Inspection on 14/08/07 for Oakfield

This inspection was carried out on 14th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oakfield 26/09/08

Oakfield 30/04/08

Oakfield 18/12/06

Oakfield 26/10/05

Oakfield 12/05/05

Oakfield 08/11/04

Oakfield 07/06/04

Oakfield 04/09/03

Oakfield 19/06/03

Oakfield 30/07/02

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

CARE HOME ADULTS 18-65 Oakfield Easton Maudit Wellingborough Northants NN29 7NR Lead Inspector Sarah Jenkins Unannounced Inspection 14th August 2007 09:00 Oakfield DS0000012876.V346776.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 Oakfield DS0000012876.V346776.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. Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakfield Address Easton Maudit Wellingborough Northants NN29 7NR 01933 664222 01933 664333 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) Oakfield (Easton Maudit) Limited Vacant Care Home 18 Category(ies) of Learning disability (18), Mental disorder, registration, with number excluding learning disability or dementia (8) of places Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No one falling within category MD may be admitted into the home where there are eight persons of category MD already accommodated within the home. 18th December 2006 Date of last inspection Brief Description of the Service: Oakfield is situated on the outskirts of the village of Easton Maudit. The home is registered to provide care for 18 service users with a learning disability, up to 8 of whom may have additional mental health needs. All accommodation is in single bedrooms spread over two floors. The home has a minibus, a people carrier and a car at its disposal. People living at the home can attend day care services provided in the same building. The home is set in a rural location, on the outskirts of Easton Maudit. Within the grounds there is land on which service users look after animals that belong to the home, with support from the staff. There is a pleasant outdoors seating area overlooking the open countryside. The home is owned by Oakfield, and is a registered charity. A board of trustees and directors provide oversight of its operation. The basic fee, which includes access to the day care service, is £947. However there are additional individual charges, which are agreed at the time of the initial assessment, dependent on the specific care needs of prospective service users. These are not detailed in the Service Users Guide as they are arranged individually. This information was current at the time of the inspection. Information about the home in the form of the Service Users Guide and Statement of Purpose is available from the Manager although these are to be updated. The most recent published inspection report is available from the home or on the Internet. Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting three service users and tracking their care through meeting with the service user, a review of their records, discussions with the care staff and observation of care practices. The Inspector visited during the morning, in order to observe the routines and meet with the staff. Two inspectors visited, Ms Sarah Jenkins and Mrs Kathy Jones, and the inspection site visit at the home was undertaken over a period of approximately six hours. Service users have learning disabilities and thereby some have communication difficulties. Some service users have additional mental health needs. Establishing their choices and informed decisions is dependant to a large extent upon observations of their apparent satisfaction with their daily routines and the quality of their interactions and communication with staff. The inspection was conducted with the assistance of the Acting Manager and other staff from the organization. The Annual Quality Assurance Assessment has been submitted, and feedback forms have been returned. In total the inspector received 8 forms from service users and 12 forms from visitors and relatives. Comments were mixed and included praise for the “good” home and its “caring” staff; an indication that the home was “a happier place” recently, and questions (from two relatives/visitors) about whether the training and skills of staff were adequate. Some service users raised issues about the extent to which they were enabled to make decisions about their lives. What the service does well: Staff were observed to be alert and responsive to service users perceived needs and there was a high commitment amongst them to provide a full and caring service to residents. The staff support an interesting, stimulating and enjoyable lifestyle for service users, which includes access to hobbies that they have, and work with the animals cared for at the home if they wish. The general environment is conducive to a good lifestyle. There is much information in records, and evidence that staff try to ensure that the records support good practice. There was evidence that records enable investigation and cross checking of information. Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The improvements that have been initiated should be ongoing. Some areas detailed on this report need to be prioritized. In particular a properly qualified and experienced staff team needs to be fully established and maintained. The training and supervision of staff is central to the protection of service users and their rights. The homes processes for dealing with challenging behaviours and safeguarding adults, both need to be developed, and service users care plans should inform and support professionalism in these areas. Healthcare at the home should be reviewed to establish whether good healthcare is being consistently delivered, and whether records accurately reflect the quality of the care. Medication should be further reviewed, in particular the use of placebo medicines. There needs to be strong leadership and overview of practices in the home. This should include the organizations support of a Registered Manager (yet to be appointed) through the Regulation 26 visits. There needs to be better focus on outcomes for service users. Without proper input to these areas there is a danger that the full spectrum of service users needs may be met erratically, with variable quality, or poorly. Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 7 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. Oakfield DS0000012876.V346776.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 Oakfield DS0000012876.V346776.