Inspection on 26/09/08 for Oakfield

This inspection was carried out on 26th September 2008.

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

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

Other inspections for this house

Oakfield 30/04/08

Oakfield 14/08/07

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Oakfield Oakfield Easton Maudit Wellingborough Northants NN29 7NR     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ansuya Chudasama     Date: 2 6 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Oakfield Oakfield Easton Maudit Wellingborough Northants NN29 7NR 01933664222 01933664333 rm.oakfieldltd@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Oakfield (Easton Maudit) Limited Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: 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. Date of last inspection Brief description of the care home 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 Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 0 18 8 Brief description of the care home 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 home. Both documents need reviewing to ensure that all the information required as stated in the National Minimum standard for younger adults is available in the documents. It was stated at the last key inspection that these documents were being updated but this had still not been done. The home has developed limited user friendly information for current and prospective service users. The most recent published inspection report is available from the home or on the Internet. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home without telling any one on the morning of 26th of September 08. This was a key inspection to look at how the home had met the last requirements we had made when we visited the home on the 30th of April 08. We spoke to the staff, the manager and some of the people living in the home. We looked at information about policies and procedures, which tells the staff how to do things in the home. We asked the training that staff do to look after the people living in the home. The manager showed us around the home. We looked at information about some of the people who live in the home to find out how their needs are being met by the staff. This is called case tracking. We watched Care Homes for Adults (18-65 years) Page 6 of 35 how the people and staff living in the home got along together. We were concerned about some of the things that we had seen at the last inspection and asked the home to take action to meet the requirements, however these had not been met at this inspection. We wrote an urgent letter and informed the manager that we would be collecting evidence that may be used during any enforcement action we may take. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 35 Care Homes for Adults (18-65 years) Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The contract for the people living in the home is not individualised and does not protect their rights for staying at the home. Evidence: The Statement of Purpose and Service User Guide has not been reviewed since the last inspection. People have comprehensive assessments of needs when they move into the home. There have not been any new admissions recently but there is a vacancy at the home so care should be taken that new assessments are signed and dated by the assessor as highlighted in the previous inspection. We looked at two peoples files. Copies of contracts were seen in both of them, they were generic and not individual to the person involved. They were signed and dated by the homes representative and the person moving in. They have not been changed or amended since the last inspection when a requirement was made that they must be made individual to each person and contain the required information as set out in standard 5. Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: The contract states that people are responsible for paying for meals when they eat out. However meals are included in the cost of staying in the home and this should be taken into account when the cost of eating out is calculated so that people dont pay twice for their food. The home must calculate the cost of each meal provided by the home so that that amount can be deducted from what people pay when they eat at restaurants, cafes and have take away meals. The contract must be amended in this area to reflect that people will only be asked to pay the cost of a meal that exceeds what they have already paid for their food included in their fee. The home charges each person 40 pence per mile for using the homes transport. This information needs to be recorded in the contract so the person and their representative are aware that they will be charged for using transport provided by the home. We had received a letter from the home to state that they had written to Social Services and had given notice to terminate a contract of a person living in the home. The reasons given by the home was that it was due to the actions of a relative who had given money to a member of staff for activities for their son and the staff was told not to tell management. The letter from the home said that this action breaches both the companys policy and CSCI regulation. In the letter it also stated that the staff were aware that this was not within the companies policies and procedures. We asked the manager to show the policies and procedures for staff to follow when families give them spending money for activities for the people living in the home. The manager was not able to find these policies and procedures. The staff spoken to told us that they had not seen any policies or procedures about receiving money from families of the people living in the home for activities. Staff told us that when a family member gave them money for a person living in the home, they would inform the senior member of staff on duty and the money would be locked away safely in the office. The management in the home had inappropriately used the Care Standards Act regulations regarding the action they took to terminate a persons contract. This was discussed with the manager of the home and we were told by staff that the member of staff should have informed the senior staff on duty that they were given money for activities for a person living in the home. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans do not state how a person’s changing needs and aspirations and personal goals will be achieved to meet their independent living skills Evidence: We examined two care plans and found evidence that they have been reviewed and updated recently. However many of the concerns raised about the care plans in the previous inspection report had not been addressed. They were not signed or dated by the person drawing up the care plan so we were unable to ascertain when they had been reviewed. The care plans mention goals but there was no indication how the goals were to be met and there were no records of work done in working to wards them. The plans were not written in a way that the people in the home would find easy to understand. Records and guidelines were not always recorded in a way that was appropriate. People were referred to as being naughty and stubborn. One old document that referred to people in a similar manner had been incorporated in an updated care plan. It is important that the files are checked and that all inappropriate Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: or demeaning statements are removed. Staff must be given guidance on how to write reports and undergo training in this area. The manager talked about his plans to completely overhaul the way care plans are generated and presented. He intends to introduce a more person centered approach. We were told that the home has regular house meetings where people have an opportunity to take part in making decisions about food menus, activities and care plans seen talk about encouraging people to chose what they want to wear and when they get up at weekends. The manager has made arrangements with an advocacy service to become involved with the people living in the home and they will be invited to attend reviews and meetings to help and support people to make decisions about all aspects of their lives. Risk assessments are in place but have not been updated since the last inspection so has not been changed to incorporate the guidance given in the previous report. The care plans did not state how a person living in the home was helped to manage their finances. There was no evidence to show that the people living in the home had seen documents about how the home managed their finances. There was also no evidence to show that the people living in the home were supported to go to the bank to withdraw their own money. The homes finance manager managed the finances of all the people living in the home. Care Homes for Adults (18-65 years) Page 14 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The privacy and dignity of the people living in the home is not being maintained from people who use the day care provision and wander around the home with out the peoples permission. Evidence: Information taken from the Annual Quality Assurance Assessment tells us that people are given opportunities to attend adult education classes. Daily records show that people attend church services, go to the local gateway club, local shops and visit the local pub. The staff also told us that they take the people to the cinema, boat rides, bowling, and different adventure parks. We observed that one of the people living in the home was sitting on the floor near the door. This was observed at the last inspection. We discussed this with the manager of the day centre who informed us that the person did not want to go swimming and had not been for a long time. We Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: discussed what alternative options were being provided, and we were told that there were not enough staff on duty to do things with the person. The floor was hard and people opening the front door could have accidentally hurt the person sitting on the floor. We were informed that it was the persons choice to sit on the floor. We did not observe any staff encouraging the person to sit on the settee or keep them occupied doing other things. The day service was closed on the day of the inspection. The manager of the centre was sitting on a chair with another person who came from the community for day care, at the front entrance of the home. Due to the persons mood swings and feeling agitated, the day centre manager and the person spent the whole day sitting at the front entrance of the home. This meant that the people living in the home were not able to sit in these chairs. The Manager, staff and the Annual Quality Assurance Assessment refer to a day centre attached to the home that the people attend. However on further discussion and exploration of the premises it became apparent that the day centre was an integral part of the home. It is accessed through the homes main door and meals are served in the dinning room. People attending the day centre have free access to the main house during the day. The home offers day services to people living in the services sister home and people from the local community. This means that the people living in the home have people coming in and out of their home throughout the day. Staff spoken to said that these people wander around the whole house. The home must take action to ensure that the day care services do not impinge on the privacy of the people who live at the home. We were informed that staff are provided to run the day centre but on the day of the inspection it was not in use, the three people from the providers other home were not on site and the centre manager was working on a 1 to 1 basis with a non resident person in the main house. When the day centre is open, It was said that the people are offered a large variety of activities, but when it is not open during the day and in the evenings, and at the weekends there is little evidence that the people are offered meaningful in-house activities. Since the last inspection a rubberised safe surface has been laid in the garden so that people can play netball, football and basketball etc. People have maintained contact with their families and go on regular home visits, friends and family are welcome and are able to visit their family in the privacy of their own room, the Annual Quality Assurance Assessment says that people are encouraged to write letters and send postcards home. The majority of the people living in the home did not have net curtains in their bedroom windows to maintain their privacy and dignity. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: Drinking water fountains are available in the home, but the people are not given free access to snacks and food other that what is offered to them at set refreshment times. The main kitchen is large and industrial in style and people are not given access to it at all. When meals are not being cooked the people should be enabled to prepare snacks and light meals in the kitchen with support from staff. A discussion took place with the manager regarding using the kitchen area on the first floor for people living on this area to help them prepare meals. On the day of the inspection we observed that most of the people living in the home were having their meal in the upstairs kitchen with two members of staff supervising the them. However the majority of the staff were sitting in the main lounge with a few people living in the home. Care Homes for Adults (18-65 years) Page 17 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of the people living in the home are being met but further development is needed to ensure that risk assessment for seizures are detailed to address the peoples safety at all times Evidence: Care plans do record peoples needs and state how they should be met, but they were written in a task lead way rather than a person centred manner. For example one file contained a list of toiletries this person should use,and there was only one brand mentioned. This may have been the preference of this person when the list was written but it takes away the persons opportunity to explore options and new experiences and to make choices on a day-to-day level. There is evidence in the care files seen to show that the people are offered support for their physical and emotional health needs. There are records of doctors and hospital appointments and people have access to opticians, dentists, psychologists and other health care professionals. The behavioral charts were being completed but the detail was minimal. The charts need to be detailed so that health professionals offering Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: support and advice would be able to analyse the information captured. More care is needed in completing the behavioral, seizure charts. Seizure risk assessments are in place but they do not hold sufficient information. They must be more detailed and address the peoples safety when alone, and during the night. Measures must be put in place to keep people safe at all times. It is essential that staff know exactly what to expect when someone is epileptic. There are several people living at the home who have epilepsy. It will be a requirement that detailed guidelines are produced for everyone who has epilepsy that describes each individuals pattern; the triggers, any warning prior to the onset of a fit and what happens during and immediately after a seizure. The guidelines should also give instruction on the dangers to the person during a fit and how the staff should react. The staff spoken to stated that they had training on giving out medication. The manager confirmed this. The room the medication was being stored was very hot. There was a fridge in the room and some of the medication was kept in here. The temperatures were not recorded on a regular basis and evidence showed that the temperatures also varied each day. The room was too hot for us to carry on inspecting the medication. The Pharmacist inspector of the CSCI will further inspect this standard Care Homes for Adults (18-65 years) Page 19 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The financial records maintained for the people living in the home are not robust, there is no clear audit trail leaving people using the service open to financial abuse. Evidence: We were informed by the manager of the home that they did not deal with the finances of the people living in the home. We were told that the finance manager of the home dealt with this. At the last inspection requirements were made to make sure that the people living in the home had their own accounts in their own name for their personal money and there was a clear audit of how the peoples money was being managed by the home. The evidence we collected showed that peoples monies were combined in one bank account, which included everyones money, including monies of some people who dont live in this home. The homes records of money transactions showed individual totals for each person, these showed that some people did not have a positive balance within the pooled account so there fore the other people living in the home were subsiding their spending. We were assured that every six months interest accrued on that joint account is calculated and added to the individual totals, we asked to see records showing when the interest is allocated to the people and the finance manager said she could not find this information. Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: We asked for a bank statement concerning the pooled account and were given a copy of the last one dated 1st April 08 to 1st July 08, the statement showed that there had been no movement in the account apart from an interest payment on the 30th June 08. This indicated to us that this was not the account that peoples benefits were paid into so we asked the manager and he was told by the finance manager that the peoples benefits were paid into another account held by the home. A printout named Oakfield (Easton Maudit) Ltd Normal Activity, Resident Control Account was seen and confirmed this. The sheet is separated into sections with the peoples initials against them, including people living in both of the providers homes. This seems to indicate that all monies paid to people living in this house and a sister home are jointly paid into one account in the providers name. There is no indication or evidence to show that interest accrued on this account is passed onto the people the money belongs to. The evidence collected contradicts the assurances we have been given on several occasions that the peoples money is paid into one bonus savers account and interest is shared between all of the people having money in it. There are at least two pooled accounts that are in the companys name. The manager was issued with Code B notices under the Police and Criminal Evidence Act and was informed that we would be collecting evidence that may be used during any enforcement action we may take. We were informed by the manager that the last on going complaint had been resolved to the satisfaction of all concerned. When we asked to see the documentation concerning this complaint, the manager was unable to find the information. The complainant has contacted us regarding this concern and we are aware that the complaint has not been resolved. Care Homes for Adults (18-65 years) Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes premises have been decorated to make the environment comfortable however the facilities provided are not user friendly and do not promote the peoples independent living skills. Evidence: Peoples bedrooms are homely and comfortable; they were individual to the occupant and are nicely decorated. The communal rooms upstairs, a sitting room