Inspection on 18/08/05 for Oaklands

This inspection was carried out on 18th August 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oaklands 06/03/08

Oaklands 24/11/06

Oaklands 29/12/05

Oaklands 09/12/04

Oaklands 21/09/04

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Fairways

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

CARE HOME ADULTS 18-65 OAKLANDS 5 The Green Theale Berkshire RG7 5DR Lead Inspector Stewart Mynott Unannounced 18 August 2005 10:45am 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 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 Stationary 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 H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Oaklands Address 5 The Green Theale Berkshire RG7 5DR 0118 9305288 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Milbury Care Services Mrs Theresa Ann Bieny Care Home 6 Category(ies) of Learning disability (LD) registration, with number of places OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9 December 2004 Brief Description of the Service: Milbury care services ltd is a private company that is registered to provide care and accommodation for up to six adults who have a learning or communication difficulty. The accommodation is provided in Oaklands, a large, older-style detached house that is situated on the outskirts of Theale village. The home is within walking distance of local shops, churches, pubs and cafés. There are bus and rail services from the village to the towns of Reading and Newbury. A private drive at the front of the house provides parking space for several cars and there is a large garden to the rear of the property. Each of the Service Users has an individual bedroom in addition to use of the shared accommodation of the property. OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection during the day, which lasted for 4½ hours. The manager gave a full tour of the building. After this time was spent with the service users and staff on duty which included lunch and observation of every life at the home. Some of the service user and homes records were examined to support observations made during the day. 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. OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 7 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 standard(s) Standards 1 to 5 were not assessed during this inspection. EVIDENCE: OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 8 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 standard(s) 6, 7 and 9 Service users benefit from an excellent standard of care and risk planning which is underpinned with a person centred philosophy. Service users are supported to make decisions and be as independent as possible. EVIDENCE: Each service user has a daily care file and a more in depth file containing care plans, reviews and information about health. Two service users care records were examined in detail. In the care records is a document called “what is essential about me” this was compiled by the manager with staff assistance. It is presented in a clear person centred manner as if written by the service user and refers staff to important care documents to support the information recorded. The care plans for each service user are clear, easy to read and informative and are based on assessed needs. A senior support worker had regularly reviewed the care plans seen and progresses in regards to goals were accurately recorded. One care plan established the potential for one service users to self harm. The outcome focussed on positive behaviour. Staffs spoken to were aware of this plan. The assessed needs of each service user are also reviewed on an annual review, which includes the service user and a care manager. OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 9 Most service users do not communicate verbally. Further work in addition to comprehensive care plans include a communication book devised by the home manager. This clearly states how to communicate and interpretation of nonverbal actions and was viewed as excellent practise. The staff spoken to understand each service users needs and were able to explain communication methods in detail. During the inspection it was clear that service users are able to exercise choice, make decisions and were engaged by the staff team for all activities of daily living. Care records also demonstrated support needed to make appropriate decisions. Service users daily life and choices are also supported by comprehensive risk assessments. These were supportive to ensure all activities remained safe yet were not overly restrictive. There was a clear and simple audit of review of these documents. OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 10 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 standard(s) 13 and 16 Staff assist service users to enjoy daily routines that promote individual choice, independence and use local facilities in the community. EVIDENCE: The daily routine of the home was observed to be relaxed with service users having unrestricted access to the outside space and communal areas as well as spending time in private in their rooms. Staff were seen to interact well with service users and emphasis on the individuals routines were observed. Service users were enabled to assist with housekeeping tasks with staff support. During the inspection most service users had local activities organised at different times during the day in small groups, which included swimming and bowling. One service was supported to access the local shops and staff confirmed that service users are encouraged to spend time using the village facilities. OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 11 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 standard(s) 18, 19 and 20 Service users personal and health care needs are fully met by a knowledgeable and supportive staff team. Some inaccuracies with recording of additional medicine stock were noted in the homes medication records. EVIDENCE: Most service users are not able to communicate verbally and rely on staff to interpret their needs and provide personal support. Staffs were observed to clearly understand service users behaviour as well as their care and support needs. Staffs were seen to support service users in a professional yet relaxed manner. Each service user had a key worker and one staff member was clear in this role and the importance of continuity of support. Care records also detail individual support requirements as well as likes and dislikes and support needed by staff. Daily records were completed detailing personal care and daily routines and reasons for cross gender care when provided. One service users needs had changed and additional equipment was provided after professional assessments to support independence. Staffs were clear on how to use the equipment provided. Service users records in combination with discussion with the manager revealed each service user has full access to local NHS care facilities. Service users health is clearly monitored including an annual medication review. Two OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 12 accident reports for July were also examined and were appropriately followed up by the manager. The Manager explained how the homes medication system operated. Records for service users included assessments for using medications and appropriate records