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users needs and aspirations are assessed and service users are enabled to make an informed choice about their admission to the home. EVIDENCE: No new service users have been admitted for some time, there are no vacancies at the home. The admission policy was reviewed and the assessment and admission process were discussed with the Acting Manager. From this limited evidence it was apparent that flexible arrangements would be made in accordance with prospective service users needs and wishes and that the home would strive to gather all relevant information from various sources including carers, prior to any new service users admission. The Acting Manager was advised that the Statement of Purpose and Service Users Guide need to be updated and that progress should be made towards providing various documents at the home in user friendly formats. Oakfield DS0000012876.V346776.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 poor. This judgement has been made using available evidence including a visit to this service. Resident’s individual needs and choices may be identified but are not always fully understood in context, nor thereby properly accommodated. Staff do not always respond appropriately to service users behaviours. EVIDENCE: Service users have care plans that are accessible for staff to use. The care plans reviewed had relevant information on them and contributed towards some consistency of care. However some information had not been recently reviewed and was out of date, and some important and relevant areas of care were not always identified on the care plan. In one instance where there was a lack of information on the care plan about a service users hygiene routine and habits, the inspector received contradictory information from different senior staff about this. Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 11 There was a lack of sufficient detail in care plans as to how service users challenging behaviours were to be responded to by staff, and from records and discussion with staff it was evident that practice is not always sufficiently consistent to provide good outcomes for service users. For example a care plan detailed that a service user was to be restricted in movement to and from the dining room at mealtimes if their behaviour was disruptive, there was no detail as to the method by which this should be achieved. In the care plans staff were directed to refer to the homes “physical intervention policy” which gave only generalized guidance, and in turn referred to the “Department of Health guidance”. When asked, a senior staff member was not aware of what this guidance was or how to access it. Some notifications received from the home since the last inspection are indicative of possible poor practice. There may also be training needs among staff in the area of recording factual information clearly. Discussions with staff revealed good intentions towards assisting service users. However there is some inexperience among some staff and some lack of knowledge about service users behaviours or needs, which leads to the unnecessary restrictions on service users choices. This lack of staff training and experience was discussed with the Acting Manager and may also reflect on how service users are enabled to take responsible and reasonable risks. Some risk assessments had not been appropriately updated. Advice was given on the need for awareness about the impending Mental Capacity Act and how this may impact on both practice and records at the home. At the time of the inspection service users were seen to be generally confident in their routines and expressed general content with the care they received at the home. The Inspector did not observe any staff dealing with challenging behaviours although there was evidence in records that several service users present such behaviours. Oakfield DS0000012876.V346776.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): 12,13,15,17 Quality in this outcome area is good. Service users enjoy their daily activities and are enabled to live active and stimulating lifestyles within a supported environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are offered interesting activities at the day centre run by the home, the Inspector visited this on the day of the inspection and met with some service users who had just started their daily activities. Service users are also supported in their leisure activities. Within the grounds of the home there is a small animal farm that had two pigs, two Shetland ponies and a donkey, service users help to feed and care for the animals, with staff support. Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 13 Some service users spoke enthusiastically to the Inspector about their love for animals, and clearly enjoyed this activity. Several service users commented positively about their activities in the feedback forms. Service users are encouraged to integrate with the local community; regular outings to local public houses and places of entertainment were documented in the service users care plans, and records of communication with families and family contact were seen in the individual care plans. Service users rights in the larger community are recognized and there was evidence that staff are alert to issues of discrimination and report any problems appropriately to the Acting Manager. The weekly food menus seen demonstrated that varied, nutritious meals were provided. The service users participate in choosing what is to be included on the menus in advance and within the daily menu individual needs and choices of foods are provided. Catering staff were fully aware of service users who had food allergies and food intolerances, and of service users food likes, dislikes and dietary requirements. A choice of breakfasts was provided including a cooked breakfast for those who wanted one. Evidence from observations of service users attending the activities provided, and from discussions with both service users and staff showed that service users are enabled to live active and stimulating lifestyles. Service users showed an enthusiasm for the trips, and a wish for even more! Standard 16 was not reviewed at this inspection in view of the findings under the outcome section “Individual needs and choices”. Oakfield DS0000012876.V346776.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 adequate. This judgement has been made using available evidence including a visit to this service. The physical, emotional and healthcare needs of service users are identified and generally well met by the staff at the home, although records do not always evidence good outcomes for service users, and there is a need for further management review by the home. EVIDENCE: The staff were observed to provide support to service users, in a respectful manner. There was a homely atmosphere and the service users were relaxed and friendly with each other. Within the care plans seen, there was generally detailed information for staff to follow on the individual service users personal support requirements. From discussion with staff however it was apparent that the information was not always properly updated and that there may be some inconsistencies in practice. Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 15 All of the service users were registered with local General Practitioners, and records were available within the care plans of visits to the doctors, optician, dentist and chiropodist. Unfortunately some records were not working for the purpose intended i.e. to promote consistent care and follow up through the history of healthcare needs and treatments, and to evidence prompt response to issues arising. The Acting Manager was advised of two instances of service users health care issues that did not appear from the records to have been properly followed up. The medication system was sample checked and found to be generally well managed although there were some issues that need improvement. For example some PRN (as required) medications had not been signed for on the Medication Administration Sheets, although the Acting Manager was able to track back and demonstrate that these had been given. Some medicine stocks were not being used in the correct rotation (i.e. the oldest tablets first). There were also issues of practice in relation to administering “placebo” medicines and a lack of procedure or evidence as to how these were used. Medication profiles were not kept properly up to date to serve as individual histories of medication prescribed. Oakfield DS0000012876.V346776.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 adequate. This judgement has been made using available evidence including a visit to this service. Although there is reported progress and improvement, and evidence that there is an increased commitment to dealing professionally with this area of outcomes for service users, there are still some areas of shortfall that it is important to progress. Service users cannot yet be fully confident that their needs and rights will always be fully protected. EVIDENCE: Staff showed themselves to be caring and have good intentions towards the service users in their care. They indicated that they would treat service users as members of their own families and report abuse. It was evident that they wish to stand up for the rights of service users, as far as they understand those rights. More experienced staff recognized the subtle ways in which service users rights may be undermined and spoke of how they worked with staff in practice and in supervision to increase their knowledge and understanding. Some staff are fairly inexperienced in working with people with learning disabilities and may have no other experience of working in care than what they have gained at Oakfield. The Inspector discussed safeguarding with a sample of staff and found that they did not seem confident about their knowledge in the area. There was evidence in records that not all staff have received sufficient up to date training. The lack of staff training and awareness of the nuances of abusive practice, is of concern, especially so as there is a Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 17 lack of guidance and instruction to staff in dealing with service users challenging behaviours in the care plans. Most staff have recently undertaken training in dealing with challenging behaviours. Advice was given on consolidating this training through further discussion in staff meetings, and through enabling easy access to information to refresh their knowledge. Further training is needed for staff in the area of “Safeguarding” i.e. the protection of the service users in their care. There was evidence of a tardy response to a safeguarding allegation, i.e. an allegation that abusive practice had occurred at the home. Although the investigation, when undertaken, was judged by the Adult Protection Meeting to be full and thorough, action to fully protect service users prior to the investigation, had not been initiated sufficiently promptly by the responsible persons. The Directors of the home are currently concluding the investigations into two complaints, one of which includes a safeguarding issue (see above). Oakfield DS0000012876.V346776.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. The service users live in a safe, clean, comfortable and homely environment. EVIDENCE: Service users have access to a range of areas including the day centre facilities on site. The home is furnishing and decorated in a homely style, and within the communal areas there is a range of media equipment available for service users such as satellite television, books, games, CD’s, DVD’s and videos. There is access to a pleasant outside area, which was not fully reviewed at this inspection, although service users were seen to be enjoying access to the animals. Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 19 Service users showed pride in their bedrooms, which were individualised, and decorated to a good standard, having good quality soft furnishings, personal pictures, ornaments, personal CD’s and TV’s. The kitchen was clean and tidy; the Acting Manager confirmed that refurbishment work to the main kitchen is to take place in September 2007. All areas sample checked by the Inspector were seen to be clean and well maintained. Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 20 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): 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be confident that staff are sensitive, good willed and wish to provide a caring and effective service. Professionalism is sometimes lacking through the lack of sufficient training and supervision for staff and this can compromise outcomes for service users. EVIDENCE: There were sufficient staff on duty at the time of the inspection to meet service users needs. Staff interviews revealed that staff felt that the staffing of the home was generally appropriate and matched to service users needs although there were current vacancies that put a bit more pressure on staff. The Acting Manager was involved in interviewing prospective new staff on the day of the inspection. There is a rota of “on call staff” and evidence from discussion that staff can be called in and arrive quickly. The Inspector discussed the recruitment process with staff who have been appointed since the last inspection and a full and thorough process was Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 21 described that was evidenced in records. Advice was given to the Acting Manager of the need to evidence that staff who have the “pova first” check but not yet the full Criminal Record Bureau check, are properly supervised. Staff training was discussed with the Acting Manager and reviewed through the records and discussions with staff. It was evident that although staff feel they have had a lot of relevant training recently there are still considerable