is working alone and is left in charge of the care home. A new member of staff said that she felt well supported by the Manager and the other member of the team. She said that four weeks after commencing in post she was still working in a supervised capacity, does not administer medication and had not been left to work alone. New staff are provided with an in house induction but not an induction to nationally agreed standards. Assessment of a staff member’s supervision records showed an initial formal recorded supervision a fortnight after starting work. There is no evidence of further formal supervision time having been provided in the following 4 months. The Manager feels that contact and support are provided daily as the service is so small and whilst this could not be verified with the staff member concerned, a second staff member whose supervision was not assessed due to her limited time in employment confirmed the availability of the manager for support at all times. It is important that a culture of regular formal supervision is established. The Manager has not implemented a training programme or plan to help to proactively manage, monitor and evidence training provision. It is accepted that currently staff are few in number and following staff turnover current staff are relatively new but training outcomes are unclear and ambiguous. There has been little if any training provided since the last inspection including key areas such as Fire Awareness and Medication training. Action must be taken to address this before the home develops in size. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 24 The staff rota is not conventional in format. However the Inspector was able to better see from the record held which staff had been on duty when and whether one or two staff had been provided. The Manager explained that one staff is often on duty during the day, with two at busier times such as the evening and one sleeping in staff member over night. The Manager confirmed that one staff member is considered to be safe but indicated that two staff may be required for community trips currently depending on the confidence and competence of the staff member. This is not clear in the service users plan of care, staff records or risk assessments. Proportionately the home has had a high turnover of staff since it opened and whilst the manager said people are applying for the positions advertised the applications are often not coming to fruition. Four regular agency staff are used to provide as much continuity as possible. Two permanent care posts are currently being advertised, and the manager is keen to recruit into the vacant administrator post. The Manager has to work many hours in a support worker role and this is detracting from her management function. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41, 42. Quality in this outcome area is adequate. The needs of people living at the home are managed well and care outcomes for them are good. However the manager is inexperienced in the management of some aspects of a care home. There are significant weaknesses in aspects of staffing and management that have the potential to put people at risk. Steps have not been taken to address omissions identified at the last inspection. However, on the basis that service users experiences are good, management overall is judged to be adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager’s strength is working directly with service users with mental health needs. She has a good working knowledge of mental health issues and works well with partner agencies. So the Standards that directly relate to Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 26 service users’ day-to-day experiences are met well. Incidents such as service users absconding are managed well. Moreover, it is exceptional that the first service user to move into Oakdene has been successfully supported to move on within such a short time frame. Prior to her move out of Oakdene, her parents anticipated in feedback to CSCI that ‘‘Oakdene holds all the potential to enable X to recover and build up her strength towards independence’ As at the previous inspection the Manager recognises that she is still learning about the care manager role but unlike last time has had 6 months to take action to meet the gaps in knowledge and experience. Suggestions made at the last inspection to achieve this have not been acted upon and therefore insufficient action has been taken to meet the required standards. Several requirements made by the Environmental Health Officer have not been implemented. Staffing levels and the need to minimise costs have seriously undermined the Manager’s ability to dedicate her self to overseeing the management and development of the home. The home is registered to accommodate 3 service users but to date since opening has only had one service user placed at any one time. The Manager is aware that commissioners see her service as an expensive option and fees have been adjusted. The Manager said that the home is financially viable with one service user but that it is a ‘struggle’ and this has lead to her covering shifts as carer. This is at the cost of managing the service that is new and needs time and attention to devise and implement a range of systems referred to throughout this report. The following policies are not in place: • • • • • • • • • Hygiene and Food Safety Racial harassment Health and Safety Policy Infection Control Policy Managing service users monies Whistle blowing Discharge Policy Sexuality Policy Staff grievance and Disciplinary The Manager is aware that improvements have not been made but there are no concrete strategies to bring about change – no quality assurance systems (an exit poll for service users has been designed), no annual development plan and no plan to meet CSCI’s requirements. Where improvements have been made these are tempered by the need to review and improve that which has been done. For example the medication policy is new and detailed but in practice systems need further improvement to comply. A food probe has been purchased but without appropriate food safe anti bacterial wipes the probe could provide a source of infection if used. Plus the fire risk assessment which Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 27 may not be sufficient, needs to be updated following a change in risk and would benefit from advice from the fire service. The Manager said that fire systems are checked as working but are not being recorded and this includes fire drills. Staff have not been provided with fire training. CSCI discussed these issues with the Fire Service following this inspection. There has been one accident resulting in admission to Accident and Emergency but this was sustained in a community facility rather than on the registered premises. The Manager must ensure that any incidents that affect the welfare of service users are reported to CSCI. The manager was also advised to ensure that accidents records are held on the file of the person concerned to comply with data protection rules. Similarly although other service user records are stored appropriately the Manager must not store recorded information which involves staff performance / disciplinary in a bound book which is left on an open shelf in the office. This is sensitive personal information that must be stored in a way that will assure staff and service users trust and comply with appropriate regulations. One staff member is known to have appointed persons first aid training. First aid training has not been confirmed for agency staff and the Manager who also works alone with service users is not first aid trained. Therefore not all shifts are staff by someone with an appropriate first aid qualification and the risks posed have not been assessed. The Manager said that she would not put people at risk and she responds to obvious risk. For example on the day a service user who smokes was admitted to the home action was taken to improve the smoke detection system by radio linking the smoke alarms. The Manager however lacks confidence in risk assessing premises. There are consequently no risk assessments in relation to the premises that consider risks based upon the needs or vulnerabilities of service users. Staff do not need to move and handle people but will move and handle inanimate objects such as vacuum cleaners and shopping. Moving and handling risk assessments have not been carried out, moving and handling training is not provided and there is not a moving and handling policy. Hazardous domestic chemicals are freely available within the premises such as toilet cleaner but COSHH assessments have not been carried out. Some windows are unrestricted, water outlet temperatures are not monitored and the level of risk, which the manager believes to be negligible, has not been formally assessed. Therefore there is the potential for risk to service users. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 3 3 3 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 1 X 1 1 2 1 X Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4(1)(C)5 Requirement The Registered Manager must ensure that: The home’s Statement of Purpose and Service user guide is reviewed to accurately reflect the number of service users the home is registered to accommodate. The homes Statement of Purpose and Service user Guide must include in sufficient detail the arrangements for dealing with complaints / a summary of the procedure. The homes Service User Guide must include all information relating to fees, charging structures, terms and conditions and must include a standard form of contract as per regulations 5(1a) to 5 (1e) When updated, the revised documents must be issued to all service users. Requirements made at first inspection January 2007 with original timescale of Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 30 Timescale for action 30/09/07 31 March 2007. 2. YA20 13(2) The Registered Manager must as 30/09/07 a priority ensure that all staff including the Manager receive appropriate medication training. The Registered Manager must develop a system to ensure the ongoing competency of all staff to administer medication, including agency staff. The Registered Manager must ensure that any medication not administered as prescribed is accounted for in medication administration records. Requirements made at first inspection January 2007 with original timescale of 28/02/07. 3 YA20 13(2) A system must be in place to ensure that there is sufficient direction based on medical advice for the safe administration of medication prescribed as ‘as required’. This will ensure that such medication is administered consistently by all staff and in a manner, which is in the interests of the service user. Steps must be taken to ensure that all medications that are received into and out of the premises can be accurately accounted for. Steps must be taken to ensure that Medication Administration Records contain sufficient clear direction to minimise the risk of error e.g. dose, strength, frequency, time of administration etc. Steps must be taken to assure 31/08/07 Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 31 the accuracy of handwritten Medication Administration Records to minimise the risk of human error. New requirements arising from this inspection July 2007 with original timescale of 31/08/07. 4. YA23 13(6) The Registered Manager must make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. E.g. By the provision of evidenced staff training in adult protection. By developing policies regarding the management of service users monies, gifts offered to staff etc Requirements made at first inspection January 2007 with original timescale of 31/03/07. 31/10/07 5. YA30 13(3) The registered person must provide an infection control policy to appropriately guide staff how to prevent infection, toxic conditions and the spread of infection at the care home. Requirements made at first inspection January 2007with an original timescale of 30/04/07. 31/10/07 6. YA34 19 The Registered Person shall not employ a person to work at the care home unless full and satisfactory information and documents in respect of that person as per Regulation 19 and Schedule 2 have been obtained. Requirements made at first inspection January 2007 with an original 31/07/07 Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 32 timescale of 31/01/07. 7. YA35 18(1)(C)(i) The Registered Manager must ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. Requirements made at first inspection January 2007 with an original timescale of 31/03/07. 31/10/07 8. YA39 24 The registered person must establish and maintain a system for evaluating the quality of the services provided at the care home. This system must provide for consultation with service users and their representatives. Requirements made at first inspection January 2007 with an original timescale of 31/07/07. 31/12/07 9. YA39 24 The Registered Person shall produce an improvement plan setting out the methods by which and the timetable to which, the registered person intends to make the required improvements. Requirements made at first inspection January 2007 with an original timescale of 31/01/07. 31/08/07 10. YA42 23(5)13(4) Following consultation with the Environmental Health Authority at their visit of 9.1.07 the registered persons must ensure that all required improvements are complied with in accordance with compliance dates set by that Department. The Registered Person must ensure that unnecessary risks to the health and safety of service 30/09/07 Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 33 users are identified and so far as possible eliminated. Requirements made at first inspection January 200 with an original timescale of 28/02/07. 11. YA42 23 4 (4A) The Registered persons must ensure compliance with all Fire Safety regulations. As a priority the Registered Manager must carry out a Fire Risk assessment and implement any control measures to minimise any risks identified by 31.1.07. Requirements made at first inspection January 2007 with an original timescale of 31/01/07. Fire risk assessment completed but requires review and assessment of sufficiency by Fire Service 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The Registered Manager should consider including in the Statement of Purpose and the Service User Guide arrangements for bathing including specific reference to the absence of bath facilities. Recommendation made at first inspection January 2007. 2. YA2 The Registered Manager should consider developing the current pre admission assessment pro forma to ensure that medication administration needs are assessed in more detail and that bathing preferences and or needs are included. Recommendation made at first inspection January 2007. 3 YA22 The Complaints procedure should advise people of the stages and timescales in place for the management and DS0000067573.V340965.R01.S.doc Version 5.2 Page 34 Oakdene Care Providers investigation of their complaint. Recommendation made at this inspection July 2007. 4. YA31 The Registered Manager should ensure that clearly defined job descriptions and contracts of employment are developed for all staff positions and are provided to all staff, with a signed copy held on file. Recommendation made at first inspection January 2007. 5. YA35 The Registered Manager should ensure that each staff member has an individual training and development assessment and profile. The Registered Manager should ensure that a training needs assessment is carried out for the staff team as a whole to inform future planning. This should be linked to the homes aims and service user needs. Recommendation made at first inspection January 2007. 6. YA41 The Registered Manager should ensure that all policies and procedures as per Appendix 2 of the National Minimum Standards are provided to guide staff within the home. Recommendation made at first inspection January 2007. Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oakdene Care Providers DS0000067573.V340965.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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