CARE HOME ADULTS 18-65
Oaklands 87 Burton Road Derby Derbyshire DE1 1TJ Lead Inspector
Rob Cooper Unannounced Inspection 1st May 2008 10:30 Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Oaklands Address 87 Burton Road Derby Derbyshire DE1 1TJ 01332 242770 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) oaklands.derby@craegmoor.co.uk Parkcare Homes (No2) Ltd Manager post vacant Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Parkcare Homes (No 2) Ltd is registered to provide personal care for service users of both sexes whose primary needs fall within the category mental disorder MD. The maximum number of service users to be accommodated is 9. Date of last inspection 24th May 2007 Brief Description of the Service: Oaklands is a large detached house, situated within walking distance of Derby City Centre, shops and facilities. The Home provides assessment and rehabilitation for up to 9 people with mental health needs aged 18 to 65 years. People are supported to develop daily living and social skills and move towards more independent living. The Home has 7 single and 1 shared bedroom on the ground and first floor - access to the first floor is by stairs. There is a small garden area at the front of the premises. Parkcare Homes (No2) Ltd became the registered provider of Oaklands on 19 February 2007. The current weekly fees for this Home range from £821 to £1219 dependent on the individual service user’s assessment of need, by a health and/or social care professional. Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes.
This was an unannounced visit as part of the key inspection process – so that no one at Oaklands knew that the inspection visit was going to take place. The visit took approximately four hours through the middle of the day, with one inspector present. The methods used during this key inspection and visit were to visit Oaklands, where a method called case tracking was used; this involved identifying three service users and looking at their individual files and making a judgement about the quality of care they are receiving, and if their needs are being met. This was followed by a partial tour of Oaklands, looking at the activities on offer, and talking to two service users and three members of staff about the quality of the service, and their experiences of living and working at Oaklands. During 2007 the Commission for Social care inspection introduced an Annual Quality Assurance Assessment (known as an AQAA) as part of the inspection methodology, this allows care homes like Oaklands to self assess their service. Information provided by Oaklands helped to form the judgements in this report. We also sent out nine surveys asking for views and information to service users, nine to relatives and five to staff. Of these we received six back from service users, two surveys from relatives and none from members of staff, the surveys helped us with the judgements that we have made. Oaklands does not currently have a registered manager, as she has been promoted within the organisation. Therefore the acting manager Jo Scully provided much of the information during this key inspection visit. On the day of this inspection there were seven service users in residence. Prospective service users can obtain information about Oaklands from the care home, and this would include seeing previous inspection reports prepared by the Commission for Social Care Inspection. In addition information about Oaklands and the services it provides can be found at the following web site: www.craegmoorhealthcare.co.uk. Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: 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. Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Current and potential service users have access to detailed information about Oakland’s services. They receive a comprehensive assessment of their needs before the service is offered, which allows the service users or their families to make an informed decision about whether Oaklands can meet their needs. EVIDENCE: Both the statement of purpose and service user guide for Oaklands were seen during the inspection visit, with copies of both on display in the foyer. Both documents contained all of the information, which Care Homes Regulations say that they should, and provide service users and prospective service users with enough information to be able to make an informed choice about living at Oaklands, and the service on offer. Discussions with two service users showed that they had been given copies of the service user guide, and copies were seen in the service user’s bedrooms. In addition service users and prospective service users can visit the following web site at: www.craegmoorhealthcare.co.uk. Which also gives details of the services on offer, and has details about Craegmoor Healthcare (Oaklands’ parent company) and a web page about Oaklands itself. Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 9 As part of the case tracking process three service users were identified, and their files were seen. Each of the three files contained a formal assessment of need. There were a variety of different assessments, and different health care professionals had completed these assessments before service users had moved to Oaklands. The evidence showed that the information provided by these assessments had also been used to draw up the care plans. Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 67&9 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Service users at Oaklands have their needs assessed, and have an individual plan of care containing information about their needs, and risk assessments in place to support them in leading an independent lifestyle. EVIDENCE: Each of the service user’s files that were seen contained a plan of care, which identified personal goals and the service user’s needs and how to meet them. Documentation is being changed to a more person centred approach, and a number of examples were seen and the benefits of the new approach were discussed with staff. Care plans showed that Social Workers and Community Psychiatric Nurses were very involved in the care of the individuals, and care plans were being formally reviewed on a monthly basis. Each of the care files that were seen contained a “what I do” form, which had been completed with full involvement from service users, and had been signed
Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 11 by them to show their agreement. The emphasis at Oaklands is on rehabilitation, which means that service users agree to certain things in their daily lives. For example taking part in social or therapeutic activities, which will include activities such as attending college, or going to a local farm to help out, and the service users agree to this when a place is offered. There is a choice, and service users are supported in making their choices. Each of the service user’s files contained detailed risk assessments covering both specific risks that had been assessed for the individual, and more general risks associated with daily living. Service users had signed their risk assessments, and had been invited to add their own comments. For example one service user did not agree with the risk assessment, or that the risk actually existed, so they had written a comment to that effect across the bottom. Discussions with members of staff showed that they had been trained and understood the risk assessment approach to risks. Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 15 16 & 17 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Service users at Oaklands are offered a stimulating range of activities, and are offered a varied and healthy diet, while being encouraged to have an active and positive lifestyle. EVIDENCE: Discussions with two service users showed that they were leading very active lives. With one service user explaining about an expressive dance class that they attend, as well as art classes, cookery and also swimming at the local baths on a Monday morning. Evidence was seen that Oaklands have good contacts within the local community, and a high priority is given to positive daytime activities as this forms part of the individual’s rehabilitation programme. The dining room had a number of pieces of artwork on display, which had been completed by service users, and were a feature in the room. Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 13 Oaklands is situated on a main road close to Derby City centre. Service users make use of a wide range of local facilities, visiting pubs and restaurants, and taking part in community based activities, such as art classes and the green gym, which is a voluntary group working on local conservation projects and allotments. Oaklands do have their own vehicle to access the wider community, although discussions with service users showed that there is also a wider use of public transport. Discussions with the acting manager and consideration of Oakland’s statement of purpose indicated that the purpose of rehabilitation at Oaklands is firmly set in the community, and revolves around participation and inclusion. Service users at Oaklands are supported to have positive relationships, and this includes families and friends. Evidence was seen in service user’s files relating to relationships, and discussions with two service users showed that they had a wider social circle than Oaklands, with one service user saying: “I sometimes meet my friends and go to the pub for a meal.” In their service user guide Oaklands state: “The rehabilitation environment that Oaklands offers is about ‘real world’ issues and responsibilities. By this method we can continue to work towards a greater level of independence, tailored to your individual progress in the community.” Copies of cleaning rotas, and ‘kitchen duty’ rotas were seen, and discussions with both staff and service users showed that there was an understanding that service users would participate in the running of the home. Weekly group meetings in the house are a useful forum for discussing issues about cleaning, menus, and rotas. Discussions with service users prompted the following comments about the food at Oaklands: “It’s very nice, the same food as when I lived on my own, very good.” “Yes, there’s always two choices.” “The food’s good.” Evidence was seen that service users had been involved in both menu planning, and meal preparation. The kitchen was well equipped, clean and there were good stocks of fresh food, including fruit and vegetables. Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 & 20 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Service users at Oaklands have their health care well managed, and are supported in a positive manner by the staff. Medication is well managed at Oaklands. EVIDENCE: In every service user’s file that was seen there was a form entitles: “What I do” This outlined a daily programme of activities that had been drawn up with the service user’s involvement, and which they had clearly contributed to, and had signed at the bottom of the page. Evidence was seen in files that service users had commented on their care plans and risk assessments, and had added their personal thoughts in relation to risk assessments that they did not agree with for example. The service users who’s care files were seen, contained care plans relating to health, and showed clear evidence of input from health care professionals. A number of specific health care issues were identified for individuals, and these were all supported by care plans and recording systems to gather information.
Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 15 Discussions with two service users showed that they were registered with local G.P.’s, and if needed appointments were made, with staff support if required. Both service users said they had no concerns about their health, or health related matters. Boots the chemist provides Oaklands with their medication. An inspection of the storage, and booking in and out procedures showed that medication is handled safely and there is a clear audit trail for medication from the point of ordering to administration and/or disposal. Administration records were inspected and found to be complete. No resident at Oaklands currently selfmedicates. The emphasis at Oaklands is on rehabilitation, and moving on to independent living. This will mean that service users will be encouraged to take responsibility for their own medication, although at the moment, while service users are involved in the process, and evidence of that was seen, no current service user has reached that point of independence. A recommendation made at the last key inspection in respect of written protocols for PRN (when required) medication has been met, and copies of these were seen in service users files. Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Service users at Oaklands are safe, and feel their views are listened to and acted upon. EVIDENCE: Oaklands have received one complaint since the last key inspection in May 2007. A review of this complaint showed that they had been dealt with in line with Oakland’s complaints procedure. Both service users who were spoken with said they knew who to speak to if they were unhappy, and wanted to make a complaint, and both said they thought the complaint would be taken seriously and acted upon. Evidence was seen that staff receive training in safeguarding adults, this training is aimed at raising staff awareness of abuse, and through raising the issues, offering service users greater protection against abusive practice, while also teaching the staff the correct policy and procedure to follow if abusive practice is found. Oaklands operate a two year refresher for all staff in respect of this training, and this was supported by documentation seen during the inspection visit. A copy of the ‘No Secrets’ document related to protecting those in care from abuse was available in the office, together with Oakland’s safeguarding adults policy. Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Oaklands is a clean, safe, homely and comfortable care home, with good quality fixtures and fittings to enhance the lives of service users. EVIDENCE: A partial tour of Oaklands showed it to be comfortable and well maintained. Two service users were asked about the building, both said that they had comfortable bedrooms, with everything that they needed and that they liked living there. In their AQAA Oaklands said: “The unit meets fire and environmental health standards. The home is comfotable and homley, with heating and lighting at a comfortable and appropriate level. There is space to sit outside and a well maintained pond area built by service users and staff.” During the inspection visit, Oaklands was found to be clean, and smelt fresh. Cleaning schedules were seen, as well as evidence of service user involvement in routine cleaning of the communal areas as well as their own bedrooms.
Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 34 35 & 36 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. A competent, well-trained and supervised staff team that has been professionally recruited to support the service users at Oaklands. EVIDENCE: A review of the staffing rota and staffing levels at Oaklands showed that there were enough staff currently employed to meet the resident’s needs. Staff are employed through the day, with one member of staff sleeping in over night and available should the need arise. Two service users were asked about staffing levels, and they both said that they thought there were enough staff employed to meet their needs. In their AQAA Oaklands commented in relation to staffing: “We have a low turn over of staff ensuring continuity of care. We have reliable and regular bank staff and it is extremely rare that we use agency staff.” Three staff files were seen, to check if they contained all of the information that would show that staff had been recruited in a safe manner – in that applicants had to fill out an application form, provide two written references
Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 19 and undergo a Criminal Records Bureau check. A review of the documentation showed that the recruitment process had worked to protect service users. Discussions with three staff members about their recruitment showed that they had undergone pre-employment checks, and had not started working until those checks had been completed. In their AQAA Oaklands commented in relation to staff recruitment: “The Craegmoor Support Centre make sure that all checks are completed before staff begin work.” A review of the staff training records showed that Oaklands does have a training plan for its staff, and that there are staff training courses planned for the coming months. The records showed that staff were receiving the skills training to be able to do their jobs, and discussions with three members of staff supported this view, and provided evidence of the different training courses staff had attended, including training in the mandatory areas – fire, food hygiene etc. In addition the majority of the staff have National Vocational Qualifications (NVQ) to level II and above (the majority at level III). The care industry considers NVQ to level II in care to be the basic qualification for staff working in residential care. It is recommended that a minimum of 50 of the care team are NVQ qualified, and the staff team at Oaklands have achieved this figure. Oaklands has a system in place for supervising its staff. This relies on staff receiving formal supervision with the manage. Formal supervision offers staff support and guidance in carrying out their work, and is seen as an essential management tool in residential care. Three members of staff were asked about formal supervision and everyone said they were receiving formal support and supervision on an eight weekly basis, which was supported by the documentation on file. Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 & 42 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Oaklands is a safe, well managed, and organised care home, with good recruitment and quality assurance systems in place. EVIDENCE: Currently Oaklands do not have a registered manager in post, and discussions with the acting manager identified that the post will be advertised shortly. A requirement made at the last key inspection in respect of the registered manager undertaking NVQ IV training is currently not applicable. Oaklands has a quality assurance system, which relies on questionnaires being filled in by service users and relatives twice a year. Copies of the questionnaires were seen together with evidence that the questionnaires had been evaluated, and an action plan produced. In addition Oaklands hold
Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 21 regular weekly service user meetings, and minutes were seen. Craegmoor also have a national forum called ‘Your Voice’ where service users from around the country can come together to discuss issues, and service users at Oaklands are involved in this national forum. A range of different health & safety records were seen, including the fire safety records – weekly tests, emergency lighting tests and extinguisher maintenance records, and the Control of Substances Hazardous to Health (COSHH) records, all were found to be correct and up-to-date, which evidenced that the service users and the staff are living and working in a safe environment. Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 22 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 24 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 Oaklands DS0000069564.V364101.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!