Inspection on 30/04/08 for Oakfield

This inspection was carried out on 30th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oakfield 26/09/08

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 28/09/2008.

CARE HOME ADULTS 18-65 Oakfield Easton Maudit Wellingborough Northants NN29 7NR Lead Inspector Ansuya Chudasama Unannounced Inspection 30th April 2008 11:00 Oakfield DS0000012876.V363508.R02.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.V363508.R02.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.V363508.R02.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 Manager post 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.V363508.R02.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. 14th August 2007 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 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. Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 5 Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This home has 0 star rating and this means that the people using the service receive a poor service. Two inspectors went to the home without telling any one that they were going to visit on the morning of Wednesday the 30th of April 08. This was the first time we had visited the home and the staff showed us around the home. We spoke to the staff and the manager. We talked to some of the residents, and looked at information about policies and procedures, which tells the staff how to do things in the home. We looked at the training that they do to look after the residents. We also talked to the home about concerns that were highlighted to the commission for Social Care Inspection (CSCI). 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 how the young people and staff living in the home got along together. We were concern about some of the things that we had seen during the inspection and we wrote an urgent letter asking the home how they were going to sort this out. The people living in the home are called ‘residents’ as this is what they are referred to in the home. The report will refer to people using the service as residents. We would like to thank the staff, and the residents for their time in helping with this inspection. This inspection report should be read alongside the National Minimum Standards for Younger Adults. What the service does well: These are some of the things that we saw and the young people and the staff told them about. • Oakfield The residents like their room DS0000012876.V363508.R02.S.doc Version 5.2 Page 7 • • • • • • • • They like cooking and three residents were observed cooking with staff on the day of the inspection. They like sport and going out shopping They like the staff and this was observed on the day They like to care for the animals in the farm The staff like working at the home. They go on training to help them understand the needs of the residents They like the manager They like doing activities with resident. What has improved since the last inspection? What they could do better: The home should ensure that: • • • • • • • • • • The financial procedures for residents are satisfactorily maintained and recorded in the home. Individual contractual agreements are drawn up for resident’s that details the costing of their placements. Care plans are reviewed to reflect accurate care intervention required and identified in needs assessments. Residents are involved in their care plans All bathroom doors shut on their rebate. The resident’s monies are not pooled collectively in bank accounts. All the medication used in the home for residents must be prescribed and not used from one bottle. Arrangements must be made to ensure safeguarding referrals are made when incidents occur that adversely affects the health and wellbeing of a resident. Structured activities must be undertaken to ensure that satisfactory stimulation and motivation is gained for all residents. Have enough staff so all residents can do activities and go out Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 8 • • • • • • • Ensure that advocates are involved in helping residents to make decisions about their care Staff sign and date important documents. Update care plans after having a residents review Residents are actively supported to help plan, and prepare meals Residents should be enabled to maximise their independence in regards to having choices to become more independent Provide information in user friendly language that is easy for residents to understand. Provide person centred planning to meet resident’s needs. 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.V363508.R02.S.doc Version 5.2 Page 9 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.V363508.R02.S.doc Version 5.2 Page 10 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 “People who use 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.” Some systems were in place that ensured people received sufficient information about the home but further development was needed to ensure individual contractual agreements details the conditions of placement, as a result users rights and best interests could be compromised. EVIDENCE: The Service User’s Guide did not have all the information stated in the standard. Although the home had upgraded this document to incorporate the ‘Widget’ format this was still not suitable for all of the people who live at the home. The manager did not inform us if any of the residents used the Widget format. A copy of the complaints procedure and information about how to contact the local social services and the CSCI office was not available in the guide. Information about key contract terms covering admission, occupancy and termination of contract was also not available. Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 11 The Statement of Purpose read showed that it discussed information about Oakfield and of another sister home. Each statement of purpose needs to be individualised to meet individual homes. The information on organisational and staff structure was difficult to understand as this incorporated Oakfield and Homestead. Schedule 1, of the Care Homes Regulations states that the ‘organisational structure of the care home’ needs to be recorded. The name and address and relevant qualification of the registered provider were not available. The number, relevant qualifications and experience of the staff working at the home was also not available. (See concerns and complaints section in this report). The Statement of Purpose has a policy on ‘emergency/crisis’ at Homestead, the home have said that this document also refers to Oakfield. The home has not produced a document specific to each home. At the last inspection the acting manager was advised to review both documents and