CARE HOME ADULTS 18-65
Oaklands 183 Faversham Road Kennington Ashford Kent TN24 9AE Lead Inspector
Lois Tozer Announced Inspection 16th September 2005 09:30 Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 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 DS0000065339.V249312.R01.S.doc Version 5.0 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 DS0000065339.V249312.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Oaklands Address 183 Faversham Road Kennington Ashford Kent TN24 9AE 01233 632381 01233 632381 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) CareTech Community Services (No.2) Ltd Miss Maria Burchett Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th September 2004 Brief Description of the Service: Oaklands is a detached property which offers care and support to a maximum of 4 service users who have learning disabilities. It is situated in the Kennington area of Ashford, with access to a local shop and pub a few minutes walk away. The town of Ashford is accessible by the public bus service and by using the homes dedicated vehicle. The home is owned and operated by Caretech Community Services Limited. Day to day management is conducted by Miss Maria Birchett. The home is set in its own ground, with parking for 3 vehicles to the front and a large, secluded garden with patio space to the rear. The home offers 3 communal rooms, two lounges and one dining room. Two bathing and W.C. facilities are available, on the ground and first floor. All bedroms are registered for single occupancy. The main ethos of the home is the promotion of greater independence in skills and social development. Activites are organised to develop practical skills both within the home and in the community. There are a wide range of leisure opportunities available. Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory announced inspection took place on 16th September 2005 between 09.30 and 14.00, and was assisted by Miss Maria Burchett, manager, two of the people living at the home and two staff members. During the inspection, the area manager popped in to offer support to the manager. The following methods were used to conduct this inspection; discussion with 2 residents, discussion with 3 staff members (the third coming on duty as the inspector was leaving). brief contact with a third resident; observation of the staff supporting residents; discussion with the manager; documents included – pictorial and written shift planner, medication administration records and storage; individual support plans, risk assessments, goal plans, review notes, health and safety documents and a tour of the premises. Through discussion and the comment cards returned by residents and their friends / relatives, feedback indicated that life was to the residents liking and the staff team, supported by the manager, were striving to promote personal development. Some comments indicating how people felt about Oaklands are as followsResidents; ‘I am planning my holiday, X has had his, I am looking forward to it, its going to be fun’. ‘Still being helped with not smoking, (Is that your choosing?) Yes, its better for me, and I want to stay quit’. ‘We have done lots of gardening this year, we are going to get handing baskets’. ‘Everyone still takes turns to do jobs, see, you can see who’s job is on the day by this rota’ (showing picture board of photos of household jobs). ‘Yes, I am still enjoying life here, we have nice staff’. Staff said; ‘I am loving my job, the induction was very good, the focus is on the people who live here and what we can help them achieve. The staff support is excellent’. ‘I have no concerns about the safety and support of the residents, we have good training, and the support from the manager is always there.’ Three relatives and friends comment cards were returned, all were satisfied with the overall standard of care provided and felt the home was friendly, enabled privacy and kept (where appropriate) in touch with important information. Two were aware of the complaints procedure, the third was not. Additional comments were; ‘ I am very pleased with the way X is being looked after & cared for. In fact, I couldn’t wish for better attention X gets from the staff. I can be rest assured that [Key worker] is the best for X. The staff are angels’. ‘There are always sufficient staff on duty, but not always regular staff, they have to use bank’. Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection?
Environmentally, the ground floor and bedroom carpets have been replaced and new fridge and freezers have been purchased. The smoking room (now not being smoked in) has been redecorated. Although medication training is still outstanding, the practice, policies, and procedures protect the individuals and training provision has been identified and is imminent. The manager has achieved registration with the C.S.C.I.
Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 7 Recruitment procedures have been revised and updated centrally, and the manager has benefited from recruitment, selection, disciplinary and grievance training. 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. Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 The service user guide and statement of purpose are informative and contain the right sort of information to help make a decision about the home’s suitability. Individual assessments are thorough, although have not been tested for many years. Needs and aspirations are met. Trial visits would be required to make sure new and existing service users could get along with each other. Individual statements of terms and conditions are clear and are written in plain English. EVIDENCE: The statement of purpose and service user guide offers the reader a good reflection of the services and accommodation offered. Pictures and symbols are available where required. Initial assessments have not been tested for many years, however the policy and procedure is robust, as is the assessment tool used. Support from senior management is available to assist where required. The terms and conditions of residency are laid out in the contract and residents are supported to understand the content through regular talk time discussions, reflection by example and teaching plans. Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9. 10 Residents benefit from support and development plans that are reflective of their individual needs and aspirations. Responsible decisions are actively encouraged, as is participation in all aspects of home life. Risk assessments are in place to enable greater independence within an assessed framework, work to minimise risk and increase opportunity is evident. Residents know that sensitive information is kept safe and confidential. EVIDENCE: Care, goal and support plans were very well documented and were being reviewed on a regular basis. Residents are involved in the development of their goals and are aware of the content of support plans. Staff actively encourage residents to make decisions that have a positive outcome for the individual. Staff were seen to support people in a discreet, respectful manner, allowing them to take the lead in activities. Every resident is fully involved in the day to day running of the home. Domestic duties are rotated so that everyone has a chance to develop their skills; the rota is displayed photographically, and is therefore accessible to everyone. Risk assessments are in place for known risks and work to reduce risk and increase opportunity takes place. The reviewing system of all documentation above was efficient and effective and had input from a range of professionals concerned with individual persons development and wellbeing. The storage of information was
Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 11 safe and secure and access to sensitive information was on a need to know basis. Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Personal development is a key feature of the home. Activities are created and developed with resident’s full input and focus on ordinary life development. Every resident has regular opportunity to be part of the local community. Leisure activities are frequent, are chosen by resident’s and are much enjoyed. Relationships are supported very well. Rights and responsibilities are built into the day-to-day running of the home. A good budget for food is in place and residents have a major say in what goes on the menu. EVIDENCE: Each individual plan has been written in consultation with residents and promotes their responsibilities as people sharing a home. Development of negotiation skills (featuring anger management, sharing and turn taking) is an important feature and has been well supported with positive outcomes for all. Wide ranges of activities are supported, both within the organisation and using community facilities, such as college, leisure centres, and other public amenities. Risk assessments have enabled people to develop greater independence and community participation in the local area. A wide and varied menu is in place, the choices have been suggested by the residents, and staff help the purchase of healthy choice, fresh fruit and vegetables and support individuals stick to healthy eating plans. All three residents giving
Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 13 input said they liked the food. Residents have unrestricted access to the kitchen, and are encouraged to regulate their drink and food intake, which has been successful. All residents have developed practical skills in this area. Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 The individual plan is explicit in describing the exact personal support requirements needed. Physical and emotional health is very well supported and recorded. Medication training is still needed, but the outcomes to the management of medication are, at this point safe. A recommendation that individuals are supported to develop a greater degree of self medication skills has been made. EVIDENCE: Two residents said that they have personal care help when they need it, indicating it is done in a respectful manner that is right for them. Where individual requirements are required to be exact, this is set out in explicit form in the individual plan, reducing the level of anxiety that could be experienced by the individual. Physical and changing healthcare conditions are well monitored and professional support and advice is sought without delay. Records are very well kept and reflect the sensitive and dignified support being given. Medication training remains outstanding, but is said to be imminent. The outcome to the residents does not seem effected, and the policy, practice, and procedures employed by the home are clear and understood. Documentation is well completed and each resident knows what medication they take (by colour, shape or name). A greater level of self administration and management, within a risk assessed framework and teaching plan, is strongly recommended.
Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Resident’s views are listened to and acted upon. Adult protection protocols and procedures are well understood by staff and resident’s and are put into action where needed. EVIDENCE: Staff understands individual’s method of communication and key worker’s establish trusting relationships with individuals. Regular (weekly) 1:1 time is offered, and the outcome of these meetings is documented. Where problems have been highlighted, immediate action, following robust procedures, has taken place. All residents feel safe and listened to. Adult protection protocols are understood by the manager and implemented where required. Staff benefit from adult protection training and discuss policy and procedure at staff meetings. Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 The home is comfortable and safe with a homely atmosphere. Bedrooms meet individual needs and lifestyles and promote independence. There are sufficient toilets and bathrooms. Sufficient shared space freely is available. No resident requires specialist adaptations. The home is clean and hygienic. EVIDENCE: There is an ongoing maintenance and improvement programme in place, planning permission for further improvements is currently being sought. Communal areas are decorated and furnished to a good standard and residents are fully consulted regarding redecoration. The house is very much an ordinary domestic dwelling. The kitchen is reasonably sized, and has an adjoining larder. Laundry facilities are separately located. Residents are encouraged to furnish their rooms with items of their choosing, developmental work to supply a more suitable sink is ongoing. Rooms are decorated as each individual wishes. Staff continue to sleep over in the lounge, but residents say this is not a problem (and a fold out bed that looks like a chair has been purchased). The house does have problems with damp in a variety of places. This has been recognised by the company, and work to limit the effect on residents has taken place. The long-term improvement plans do not have any firm date for completion, and some areas identified by the manager need rapid attention.
Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 17 Maintenance attention has been unavoidably delayed due to unforeseen circumstances, but should be forthcoming in the near future. Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Job descriptions make clear the roles, responsibilities and limits of the support worker. All staff benefit from a LDAF and ‘in-house’ induction. Residents lives are full and active, indicating adequate staffing levels. The recruitment procedure and policy has been reviewed to reflect legislative changes. Other than medication training, the provision is very good and meets service needs. All staff have regular 1:1 supervisions. EVIDENCE: Through the job description and a well implemented induction process (Learning Disabilities Award Framework accredited), new staff were able to say that they understood their job role. In discussion, the general social care councils codes of conduct had evidently been supported and the staff member had a clear understanding of the support needs of the people in the home. Staff took a supporting role and encouraged residents to do tasks with minimal support, offering encouragement and praise as needed. Much casual, relaxed support was evident and this clearly suited the residents. Residents said they liked staff, and minutes from their meetings showed that new staff had been well accepted. All staff are encouraged to undertake NVQ training, with 3 working towards it at present. A wide range of relevant training has been received and forthcoming training plans are in place. Recruitment practices have been reviewed in line with the change to legislation and are robust. All staff benefit from 1:1 documented supervision. Staff said that they were well supported and could access the manager easily.
Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 The manager is competent and runs the home well. A service-user focused ethos is evident and is promoted by the manager through staff supervision, training and meetings. An array of quality assurance tools are used to develop the service in the way residents wish. Health and safety of all persons is well supported. EVIDENCE: The manager has now achieved registration under the Care Standards Act 2000, and has continually demonstrated competence in her role. A clear audit trail of consultation with residents is in place, and a variety of methods (pictures, symbols, 1:1 contact, group meetings) are used to ensure everyone has a say. Relatives, friends, and professionals are encouraged to give feedback and say how they feel the service is doing. Regular, unannounced visits take place from senior management and a minimum annual audit by an independent person takes place to monitor the service against the company’s own expectations. All service certificates and health and safety checks are up to date. Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3
3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 4 4 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 3 3 N/A 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 4 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Oaklands Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X 3 X DS0000065339.V249312.R01.S.doc Version 5.0 Page 21 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 YA20 Regulation 13 (2) Requirement (PREVIOUS REQUIREMENT) Staff who administer medication to have training from an appropriately qualified source that covers the work they are required to undertake. Timescale for action 01/01/06 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 YA20 Good Practice Recommendations Residents be supported to take a greater part in the management and administration of their medication. Oaklands DS0000065339.V249312.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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