Inspection on 23/01/07 for Oakdown House

This inspection was carried out on 23rd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oakdown House 25/10/05

Oakdown House 09/06/05

Oakdown House 18/01/05

Oakdown House 01/09/04

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Thorndene

Insight - Eastchurch

Southfields

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Seabourne House

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Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Oakdown House Ticehurst Road Burwash Common East Sussex TN19 7JR Lead Inspector Jason Denny Key Unannounced Inspection 23rd January 2007 09:30 Oakdown House DS0000021177.V325794.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 Oakdown House DS0000021177.V325794.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. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakdown House Address Ticehurst Road Burwash Common East Sussex TN19 7JR 01435 883492 01435 883369 oakdownhouse@tiscali.co.uk 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) Oakdown Limited Mrs Joyce Chapman Care Home 44 Category(ies) of Learning disability (44) registration, with number of places Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of residents to be accommodated is forty four The residents will be between the age of eighteen and sixty five years on admission Total accommodation includes twenty six residents in the main house, six residents in the bungalow and twelve in the pavilion To accommodate a maximum of twelve (12) service users with a learning disability and physical disability in the Pavilion. 25th October 2005 Date of last inspection Brief Description of the Service: Oakdown House provides accommodation for forty-four adults with Learning Disabilities. The Main House provides for twenty-six service users [Residents] on three floors, separated into three ‘flats’, each including a communal lounge/dining area and kitchenette. There are three bungalow Flatlets, designed for two which provide semiindependent living. Adjoining the Main House is a purpose-built special care unit for twelve service users with high dependency needs associated with their learning and physical disabilities [The Pavilion]. A communal area and assisted bathrooms are provided on each of the two floors, in addition to specialist aids, equipment and adaptations. At ground level there is a wellequipped day resource with an outdoor activity area and a sensory room. On-site workshops for daytime activities include craftwork, and a newly built computer suite. A range of work-based, educational and leisure activities are offered off site. The buildings and extensive gardens are set in a rural location with accessible village community facilities such as a church, public houses, and a bus route, a few hundred yards away from the Main gate. Information on the range of fees charged is within the homes current statement of purpose/service user guide and currently ranges from £400 to £1630 per week. Service users [Residents] are additionally charged for personal items such as toiletries and clothes beyond the basics provided and holidays, hairdressing, and additional restaurant meals. Inspection reports are not routinely sent out to families and advocates after each publication with copies are kept on display in the reception areas of the home and can be obtained via the manager. A service user guide containing the most recent inspection report is sent to anyone looking to move into the home. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced key Inspection, which included a visit to the home by two inspectors which took place between 9.30am and 4 .00pm on January 23, 2007. The inspection focused on the key areas such as how needs are being met, activities, lifestyles, environment staffing, and management. During this inspection process, which covers the period since the last inspection October 25, 2005 and the week of the home visit, contact has been made with most social workers involved with the home and 4 relatives. 30 Residents were observed or spoken with which involved staff at times helping with communication, and many completed survey cards prior to the visit The staff interaction with Residents was observed. Some Staff on duty[7] were spoken with. 8 of the Residents care-planning records was looked at in detail along with how all their needs are met. This focused on some of those who have been involved in protection issues, new Residents, or some who have high needs. Diversity and equality areas were explored in relation to lifestyles. Discussions with management looked at progress since the last inspection. The inspector’s toured all communal areas of the home and some bedrooms. Meal arrangements were examined, observed, and sampled. A record of complaints was inspected. Staffing was looked at along with the homes management, including measures to ensure quality for Residents. One [1] outcome area is assessed as Excellent, and the seven [7] other areas are assessed as Good overall. What the service does well: Social workers and relatives shared the view that the service is good. Comments included “settled in ever so well, she loves it”, “Cannot praise them enough, very flexible”, “I would recommend the home to others”, and “On the whole I am pleased with the care my service users[Residents ] are getting.” The home is excellent at ensuring that new Residents settle in and responds well to any difficulties. The home was again found to do most things well excelling in a number of areas, such as management, training, support to staff, and the involvement of residents in the running of their homes. The management of the home was again found to be especially good and dedicated to supporting residents and staff. The management team is well skilled and operates in an open and inclusive way in supporting both residents and staff and the continuous improvement of the service based on seeking the views of those involved with the service. Close review of resident’s health and changing needs is maintained. The home deals well with Concerns from residents and staff. The needs of Residents continue to be promptly met with a range of specialised advice and input sought. Residents’ benefit from an independent counselling service. The rights of Residents are promoted and protected. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 6 The large external grounds and garden areas are well maintained. A good range of activities and facilities are provided which most regularly take part in. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3, 4, & 5 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The information in the homes guide is full, clear, and accessible. Prospective new Residents are carefully assessed before moving in, with existing Residents under effective ongoing assessment to ensure their needs continue to be met and do not adversely affect others EVIDENCE: Accommodation throughout Oakdown House is arranged on different floors and various buildings. In each area there was found a continuously updated guide to the homes services. The service continues to explore ways of making such information accessible to each individual according to their own communication needs. This is a work in progress given the numbers of Residents [service users]. All information is full with an appropriate Statement of Purpose which the service continues to operate within whilst ensuring compatibility. This has included since the last Inspection moving some Residents to more appropriate parts of the service or creating single accommodation. It is evident from records, observation, and action plans following incidents how carefully Residents are assessed to ensure the service continues to meet needs. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 9 This has included the service successfully obtaining more 1:1 funded support for 3 Residents since the last Inspection, which has helped, reduce behavioural incidents, and created more positive activity. Examination of Records, discussions with staff and relatives showed that one of the newer Residents since the last inspection indicated that an exceptional number of trial visits took place before this person and their family decided it was the right home for them. Assessment information was very detailed and records and survey cards indicated that this person continues to enjoy living in the service. The persons relatives indicated that the person is more active has made friends and in their words “loves it there, always excited to go back after weekend visits to family”. Since the last Inspection the service have, as seen in contracts inspected organised for an independent persons to sign the Terms and Conditions on behalf of Residents. From the records inspected it was not clear if any parts of the contracts needed to be explained to any individual or were questioned. The manager confirmed that the advocate is available to Residents should they have questions. The contracts/terms and conditions are well presented and are fully detailed including the fee charged and what this covers, including any costs for extras. A number of Residents receive services, free of charge, beyond what is paid for by the local authority. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, & 9. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Care-Plans contain good information, which is both followed in practice, and is becoming more person centred and individualised. Sensible, full, and positive risk assessing takes place. Residents have an advocate who speaks on their behalf. EVIDENCE: The Inspectors sampled 8 care-plans. These included some newer Residents, those with high needs, and some of those involved in behavioural incidents since the last inspection. Care-Plans were found to contain good information subject to regular review with all relevant people. Care-plans showed evidence of being put into action and were found to be highly relevant to the needs of the individuals concerned. A newer Resident who has been in the home less than 6 months has already had two reviews with social services with all stakeholders confirming to the Inspector satisfaction with arrangements. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 11 Her relatives commented, “ settled in ever so well, she loves it” always keen to go back. Staff are nice and the manager. Already had 2 reviews. Is more active in this new placement more engaged previous placement just listening to music, likes room”. Care-plans for those with high needs were found to be comprehensive especially regarding personal care guidelines with both having useful communication passports with good use of clear photographs The key worker together with the resident carries out care planning. Residents have access to their plans and choose who is to attend their review meetings. The care plan includes an assessment of all aspects of personal and social support and healthcare needs. The Inspectors found a basic level of information helpful for staff in meeting needs. The inspectors found that most of the recent changes for residents had been reflected in amendments to the plans. The plans also contained an individualised daily planner to show staff what assistance is necessary for each resident. The planner also focuses on the development of daily living skills. These plans are regularly reviewed and staff are closely supervised to ensure that they are filled in correctly. The plans were easy to navigate. Another care-plan was found to have detailed health guidelines and an accurate personal profile including catheter care. This plan also contained a range of recent agreements between the resident and the home. His relatives commented, “cannot praise them enough, very flexible. He will often panic and gets frustrated due to health and mobility issues but the Home manages this well we had a good review last Summer 2006. There has been an improvement” Social services indicated to the Inspector that overall the home is good and meets care-needs and responds well to advice. They also indicated that the home was getting better at developing person-centred approaches which is a challenge given the number of Residents. Risk assessments were found to be relevant and thorough. Risk assessments also form part of the care planning process and are regularly reviewed such as example of one reviewed during the month of the inspection. This includes a moving and handling, environment, and general risk assessment. Residents are encouraged to exercise responsibility and make choices about their day-to-day living, this was confirmed in survey cards, observations, and records. A number of the residents manage their own savings accounts and pocket money expenditure and have keys to their rooms. Those who do not manage their own money sign an agreement to allow the home to do this. This is subject to regular review. The home retains details of an Independent Advocacy Service, should any Resident require this. Particular Residents confirmed that they access the independent counsellor who visits twice a week for such a service. Residents are all supported to be as independent as is practically possible. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,15,16, & 17. Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. There are good and improved arrangements in place in respect of activities which are regularly reviewed Meals have improved for service users but better planning is needed in one area to meet preferences EVIDENCE: Social Services and relatives, along with most Residents survey cards indicated that there is a good range of regular activities provided by the service. Some Residents as observed during the inspection and seen in records enjoy an excellent lifestyle, which is active, and wide ranging. It continues to observed that not all Residents especially those who are older participate significantly in the scheduled activities with the service encouraged to continue to explore person centred opportunities. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 13 Some staff spoken with where felt that activities for Residents could be more diverse the example quoted that “not all want to do painting”, and there “should be more outings”. Those who have high needs have a range of good facilities. Timetables also indicate several choices for each day. Access and participation in the community is affected by the homes rural location although this provides the opportunity of vast safe grounds and affords a day activity centre. Since the last Inspection weekend and evening activities such as trips out have increased to more fully meet Residents preferences and is a area which socials services are keen to see develop further within service limits. A full, weekly programme of activities is available to all Residents with their names recorded on weekly and daily activity sheets according to what preferred activities they wish to attend. Most Residents spoken too confirmed that they were generally satisfied with activities. This was also confirmed in records, minutes of monthly meetings inspected, and observations. Activities are also now an agenda item at each Residents meeting with management of the service keeping this under closer review. Regular activities organised on site include, woodwork, computer skills, sensory room, music and movement, painting, drama, counselling, gardening, horticulture, physiotherapy, reflexology, and cooking. Community activities include college classes at Ringmer, swimming at Eastbourne along with other community leisure activities such as hydrotherapy and pub and shopping trips. The inspectors toured the two main activity centres on site. The Pavilion home for people with a more severe physical and learning disabilities has its own purpose built activity centre within the home. All residents were observed to be engaged in varying activities supported by trained staff. The home also has a touch screen computer, its own sensory room, and cycle area. At the large day centre next to the Main house used by other residents, a music session was in progress with 8 residents. Computing was taking place for others with drama planned in the afternoon. A number of residents were found to be less active, which was partly attributable to age, and motivation and mainly their choice as confirmed in discussions. It was also confirmed that some of these Residents were resting after attending activities earlier in the day and tend to sample activities for shorter time periods. One resident indicated that he is supported to go to Church every Sunday and has gone overseas to Spain on holiday supported by the home. Residents confirmed through survey cards, minutes of meetings, and during the inspection that food and meals served has improved. The inspectors sampled a meal and saw improvement in quality, which was also confirmed in menus. Some high need Residents rely on their food being served to them by staff along with assisting with eating, which make planning very important. An unacceptable delay was found due to staff not focusing properly when food arrived at the Pavilion resulting in a long delay with food being served where Residents were observed to become frustrated along with hot food cooling.The manager indicated that this is not accepted practice and will closely monitor this. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, & 20. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Health needs of Service Users are well managed in their very best interests. EVIDENCE: A range of individualised protocols is in place with clear guidance on how to support those residents with varying epilepsy or other conditions. Staff were found to be fully aware of their differing needs with clear written guidance in place along with nurse on call buzzer systems in the home. A resident whose health needs has increased was found to have moved from the bungalow back into the main house where more staff support is available. Another resident was found to be receiving effective regular input from a psychologist following changes in behaviour. The inspector looked at PRN[medication designed to calm someone ] guidelines and practice in respect of those Residents who occasionally have challenging behaviour. Any such decision was found to be carefully assessed with clear guidelines, which always involves the manager. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 15 One Resident has had input from a behavioural specialist along with staff training based on protecting everyone. The plan to create two further rooms on the ground floor on the Main house is seen positively by Social Services as it help meet the needs of older people. Records indicated the close way health and medical conditions are monitored and responded too. Records and discussion indicated that all residents are supported to manage as much of their self-care as possible with this clearly recorded in care-plans. The care-plans clearly indicate what support staff are to give. Those residents spoken with confirmed that they were happy with the way staff support them in their health needs. One resident indicated that he had been well supported since returning to the home following a hip operation. He described how his increased need of staff is well met. Staff were observed to skilfully support residents. This was particularly evident in the Pavilion where highly complex needs were being managed and where staff showed a good awareness of the needs and preferences of people with communication needs. The system of storing and administration of medication in the Pavilion was found to be in order, along with guidelines for some of those who live in the Main house and the bungalows. Only trained senior staff handle Resident’s medication with them recently undergoing refresher and accredited, training. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Service Users are encouraged to raise concerns by receiving a good response. Complaints or protection issues are dealt with seriously and effectively by the home. EVIDENCE: The open and positive way in which the service encourages Residents to raise views or concerns continues to ensure that the homes complaints process is effectively used. The home also writes to individual Residents to show how they are dealing with their concerns. Three [3] concerns/complaints were found to be recorded in the homes complaint file as they relate to Residents. The concerns came from individual or groups of Residents relating to the behaviour of their peer’s. Two of these concerns were found to be justified with the home taking prompt action leading to improvements. The inspector spoke with some of the Residents who raised these concerns who confirmed satisfaction with how the home responded. The rate of Complaints continues to be low relative to the number of residents, with most issues promptly dealt with informally. Staff continue to demonstrate a sound understanding on how to prevent and report abuse and continue to benefit from adult protection training. Staff were found to be aware of the home’s complaints recording policy and procedure. All staff follow a consistent approach when dealing with residents distress. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 17 Key workers are trained to respond to service user’s wishes, suggestions, or concerns. All staff have received training in the Protection of Vulnerable Adults. There is policy guidance for staff to adhere to. This is covered in new staff ‘s induction and via periodical training with sessions taking place regularly throughout the year. The manager was found to be have completed a Social services run Protection of Vulnerable adults course. Socials services and some relatives who attend reviews or adult protection meetings following incidents of aggression commented positively on how the homes management reports and deals with issues. In one instance a Resident now has single use accommodation due to the risk attached to sharing with others Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 18 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): 24, 30. Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a continuously improving environment. Some parts of the environment are excellent whilst other areas still need improvement with it expected that by the end of 2007 that all Residents will enjoy a good environment. It is also expected that once major works are completed that routine maintenance tasks will be done more promptly EVIDENCE: The Main building and its 26 rooms were toured as were the Pavilion for 12 people along with the 3 bungalows which house 1-2 people in each. Some bedrooms were also looked at. The Pavilion was found to be ideally suited for its purpose. This home was clean, personalised, and well equipped. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 19 Wheelchair access to the garden is improved. Access is available to the courtyard. Areas such as bathrooms, bedroom carpets, flooring and redecoration continues to been renewed as part of a clear rolling programme. All hallways are due to have new carpets by the Summer of 2007. New sensory equipment has been introduced into specialised room along with new alarm systems. Some renewal work was found to be necessary on the bathrooms. Of more immediate concern is a top flat door, which is still awaiting replacement, which due to the delay means that Resident has to be locked when in their room for their own protection restricting her access around the flat. The manager confirmed that she had thought this had been repaired and was surprised to find it was still outstanding. Some staff in the home confirmed that maintenance jobs take longer than is reasonably expected although the overall environment, which is purpose, built remains good and has excellent and well equipped gardens. The Main House A stair lift has now been installed creating better access to other floors which is awaiting approval before use. It is positively noted how the current lounge is no longer a smoking area and has been redecorated. Current plans [with work now commencing] shown to the inspector showed how this room is to be moved and a separate smoking room developed along with a new relocated dining room, with one remaining double room being made a double. Accommodation on the ground floor will increase from 8 to 10 rooms. The existing lounge will become two en-suite rooms. A bath has been repaired on the top floor of the Main house with a shower room installed, as this is more popular with those residents. A dishwasher has also been installed. Both measures avoid the residents having to come down a floor to access facilities. Cleanliness was found to be good apart from the Attic lounge which according to records had been cleaned the previous day, but on inspection was dusty, and unclean Resident’s benefit from lots of space and several lounges spread across each floor. Bedrooms looked at are well equipped and some very spacious, with all personalised. All of the three bungalows were found to be cleaner. The last inspection report 25th October 2005 indicated that there was a redecorations and renewal plan to make them more homely which would include new kitchens in 2006. Although radiator guards had been installed the accommodation in each of the 3 bungalows was found to be unchanged and needs renewal and further thought about how they are contributing towards independences. One bungalow for example was found to have no working fridge. It was explained that this was due to one of the 2 Residents and has been the case for 2 years, with a replacement of a different type of fridge planned. The home was asked to consider the effect on the other Resident. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 20 Similarly in another bungalow one of the 2 Residents was observed to dominate communal space with his items. It is positively noted that due to behaviours and needs of a Resident a particular bungalow is no longer shared with this better suited to the individual Resident. The home is funding this under-occupancy and have applied for more funding to make this a permanent arrangement. The organisation are asked to look at whether these bungalows are big enough for 2 people or whether the mix of Residents is compatible. The bungalows are more the style and size of a chalet. One partial solution would be to look at additional storage outside the bungalows such as large shed as hallway, bathroom and kitchen space is taken up with multiple coats and shoes, along with mop buckets. It is positively noted that Residents are now receiving more appropriate support to look after their bungalows and staff were observed doing this during the morning of the inspection. Increased night-time staffing in the Main house offers more ongoing evening support where necessary. It is noted that the service has had to undergo extensive refurbishment and renewal of its large environment to update it . Once this is complete it is expected that ongoing maintenance tasks will be easier to manage. . A number of residents were found to have keys to their rooms and their own lockable storage facilities. Staff and management were found to have received additional infection control training and advice with all using belt mounted gel hand wipe packs. It is positively noted that bins had been replaced with a more appropriate type. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 21 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 Good. This judgement has been made using available evidence including a visit to this service. Staff are well supported, supervised, exceptionally well trained, motivated, and well suited to meeting the complex needs of Residents. Although staff are carefully selected some improvements are needed to the recruitment process to making it tighter to reduce the risk to Service Users. EVIDENCE: Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 22 Rota’s inspected showed that staffing levels meet assessed needs. Staff confirmed that the pending start of an additional night person in the Main house is welcome and long needed due to the size of the building and increased needs which is difficult for I night staff person to manage. The inspector found that a person has been recruited and due to start in February 2007. this will help support any emergencies for the more independent bungalows who do not have staff based in their building during the evening. The Pavilion was found to be have 7 staff plus a deputy for the 12 residents during the day, and one staff 8-10am for the more independent residents in the bungalows [5 residents]. These levels decrease in the evenings according to need. Dedicated day care workers and the availability of deputy managers also boost staffing. The manager assured the Inspectors that staffing levels were sufficient to meet need. Three Residents have obtained additional 1:1 staffing since the last Inspection, which has increased meaningful activities. One of the inspectors observed staff during 11 and 12 noon in the Main house that there was plenty of staff mainly occupied in activity other than interacting with Residents. This was discussed with the deputy who confirmed that staff spend this period tidying and doing admin work and interact more with Residents during the earlier part of the morning such as personal care and then at lunchtimes. A number of Residents in the main house [9 observed] did not attend the daily programme in the activity centre and so there could be an opportunity to organise alternative activities on this day or extra outings. All of these Residents were found to be aware of planned activities. The inspectors looked at three staffing files for recently employed staff and found all necessary documents with one exception in place before the person’s started working with residents. These documents included ID checks, Police CRB disclosures, two references, and POVA Firsts where staff names are checked against a register. There was not references in place from two people’s last employer with it not spotted on the application form that the applicant had not put them down as a referee. One applicant had no professional references despite having several jobs. In another case a referee from a previous employer was not authenticated. The service was also advised about how application forms need to be in line with changing legislation. During the Inspection visit the home made the necessary changes to the application from. There was no evidence that these shortfalls had affected outcomes and all staff were progressing well. The service is using the appropriate induction workbooks and an induction session was observed with a new staff member and the training officer during the Inspection. All staff receive an excellent range of training which also includes a focus on learning disability as well as Health and Safety training such as food hygiene and Moving and handling, and Fire. The home was found to be close to meeting the Government target of 50 of staff having at least level 2 National Vocational Qualification in Care with 23 of Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 23 50 care staff already passed and a further 3 staff by March 2007. Staff confirmed that they receive written supervision every 6-8 weeks. The training officer confirmed she has personally carried these out for new staff during their inductions. The manager showed examples of supervision of established staff .The inspectors spoke with 7 staff who were observed to be professional, motivated and showed good knowledge of Residents needs. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 24 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, & 42. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The service is well managed with a continued focus on improvements, which benefit Service Users. Service Users benefit from a good quality service, which is carefully reviewed. A closer attention to fine details could lead to Excellence. EVIDENCE: Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 25 The Registered manager has 40 years of relevant experience in this field of work. She has undertaken periodic training to update her knowledge and skills relevant to the needs of people with learning disabilities both younger and older. The manager is a Registered General Nurse holding a diploma in social work. She has also achieved the Registered Managers Award. One of the three deputy managers has National Vocational Qualification level 4 with the other two deputies achieving National Vocational Qualification level 3. The management team through discussions again displayed their knowledge of the needs of Residents. The directors of the organisation are also helpfully involved in the overall management of the service and support via monthly inspections of the premises and give support and resources to the manager. Minutes were seen of a range of monthly staff meetings The Inspectors observed staff and Residents having regular and open access to management. Staff spoken too confirmed how well supported they are by the manager. Management was highly praised by all stakeholder who spoke with, or wrote, to the Commission Residents indicated in survey cards and discussions that they are encouraged to participate in the running of the household, wherever possible. Resident’s views are formally sought at their reviews, during their fortnightly house meetings and informally through sessions with their key worker. Minutes of a meetings, which took place on 05/12/06 and 20/01/07 in different areas of the Main house were seen which indicated suggestions such as action plans for more activities and new furniture in the Attic lounge. Improvement to weekend activities has been implemented. Some additional trips such as one to France took place for 4 Residents in November 2006 as result. Care plans, policies and procedures are regularly reviewed and updated. A commitment to service user involvement is demonstrated in the planning and delivery of services. Resident’s periodical satisfaction questionnaires were also inspected. The inspector also found that concerns such as those about the behaviour of a Residents are quickly addressed. The monthly section 26 visits reports are undertaken by the Main director [Responsible Individual], and have improved in terms of detail and make useful distinction between the three distinct sections of the home. The overall management of home has the potential to be assessed as excellent once the management fully demonstrate that routine maintenance jobs are addressed in a timely manner and that some other finer details such as staffing routines are more closely supervised [standard 17]. it will also be useful to reach agreement with all Residents, staff, and social workers that there is the best possible and diverse range of activities which can reasonably be offered. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 26 Records showed that all established staff had done all health and safety related courses with Residents further protected by having all appliances regularly tested as confirmed in records such as the Commission’s questionnaire completed by the manager. The most recent environmental health visit in September 11 2006 made no recommendations. The service promptly reports and takes immediate action following incidents, which affect the welfare of Residents, an observation fully supported by Social Services care managers. Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 27 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 4 2 3 3 3 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 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 3 33 3 34 2 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 3 X X 3 X Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 28 No 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 YA17 Regulation 12[1][[a] Requirement Timescale for action 23/02/07 2. YA24 3 YA34 That the Registered Person must make proper provision for the welfare of and preferences of Service Users. With particular reference to ensuring that meals are more carefully timed and planned when served to Service Users in the Pavilion. 23/12/07 23[2][b] That the Registered Person must ensure that the premises are kept in a good state of repair. That the Registered Person confirms to the Commission by the date shown when its maintenance and renewal plan has been completed and which includes all those jobs identified during the inspection. 19 That the Registered Person 23/02/07 Schedule 2 must ensure that staff are and employed in accordance with amendments the services own policies and 24/07/04 procedures and in accordance to the regulations including amendments. That the services own recruitment policy is updated to include all DS0000021177.V325794.R01.S.doc Version 5.2 Oakdown House Page 29 necessary legislation. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA24 YA24 Good Practice Recommendations That additional storage facilities for the bungalows are explored. That a review of the use of the bungalows is undertaken to ascertain the compatibility of users accommodated and explores the feasibility of these being used for single–use accommodation. That the cleaning of the Main House Attic Lounge is reviewed and monitored 3 YA30 Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Oakdown House DS0000021177.V325794.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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