to produce various documents in user-friendly formats. The information on admission process did not state that the home undertook a needs assessment of potential users. The home has said that the company policy document on referral and admission states that the referral information should include a comprehensive needs assessment. However the care plan documentation inspected showed that all people using the service received a comprehensive assessment but the assessment seen did not state who had completed this process or when the assessment was completed. There was also no information recorded to show if the person living in the home and their family had been involved in the assessment process. Evidence showed that families and potential users had visited the home prior to their admission to the home. The home talked about providing a day service unit but it did not state what activities are provided so potential users know what is available at the home. The information in the statement talks about the aims and objectives of the home but this is not stated in the document. There was also no information discussed regarding the arrangements made for respecting the privacy and dignity of the residents. The information on fees charged, what they cover, and the cost of extras was not recorded. The Home produces generic contracts between themselves and residents but these were not individualised to show how much each resident paid towards the cost of their placement. The contracts were not in a format that the residents would understand. There was no evidence to show that the contents of the contract had been discussed with the residents. The name of the resident was not recorded on this contract but the home and the representative of the resident had signed the form. The finance manager informed us that local authorities undertook contracts and the home did not have individualised contracts with individual users of the service. In the contract it also stated that ‘after the initial period of three months, all placements are to be considered long term & a residents contract issued’. Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 12 Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 13 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 “People who use 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 homes care planning system in place were not clear to adequately provide staff with the information they need to satisfactorily meet the resident’s needs. EVIDENCE: We inspected three residents care planning documentations using case tracking methodology. In general peoples behaviours were recorded along with daily activities. However the records we inspected suggested that the intervention identified from the needs assessments were not carried forward into the care plan documentation. It was evident that the needs assessments were the only documentation available as a care plan. The documentation inspected did not show any evidence that the residents were consulted or that Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 14 choices were being offered in daily activities. There was no date or a signature on the important documentation such as assessments, care plans seen in the files inspected. This was discussed with the manager at the inspection. The information read was also confusing, as we could not establish what staff should do if one person suffered an epileptic seizure. For example in one persons file it was recorded that an ambulance should be called 15 minutes after an epileptic seizure while other documentation stated five minutes. We discussed this with the manager who stated that it was three minutes. Another person’s care plan seen had one name on the documentation and the same person was referred to as another name on the medication chart. These inconsistencies of information could result in care staff providing intervention incorrectly and putting residents at risk. Activity records were seen in pictorial formats. But again there was no evidence to show that the residents were consulted and when the records had been reviewed. The service user guide stated that ‘residents take part in the planning of their own plans’ and the plans are reviewed twice a year’. The national minimum standard states that the care planning document is reviewed at least every six months and updated to reflect changing needs. The contract stated that ‘Oakfield undertakes to update the resident’s care plans every six months in consultation if necessary with outside agencies or specialist workers and to make it available in a format that can be understood by the resident (this may include the use of graphics or sign language or visual presentations. However this was not happening. The evidence showed that there was no information to show that the resident or their representative or an advocate had been consulted when implementing the care plan. The service user guide stated that ‘family and social workers will be asked to come to your reviews which will be held every 6 months’. However evidence and talking to the manager showed that these reviews were being held on a yearly basis by the funding authorities. One person’s file showed that the funding authority had carried out the last annual review for the resident. However another annual review should have been carried out by the home in January 08 but this had not taken place. The objectives set out from the review were not incorporated in the care plan and did not state how these were to be met. For example it stated that the staff were going to teach one person to understand money. However there was no information in the care plan to state how this goal was to be achieved with measurable time scales. The home ‘says this is to encourage the person to learn, and understand money, and its values, this is ongoing. This is not meant as a goal, it was, as with all residents a learning. Reading both the care plan and the review notes, Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 15 I see that if you put a time scale on it, it would be in fact impossible’. However the contract for the residents says that ‘the resident shall be assisted and encouraged to achieve a degree of personal independence where possible and work towards personal goals’. The care plan documentation inspected did not detail users cultural needs which, cover life style, preferences, and not just religious needs, as a result the home failed to meet the resident’s diverse needs. The menus seen showed that choices were provided for meals on a daily basis. However there was little evidence to show that the residents were involved in the planning process of the meals and the menus. The home had an industrial like kitchen where residents were not allowed access to the kitchen. As a result this removed the ethos of homeliness for the people living at this service and detracted from their ability to maximise their independence. The home says ‘residents are involved with the meal and menus; we can evidence this through the residents meetings where service users request their favourite foods. This point was brought up at the last Board of Directors meeting within the staff selection and the Board of Directors decided then that all resident’s favourite meals would be served at least once a month. On the weekly menus it will show whose favourite meal it is’ The home undertook risk assessments but most of the information read showed that the information was recorded as guidelines. The home needs to follow the 5 steps to risk assessments. The risk assessments looked at did not follow this process. This was explained and discussed with the manager at the inspection. Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 “People who use 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.” People are not offered sufficient opportunities for activities, based on their individual needs and choices, as a result they were not able to maximise their independence and develop personally thus their lifestyle choices were limited. EVIDENCE: On the day of the inspection we were informed that seven residents had gone out to an adventure park. There were some people who did not wish to participate in this activity and stayed at the home. One person was observed wandering around the car park on his own when we arrived at the home. There was building work being carried out at the side of the home. The home Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 17 says ‘staff were aware of this, as were the contractors’ who know the service user. It is detailed within’ the persons care plan that they like to watch the contractors whilst working and staff are vigilant at this time’. The contractors were busy working and they would not have been able to ensure that the person was kept safe. Some people were observed sitting on the settee in the corridor and in the main lounge. One person was seen sitting on the floor near the front door when we arrived at the home. The same person was also observed sitting at the same place when one of the inspectors went out in the afternoon, and she was concerned that she nearly hit the person when opening the front door. This was discussed with the manager who stated that the person liked sitting on the floor near the door. However she agreed to have staff encourage the person to undertake an activity. A risk assessment for sitting near the door had not been carried out for this person. When we departed eight hours later, the person was still sitting near the door. The home stated that this resident ‘enjoys and likes to sit on the floor’, which the person ‘chooses to do on a regular basis, this is their ‘choice’. It was stated that the person ‘had not sat on the floor for the whole 8 hours but had attended meal times, tea breaks and had been in her bedroom while the inspectors were there’. Observation in the activity room showed that two staff were doing canvas stitching. Two of the people seemed uninterested in the activity. The opinion of the inspectors was that the activity might have been too difficult for some of these people. The peoples files case tracked showed that they had an activity programme for the week and there was no evidence to show when these were being reviewed. The documents lacked the consultation process of how choices were being made. So there fore it was not clear if the people had chosen the activities. The residents spoken to enjoyed feeding and looking after some of the farm animals with support from staff. Staff informed us that more staff were needed to do activities with the people. The people also told their families that due to staff shortage, they were not able to go out to shopping. This was also mentioned in the resident’s questionnaires. Staff were observed doing cooking with three residents as part of day activities, however one person did not want to participate with this activity. The person was not provided with another activity and was seen wandering around the house. The information read in the care plan document stated that the person had to be stimulated by staff to minimise the person’s behaviour. Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 18 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 “People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.” Inadequate systems were in place to ensure people using the service are protected with regard to the administration of medication, as a result people could be put at risk . EVIDENCE: The guidelines seen for the residents for personal care and routines were good. The health care records inspected suggested that the residents visited the opticians GP, nurse, chiropodist, psychologist and other health professions One person’s notes read showed that incidents that needed to be recorded on the behaviour chart were not always recorded. This did not give an accurate picture of the person’s behaviours and therefore the person’s needs were not being met. The behaviour chart seen was not always fully completed with the Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 19 information required and most of the time it was not signed by staff. There were no systems in place to monitor that the forms were being completed properly. Information read in the people using the service files showed that some of the incidents concerning them were not reported in the accident/incident book. These incidents were also not monitored by staff. The questionnaires completed by families stated that they wanted more feedback about the medical care needs of their family member. It was stated that they did not always get this information. (See individual needs and choices for health). We looked at the medication, storage and administration of the Home. This was satisfactorily maintained with the exception of homely remedies and painkillers. The manager said that vitamins were given to one resident who always complained of pains. However this was concerning because the manager should seek the advice of the GP and the outcome should be recorded to state that the GP has agreed for the home to carry out this practice. This was discussed with the manager at the inspection. Evidence showed that painkillers and multi vitamins were pooled together and administered to any resident that complained of pain. It was stated that this was recorded in a book but not on the medication chart. The manager stated that she audited this on a regular basis but no evidence was found of this monitoring. The manager was informed that all medication given to users on a regular basis should be prescribed by the GP. This was also to ensure that the person’s health needs were being monitored and met. Satisfactory records of receipt and disposal of all medicines were maintained. Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 20 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 “People who use 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 homes procedures for reporting incidents and safe guarding issues that affect the wellbeing of the resident are not satisfactory, as a result residents were put at risk. EVIDENCE: A complaint was made to Social Services on the 5th of March 08 and copied to the home and us. This complaint was investigated by Social Services under the safe guarding procedures. The ‘service user complaints policy for Oakfield’ was inspected. The information was difficult to understand. Evidence showed that it was not written in a suitable format that the residents could understand. The home said that the ‘complaints procedure is available for all residents in widget’ format but a copy of this was not given at the time of the inspection. The service users guide had no information recorded about how to make a complaint. There was also no information recorded in the files of the residents to state that staff had discussed the complaints procedures with them. The policy did not state how to contact the Directors of the home or the funding Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 21 authority or the CSCI if the complainant did not want to speak to the homes manager or staff but wanted to discuss issues of any concern to these bodies. The contract for residents says’ should the resident require any additional assistance or wish to formally complain about his or her treatment, an advocate will be appointed to assist the resident to represent his/her concerns to the registered manager or the directors’. This information was not recorded in the complaints procedure. The policy had information for dealing with oral and written complaints in different ways. For making an oral complaint it stated that after talking to the complainant and the ‘suggested plan of action is not acceptable to the complainant then the manager or member of staff should ask the complainant to put their complaint in writing to Oakfield and give them a copy of the complaints procedure’. However for written complaints it stated that written complaints are held within 28 days and ‘all complaints ‘are responded to, in writing’, and dealt with promptly, fairly, and sensitively’ by Oakfield Limited. However discussion with a complainant stated that they had received an acknowledgement of their letter of complaint but they had not received a full written explanation of their complaint at the time of carrying out the inspection. This was 55 days after they had made a complaint. The manager was asked at the inspection for the information regarding how the complaint was investigated by the home. It was stated that the information was not available in the home and the Directors of the home were dealing with this. The home says ’This complaint was made directly to NCC, CSCI therefore it was down to them to respond to the complainant’. Evidence showed that management had not been sensitive when dealing with the complainant’s complaint. The complainant had received an email from the finance manager stating ‘As a one off I stayed an extra 4 hours last evening to put together this information, my time spent was unpaid’. The words ‘an extra 4 hours last evening’ and ‘my time spent was unpaid’ was also highlighted to emphasis the message to the complainant. This was discussed with the finance manager who stated the message sent was a ‘gesture of good will’ to let customers know that they do this and did not think any thing wrong with the email sent to the complainant. We spoke to a relative to find out if they knew how to make a complaint. It was stated that they would speak to the home, however they had not been given a copy of the complaints procedure but they stated that they were told that a copy was available at the home. We looked at the financial records of two residents. The information was very difficult to understand. The information was not recorded in their individual separate book in a chronological order to state how the money was being Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 22 spent. Evidence showed that most of the peoples financial information was being recorded on the same statement as some of the other residents. Financial statements asked for certain dates were not provided for one of the people that was case tracked. One of the residents statement looked at showed that many errors were made and this was discussed with the finance manager who stated that it was her assistant who had made the errors but the person was no longer working at the home. The error of one family being charged 100 pounds for residents holiday was discussed with the manager. It was agreed by the manager that if the family had not questioned this money, the family would have ended up paying this money. The home stated ‘ the problem with the holiday money came about because as a home we say in our contract we will provide all residents a holiday up to the cost of £200 but this is a requirement of standard to provide one but not a regulation, this is the reason for the error’. However the finance manager gave us different reasons. When we were at the inspection the home did not inform us that other residents had also been charged £100 for holiday. We were informed by Social Services of this information. The contract for people using the service states that the home will pay ‘one weeks holiday per annum to the value of £200 per resident’. The statements seen that were sent to families did not provide details of the expenditure but had the total amount that was spent by the people living in the home rather than being individually identified. The homes petty cash vouchers seen had the date and the amount given to the residents. But this did not state exactly how the money was spent and sometimes they were difficult to understand. Most of the time it had initials of the other residents living in the home. Some times the vouchers were not signed. We were also informed that some of the people had money in the same account. The manager was informed that all residents must have individual accounts in their own names. We were informed that the staff took people using the service to eat out in the evening and so therefore they did not have their evening meal in the home. The manager was asked if the home paid for this meal