that detail administration of medicines. Risk assessments were also seen for each type of medicine prescribed within the home that detailed safety information as a quick reference. In addition there are further “medication stock records” that detail the amount of medication that are not stored within the Boots blister packs. Two service users paracetamol stock levels were checked and found to be less than that recorded in the medication stock records. Whilst it is clear medication is appropriately given and signed for on the MAR chart, the use and accuracy of these records must be reviewed. There are currently six staff members who administer medication and all have received training as detailed in staff training records. However staff may benefit from reviewing the homes policy and procedures to ensure accuracy of record keeping in relation to medicines. OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 13 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 standard(s) 22 and 23 Trained staff and comprehensive policies and procedures protect service users from harm. The home has a good complaints procedure, which is made available to service users their families. EVIDENCE: The home has a very detailed complaints procedure with clear guidelines for the home manager and staff dealing with investigation and resolution of complaints. There is also a pictorial complaints policy on display near to the lounge. In addition this is also available in the service user guide. The complaints book was examined and there had been no complaints since the last inspection. The current service users would find it difficult to complain directly as identified by staff and the manager. The manager actively sends an up to date complaints leaflet to all service users relatives on an annual basis with a survey to review the services provided at the home. The home also benefits from detailed procedures for dealing with abuse and harm. An up to date copy of the vulnerable adults procedure was also available. Staff training records detailed that staff have received training in this area. Two service users care records contained clear procedures to be followed in the uncommon event of a service users behaviour becoming harmful. Staff training records also indicated that staffs have received appropriate intervention training to deal with this. OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 14 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 standard(s) 24, 26, 27, 28 and 30. Service users live in a comfortable and safe environment, however attention is required to some areas to ensure minimum environmental standards are met. These include the downstairs toilet, bathroom privacy, poor condition of the outbuilding housing the laundry and additional communal space for service users. EVIDENCE: The manager gave a full tour of the building. The communal lounge / diner used by service users was slightly sparse of homely ornaments and fittings due to the behaviour of one service users but was still regarded as comfortable. There was a slight unpleasant odour in the lounge, and the manager identified a possible source for this. The provision of an additional communal area would also benefit service users for use during recreational activities with staff. Most of the service users bedrooms were seen and found to be clean and comfortable reflective of individual tastes. One service user has had an ensuite shower room provided since the last inspection to meet their physical needs. OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 15 The upstairs bathroom has been refurbished and is used by three service users. There is currently no sealant around the base of the toilet, which would assist to keep this area clean. Downstairs there is a toilet leading directly from the dining room, this was seen to require refurbishment as décor and fittings were old and worn. Only two service users now use the downstairs bathroom since the provision of suitable en suite facilities already mentioned. It was noted that there is a small window that does not have obscured glass or a blind and this clearly comprises privacy as staff or service users walk by this area. Outside is a large wooden outbuilding, which was seen to be in a poor condition. Inside the finishing’s are not readily cleanable and were covered in cobwebs. This was used for the laundry, additional freezers and an activity storage area. The washing machine start button had broken down and the manager was awaiting it to be repaired. The staff had been hand-washing items and the situation was very well organised and no outstanding washing was seen. Some soiled items are washed in the laundry area and the provision of a hand washing facility would enhance the prevention of cross infection. Service users also benefit from a large garden which was seen to contain a number of recreational activities that service users were seen to be enjoying, an additional fenced off area contained plants that service users were growing. The manager advised that there are plans at an early stage to refurbish and enhance some of the deficient areas in the home. This would address the downstairs bathroom, toilet and replace the outbuilding housing the laundry and may provide additional recreation area for service users. This was viewed as a positive step towards meeting the environmental standards in these areas of the home. OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards 31 to 36 were not assessed during this inspection. EVIDENCE: OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards 37 to 43 were not assessed during this inspection. EVIDENCE: OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 18 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 x x x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 2 2 x 2 Standard No 11 12 13 14 15 16 17 x x 3 x x 3 x Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 OAKLANDS Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA27 Regulation 23 (2) (d) Requirement The registered provider ensures that the refurbishment of the downstairs toilet leading from the dining room is planned. Details to be sent to the CSCI. The registered manager ensures the window in the downstairs bathroom is provided with a blind or obscured glass to ensure privacy of service users. The registered provider ensures that plans are sent to the CSCI that address the refurbishment required to the outbuilding and to ensure an internal finish that staff are able to be kept clean. This plan should also consider the provision of hand wash facilites in the laundry area. Timescale for action 30/11/05 details to be sent to the CSCI 31/10/05 2. YA27 16 (c) 3. YA24 and YA30 23 (2) (b) (d) (j) 30/11/05 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 YA 20 Good Practice Recommendations That further training for staff covering the homes policy for recording of amounts of medicines in stock is advised. H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 20 OAKLANDS 2. YA 28 Develop the outbuilding to a building standard that can be used as an additional separate leisure area. OAKLANDS H52 H01 S11150 Oaklands V223819 180805 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 2 Floor 105 Arlington Business Park Theale Berkshire RG7 4SA National Enquiry Line: 0845 015 0120 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. 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