training gaps and thereby shortfalls in the maintenance of sufficiently trained and experienced staff team on duty in relation to the complex needs of the group of service users. Essential training should be delivered to all staff as soon as possible, this should include training in the specialist skills required to meet service users needs. Records should evidence the overview of staffs’ individual training needs, how these are met, and when update or refresher training is due. Where staff undertake specific procedures such as the administration of certain non-oral medications, under the guidance of community health staff, there should be evidence of their training and authority to undertake these procedures on their files. There was some evidence discussed with the Acting Manager of a lack of cohesive teamwork on some shifts and some “niggles” between staff that would not be conducive to good teamwork. There was evidence of the need for strong professional leadership for staff, and effective supervision at the home in view of some of the lax practices identified in records in the months preceding the inspection. For example advice was given that a staff member, who had been identified, as having made a potentially serious error in respect of administering medications, had not had their performance in this respect monitored sufficiently promptly. (This matter is now being properly investigated and responded to). Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. In the absence of a registered manager, the registered provider and staff team have tried to ensure that standards have been maintained, but there is a need for the home to appoint a Registered Manager and a general need to develop up to date professional knowledge and practice in several areas. EVIDENCE: Currently the registered managers position is vacant, the Acting Manager, was supported by a full time administration assistant and had the responsibility for the day-to-day running of the home. Standard 37 has been given a score of 2 (standard almost met), however this is not a reflection that the Acting Manager Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 23 lacks the ability to manage the home, the scoring reflects the standard not being fully met due to the lack of a registered manager being in post. There was evidence through discussion and review of the records that there has been a period of unsettlement at the home since the last inspection. Morale among staff has been mixed and training shortfalls and lack of sufficient direction and supervision of staff have undermined good practice at times. There has been a lot of work done by the Acting Manager to bring about improvements but there is still some way to go to fully meet the Standards. There was no evidence of Health and Safety shortfalls at this inspection except in respect of areas already identified in other parts of this report. For example when processes for dealing with challenging behaviour is not made clear to staff in care plans, staff, in their inexperience, may breech legislation and guidance. Medication processes must be fully professional to protect service users. There has been no recent full Quality Audit. Staff have received questionnaires but there has been a poor response in returning them (11 returned out of 48 sent out). The action points identified from the fuller survey undertaken by the home in January 2006 e.g. the use of more appropriate formats for service users, have not been responded to or developed. Regulation 26 visit reports are very brief and do not evidence sufficient input by the visitor, to establish an informed opinion of the standard of care at the home as required by Care Homes Regulations 2001. Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 24 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 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 1 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 2 x x 3 x Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 25 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 YA6 Regulation 15 Requirement Timescale for action 30/10/07 2 YA6 15 3 YA32 18 4 YA37 8 Individual service users care plans and risk assessments must be fully reviewed to ensure that information therein is properly up to date and that service users are receiving appropriate care. There must be sufficient 30/10/07 professional guidance in care plans for staff to respond consistently and effectively to service users diverse health and welfare needs including challenging behaviour. Staff, including any agency staff, 30/10/07 must have the competencies and qualities required to meet service users’ needs in order that they are properly safeguarded against poor practices. The Commission for Social Care 30/09/07 Inspection must be notified of the arrangements being made to appoint, and submit an application for, a Registered Manager. Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 26 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 YA7 Good Practice Recommendations The ways in which service users rights to make decisions about their lives are supported should be reviewed. The range of decisions available to service users and the capacity of individual service users to make their decisions, should be looked at with a view to improving this aspect of their care. Records should properly evidence that service users healthcare needs are being fully met. It should be possible to track the response, and the dates of the response, to service users identified healthcare needs. Medication profiles for each service user should be properly maintained. The management of the home must demonstrate that staff deemed to be trained and experienced to deal with medication matters, are undertaking their duties responsibly and effectively. Staff training and supervision needs should continue to be fully monitored and responded to, to ensure service users are receiving high quality professional care and responses from staff. Care should be taken to ensure that the response to any issue raised as a safeguarding concern is sufficiently prompt to fully protect service users. A full and up to date matrix of training required or due for renewal in relation to individual staff should be developed to identify the necessary training for staff, to enhance the management of rotas, and to ensure National Minimum Standards are met. The Management of the home needs to be secured through the registration of a Manager; and the support of management through effective regulation 26 visits during the ongoing process of change and development. 2 YA19 3 4 YA20 YA20 5 YA23 6 7 YA22 YA35 8 YA37 Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Oakfield DS0000012876.V346776.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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