or the residents did. The manager did not know the answer and confirmed that she did not get involved with the finances of the residents. The finance manager managed this. This information was not recorded in the statement of purpose or in any other documents. An immediate requirement was issued on the day of the inspection regarding how the finances of the residents were being managed by the home. One of the people’s file read stated that the person was not able to write however evidence showed that the person was signing the petty cash vouchers and other documents. The information also stated that the person did not Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 23 understand the value of money. But evidence showed that the person was given money but there were no monitoring systems put in place to check that the person was safe guarded from any potential abuse. None of the people in the home had lockable draws where the residents could safely put their money for safekeeping. There were also no risk assessments undertaken for people looking after their own money. Record seen suggested that all staff received Safeguarding training. It was therefore concerning that there were 35 recorded incidents since January 2008 that adversely affects the health and well being of the residents were not reported under SOVA (Safeguarding of Vulnerable Adults) procedures. Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 24 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 “People who use 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 home’s premises were adequately decorated to provide comfort and safety for people using the service but it detracted from a homely environment for people to live in. EVIDENCE: We were given a tour of the premises. The stairs leading to the first floor had a lounge, and a kitchen combined with a dining room. It was stated that 9 people used the dining room. The cooked food was brought from the down stairs kitchen for the people to eat. However there were no risk assessments seen for this activity. The armchairs in the lounge were mostly different colours and did not feel homely. Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 25 The home also had their offices based in this area and another office was based down stair near the stairs. Some of the people had nice furniture in their room. However there were some rooms that needed decorating and had furniture that was old. We were informed that the people had chosen the colour of their bedrooms. The manager stated that she had not recorded this information in the person’s file. A person using the service was asked if they had chosen the colour of their room, it was stated that they had not done this but asked for the colour to be changed to blue. We were informed that there were lots of places in the home that needed decorating. The home says ‘that we have a rolling upgrading programme for the home’. The carpet on the first floor landing had silver tape put across to cover a hole in the carpet. We were informed that the separate toilet and a toilet with bathroom were being ‘done up’ soon. A wall near the cleaning cupboard needed plastering and the manager stated that this was being done. The lounge area downstairs needed to be more homely. We were concerned that the people resting in the lounge were not able to relax fully because the people who wanted to access the main kitchen and the craft area had to walk through the lounge area. On this inspection the external environment was not inspected. The day service unit was visited, two staff were doing some craft work with three people. One of the rooms in this area was used for staff events and did not feel like an activity area. Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 26 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 “People who use 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 staffing levels in the home were inconsistent and as a result the people’s care could be compromised. EVIDENCE: A copy of the care staff timetable for working at the home was given to us. The timetable was difficult to understand because it did not have the hours the staff worked at the home. This was discussed with the manager who stated that she knew what hours the staff worked. The names of the staff were not recorded in full and the timetable also had staff information working at the sister home. The timetable also did not state if the staff were permanent, agency or day care staff. Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 27 The home says ‘the care staff work in teams and the team staff listing is kept with rota. There is a separate sheet showing the hours staff work, who are not full time together with their names and if they are sessional or not. As it is a company staff timetable, why is it necessary to put every staff’s full name every week or month onto the rota sheet?’ The staffing levels for the home were discussed with the manager who said that the home runs effectively with either 4 or 9 staff. And it was understood that when four staff only staffed the home, the manager felt residents were adequately cared for with the exception of having no activities. Staff spoken to stated that more staff were needed in the home. The people using the service also stated that they could not go out on activities due to staff shortage. Evidence also showed that the finance manager helped out on the caring side of the residents care. One of the reviews read and discussed showed that the finance manager had attended the whole ‘residents review’ and was able to provide information about their care. Staff spoken to on the day of the inspection said that they enjoyed working at the home and had satisfactory levels of training. The records seen suggested that a large number of staff had NVQ level 2 or 3. 14 staff had enrolled to undertake this training in Sept 2008. We were not sure if the training information included the staff from the sister home. The training records of all training undertaken by staff were requested, but copies of these were not provided. We were not able to evidence all the training the staff had taken. We were concerned by some of the information read from the staff questionnaire. It stated that the home had staff meetings and ‘problems are raised but no one takes notice’. It also stated that ‘people were working against each other’ and ‘not having the basic information to do my job’ Records seen showed that not all staff were receiving regular supervision. One member of staff said that they had not received supervision for a while. A new member of staff spoken to had received induction to do the job. However the format seen in the staff file suggested it was very limited and basic in nature and presented in the form of a checklist. Staff files seen showed that the home was following the recruitment procedures. However the manager’s file was not in the home. It was said that this was held with the directors. Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,42 “People who use 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 systems put in place for the monitoring of the home were not robust and service users do not benefit from a well run home. EVIDENCE: The acting manager had been managing the home for 18 months, although not registered. Staff spoken to on the day said that they found the manager approachable and they were able to communicate with her. Evidence showed that the acting manager was unable to provide evidence of monitoring systems put in place to ensure that the home was efficiently managed. Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 29 The questionnaire read from the staff survey stated that the Board of Directors ‘did not take on an active part at least not as far as staff are concerned’. It also stated that there ‘seems to ‘be lack of communication between directors, management and staff’. We were also concerned that management had not followed their procedures for dealing with complaints. The complaints policy also needed reviewing to ensure it meets the standard. The policy was not clear, and not available in formats suitable for the people for whom the home is intended. The policy was not explained to each person in a format they would understand. It did not provide information of other agencies that the complainant could refer to. Not all families of the residents had been given a copy of the complaints procedure, complaints were not being responded to within 28 days. The home had not followed their safeguarding procedures to make referrals to the SOVA team. The incidents and accidents were also not being recorded in the homes legal forms and not all regulation 37 notifications were being sent to the CSCI. The homes policies and procedures needed reviewing to ensure that they meet the standard. A the last inspection it was stated that Regulation 26 visit reports did not provide sufficient information about the standard of care at the home as required by Care Homes Regulations 2001. This was still not happening. There has been no recent full Quality Audit undertaken of the home. The home had received the questionnaires from families, staff and residents. However it was not clear if the resident’s questionnaires were completed with an advocate or with staff from the home. The questionnaire seen for people using the service was not in a user friendly format. The manager was at present analysing the information. Evidence showed that the questionnaires were combined with the sister home. We were therefore unaware of what information belonged to Oakfield and what information belonged to the sister home. The home did not have an annual development plan. The accident and incident sheets were inspected for residents. Evidence showed that the staff were not always completing the forms when accidents occurred. Also some times two accidents would occur and only one would be recorded. This was discussed with the manager. The risk assessments needed reviewing and undertaking to ensure that the people using the service and staff were safeguarded from potential risks Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 30 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 2 2 2 3 2 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 X 1 X 1 2 X 2 X Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 31 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 Requirement Each service user must have an individual written contract with the home so they are aware of their rights and conditions of their stay. The care plan must state 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 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 of activities must be developed to meet the needs, capabilities and wishes of all service users to engage them in fulfilling activities. The information recorded on meeting all health needs must be recorded accurately to ensure that the service users are not DS0000012876.V363508.R02.S.doc Timescale for action 30/06/08 2. YA6 15 30/07/08 3. YA9 13 30/06/08 4 YA12 12,16 30/07/08 5 YA19 12 30/05/08 Oakfield Version 5.2 Page 32 put at risk. 6 7 YA19 YA20 12 13 (2) All staff must ensure that all accurate information is recorded in resident’s behaviour charts. Medication must be administered safely and meet the requirements set out in the ‘Handling of medicines in social care’ guidance The registered provider must follow the complaints procedure for any complaints made. The complaints policy needs reviewing to meet the standard, and it needs to be clear and easy to understand The financial records 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. 11 12 13 YA23 20 16-(2) l 13 All service users must have their own accounts in their own name for their personal money. There must be facilities for residents to keep their money and valuables in a safe place All allegations and incidents of abuse must be reported to the Local Authority Safe Guarding team to ensure the safety and protection of service users. The staffing rota must be reviewed to ensure that there are adequate numbers of staff on duty to meet the needs of service users. Staff working times must be DS0000012876.V363508.R02.S.doc 30/05/08 30/05/08 8 9 YA22 YA22 22 22 30/05/08 30/05/08 YA23 10 17-(2) Schedule 4 07/05/08 30/05/08 30/05/08 30/05/08 YA23 YA23 14 YA33 18 30/06/08 15 Oakfield YA33 18 30/06/08 Page 33 Version 5.2 16 YA36 18 17 YA37 21 18 YA39 24 19 YA40 17 20 YA42 37,17, recorded with the role and names of all staff in full, the rota must be individualised to the home Staff must be provided with regular supervision so their practices can be monitored to improve the quality of care to service users. 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. All incidents and accidents must be recorded in the home and the CSCI must be informed of this by sending a regulation 37 Notification. 30/06/08 30/06/08 30/07/08 30/07/08 30/06/08 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. Service users should actively be supported to help plan, prepare and serve meals in the home. DS0000012876.V363508.R02.S.doc Version 5.2 Page 34 2 YA17 Oakfield 3 YA35 Provide a training matrix of all training undertaken by staff and this should also include training to be undertaken. 18 Oakfield DS0000012876.V363508.R02.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V363508.R02.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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