and a dining room/ kitchen have been newly decorated and furnished in a contemporary style to a high standard. The main corridors are light and airy with pictures on the wall and the floors are attractively covered. The handrail on the staircase is designed in a way that our fingers were painfully caught by the supports. The handrail should be replaced by one of a different style that will not cause injury to people using it. The dining room downstairs and the sitting room are very large with high ceilings and although they are well decorated they lack a homely atmosphere. To access the the day care service and the main kitchen and dining room, the people have to go through the main lounge. This does not provide a homely relaxing atmosphere for people using the lounge area. The main kitchen is also very large and industrial in design. This inhibits the development Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: of peoples skills, as they are not allowed to access the kitchen. People would benefit if the design of the kitchen was changed and consideration should be given to making it more home like and more accessible to everyone. In the interim the kitchen upstairs should be more fully utilised and people should be supported to take part in the planning, preparation and cooking of meals. It is also recommended that people using the service are encouraged to help lay and clear the dinning tables by the main kitchen and assist to wash up. The gardens are attractive and well planned, there is ample space by the lounge for alfresco eating and people are helped and encouraged to care for the animals the home keeps. We saw two ponies, a donkey and pigs. We have previously mentioned that a new rubberised surfaced has been laid so that people can take part in outside activities. A risk assessment needs to be undertaken for the fire exit door in the upstairs kitchen/dinning area. The people using the service can easily open the door and wander out doors unsupervised. The equipment on the escape route staircase needs to be kept clear. One persons toilet was on a platform and a risk assessment needs to be undertaken to ensure it is safe to use. Some of the bedrooms and bathrooms need signs on the door to identify the rooms for what they are. Care Homes for Adults (18-65 years) Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels for the home are not always sufficient to meet the needs of the people living in the home Evidence: One staff spoken to said that they had been working at the home for a year and they enjoyed their work and found the staff friendly and helpful. We were told that they were doing NVQ level 2 in care and they had a good induction and had read the policies and procedures of the home. We were told that they had supervision regularly and undertake training, which was said to be good. The staff working timetable looked at was difficult to understand. At the last inspection the home was asked to record all staff working times with the roles they performed and names of all staff in full, and individualised to the home but this had not happened. It was difficult to say what staff worked at the home and which ones worked at the day care service. The manager was issued with Code B notice under the Police and Criminal Evidence Act and was informed that we would be collecting evidence that may be used during any enforcement action we may take. The staff recruitment files seen showed that the relevant information required was Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: being obtained when recruiting staff. One file inspected showed that one staff started as the deputy manager of the home. The manager was asked to send a copy of all the training undertaken by staff but at the time of writing this report, this had not been received. Evidence showed when a person in the home do not want to undertake an activity an alternative option is not provided and we were told that the home is short of staff to undertake an activity with them. This was the case for a person sitting on the floor in front of the front door. We also observed other people in the home wandering in and out of the lounge into the front corridor of the home. Care Homes for Adults (18-65 years) Page 25 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the home showed commitment to improving the standards of care in the home but at present the home was not running in the best interest of the people living in the home. Evidence: The home had employed a new manager who had been at the home for four weeks at the time of the inspection. The manager said that they had worked as a registered manager at a residential care home for younger adults with learning disabilities. In the last 11 months the manager worked with a domiciliary care agency. We were told that Mr Ivor Roy the Chairman of the Board of Directors gave the manager a verbal induction. All induction and supervisions need to be recorded for evidence to show that that these meetings take place and the home is being monitored by management. We were not informed who was managing the service prior to the manager starting employment with the home. After the inspection the manager confirmed that there was a lot of work to be done but Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: he was confident about meeting the requirements and taking the home forward to improve changes for people with learning disabilities. The managers office was based upstairs on the first floor landing and away from the main building. We were told that when visitors visited in the past, they did not see the acting manager, as they were upstairs in their office. This was observed when we arrived and we were told that the manager was upstairs in their office. The finance managers office was based down stairs in the main building. It is recommended that the managers office be based down stairs so people living in the home and visitors have easy access to see the manager. The manager will also be able to observe and monitor what is happening in the home. Under Regulation 26 the organisation should visit the home at least once a month to monitor how the home was meeting the needs of the people. Evidence showed that since the last inspection only one Regulation 26 visit report was seen for the 7th of July 08. The information recorded in the report needs to be detailed to show how the home is meeting the need of the people living in the home, and the names of people spoken to needs to be abbreviated. The manager sent us information about a survey that has been undertaken in March 2008. We had seen this information at the last inspection. An analysis of the information collected had not been carried out. There was no action plan to show how the home was going to meet some of the concerns raised in the survey. The survey was not individualized to the home. The home also did not have an annual development plan. The homes policies and procedures did not protect people using the service from how their finances were being managed by the home. The staff recruitment files for one person showed that the person did not have a contract for the different roles performed in the home. The staffing rota was not sufficiently detailed to explain what hours the staff were working at the home and what their positions were in the home. Most of the radiators in the bedrooms of the people using the service and around the home did not have covers to protect the people from scolding them selves. A risk assessment is needed for carrying meals up the stairs to the first floor of the dining/kitchen area. The home was undertaking fire drills, fire alarm testing, and emergency lighting. The names of the people involved in the fire drill needs to be recorded for evidence. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: The home did not have a risk assessment of the building and we were told that the fire officer has not visited the home since 2005. It was recommended that the home contact the fire officer to arrange for the next visit. Care Homes for Adults (18-65 years) Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 5 5 Each service user must have 30/06/2008 an individual written contract with the home so they are aware of their rights and conditions of their stay. The care plan must state 30/07/2008 how the service users aspirations and goals will be achieved and describes any restrictions on choice and freedom; the plan should be drawn up with the involvement of the service user and their representative or an advocate. The risk assessments need 30/06/2008 reviewing to ensure that the five steps to assessing risks are recorded to minimise potential risk and hazards to service users. A planned varied programme 30/07/2008 of activities must be developed to meet the needs, capabilities and wishes of all service users to engage them in fulfilling activities. Medication must be administered safely and 30/05/2008 2 6 15 3 9 13 4 12 12,16 5 20 13 (2) Care Homes for Adults (18-65 years) Page 29 of 35 meet the requirements set out in the `Handling of medicines in social care? guidance To be inspected by the CSCI Pharmacist. 6 22 22 The registered provider must 30/05/2008 follow the complaints procedure for any complaints made. The complaints policy needs 30/05/2008 reviewing to meet the standard, and it needs to be clear and easy to understand All service users must have their own accounts in their own name for their personal money. 30/05/2008 7 22 22 8 23 20 9 23 17The financial records (2)Schedule 4 maintained for residents are not robust, there is no clear audit trail, leaving people using the service open to financial abuse An Immediate requirement was issued on the day of the inspection for an action plan to be submitted to CSCI by 7th of May 08 to inform CSCI as to how the home would meet the regulation. 07/05/2008 10 33 18 The staffing rota must be 30/06/2008 reviewed to ensure that there are adequate numbers of staff on duty to meet the needs of service users. Staff working times must be 30/06/2008 11 33 18 Care Homes for Adults (18-65 years) Page 30 of 35 recorded with the role and names of all staff in full, the rota must be individualised to the home 12 37 21 Robust monitoring systems must be in place to ensure that the service users are receiving a high standard of care and they are being safeguarded. Introduce quality assurance systems as specifies by this standard and regulation to measure the quality of care provided at the home. Ensure that the homes policies and procedures are specific to the home, up to date, signed and regularly reviewed. 30/06/2008 13 39 24 30/07/2008 14 40 17 30/07/2008 Care Homes for Adults (18-65 years) Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 5 12 Notice to leave must only be 30/11/2008 given to people in accordance with the terms of their agreement and when demonstrated through appropriate assessment that the home is not able to meet their needs. This is to ensure people are treated fairly and their rights protected 2 5 5 The contract must be amended to reflect that people will only be asked to pay the cost of a meal that exceeds what they have already paid for food included in their fees. · So people can better understand their rights and responsibilities of their stay, in addition it also needs to explain who pays for meals for users when they don’t have a meal in the home, and they have to eat out as 30/11/2008 Care Homes for Adults (18-65 years) Page 32 of 35 part of the activity provided by the home. 3 6 12 Written records maintained about the people living in the home must be recorded in a way that is respectful and maintains the persons dignity. This is to maintain the persons dignity 4 15 12 The people using the day service from the community must be provided with a seperate entrace to the day care service This is to maintain the privacy and dignity of the permanent people living at the home 5 19 13 Provide staff guidelines in how to manage a person who is having a seizure This is to help meet the needs of the people and keep them safe 6 19 13 The risk assessments for seizures must be detailed to address the peoples safety at all times This is to ensure that the people are kept safe 7 24 13 A risk assessment needs to be undertaken for the fire exit door in the upstairs dinning area This is to minimize the risk to people using the service and keep then safe 30/11/2008 30/11/2008 30/11/2008 30/11/2008 30/11/2008 Care Homes for Adults (18-65 years) Page 33 of 35 8 24 13 The handrail should be replaced by one of a different style that will not cause injury to people using it This is to ensure that people living in the home are kept safe 30/11/2008 9 34 17 All staff must have employment contracts when working at the home This is to ensure that they know what their rights and responsibilities of working at the home 30/11/2008 10 42 13 A risk assessment must be undertaken for taking hot meals to the first floor dinning room This is to ensure that the people carrying the food are kept safe 30/11/2008 11 42 13 The radiators in the home must be covered up so the people living in the home do not hurt them selves To protect people from hurting themselves 30/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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