Inspection on 27/02/06 for Oaklands

This inspection was carried out on 27th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oaklands 03/04/09

Oaklands 03/04/07

Oaklands 16/09/05

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

CARE HOME ADULTS 18-65 Oaklands 183 Faversham Road Kennington Ashford Kent TN24 9AE Lead Inspector Michele Etherton Unannounced Inspection 27th February 2006 15:02 Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 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.V281021.R01.S.doc Version 5.1 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.V281021.R01.S.doc Version 5.1 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.V281021.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th September 2005 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 grounds, 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 bedrooms are registered for single occupancy. The main ethos of the home is the promotion of greater independence in skills and social development. Activities are organised to develop practical skills both within the home and in the community. There is a wide range of leisure opportunities available. Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken as part of the annual routine regulatory inspection programme. All of the key inspection standards had been addressed at the previous announced inspection. The focus of this inspection, therefore, was to assess progress made by the home in addressing an outstanding requirement and recommendation for medication management, and to check progress with proposed environmental improvements to the property. A small number of key inspection standards were revisited through discussion with staff and service users and the review of some documentation. The inspection took place between 15.02 and 17:00 hrs and incorporated a tour of the premises including viewing service users personal space with their permission and in their presence. All service users were at home at the time of the visit, they appeared relaxed and settled and were happy to discuss their daily routines and activities and to show the inspector their personal space. Four staff including the manager were also available on this occasion as a shift change had occurred, all were spoken with briefly and some observed during the course of the visit, the manager was spoken with in more depth. What the service does well: What has improved since the last inspection? Arrangements have been made for medication training for staff in April 2006, plans for environmental changes have been approved and a start date awaited to commence the agreed building works. Damp areas in the upstairs bedrooms have dried out and staff are hopeful that the previous problem has now been addressed. Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 Page 6 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.V281021.R01.S.doc Version 5.1 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 DS0000065339.V281021.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 Not assessed at this visit. EVIDENCE: Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 Page 9 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): 7, 8, 9 Service users are encouraged and supported to; actively make choices and decisions for themselves, participate in the day to day routines of the household and maximise their potential for independence all of which will require some acknowledgement and acceptance of risk in order to achieve a more independent lifestyle. EVIDENCE: In discussion with the inspector service users and staff indicated opportunities where service users make decisions in respect of their daily routines e.g. activities that they might wish to do, meals, personal relationships, selection of room décor. They confirmed their involvement in domestic tasks and all service users are afforded the opportunity to develop their practical domestic skills. Service users are encouraged to develop and lead an independent lifestyle in keeping with their needs and abilities and this will by necessity increase the level of risk they experience, this is appropriately risk assessed by home staff, and reviewed. Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 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 the following standard(s): 12,15,17 Service users are encouraged and facilitated to participate in a range of appropriate activities external to the home. Service users are supported to maintain contact with their families and to develop personal relationships outside of the home. Service users are fully participant in the development of menus and participation in producing meals. EVIDENCE: The inspector was advised that each service user has an activity package that incorporates use of SEC, college or other leisure activities within the community, trips out with staff are also a routine feature of service users weekly programme. Service users confirmed their activity programmes with the inspector and seemed satisfied with the range and frequency of activities, service users also enjoy time spent at home when they undertake domestic tasks. All of the current user group have contact with family or friends, with some more frequent than others. Staff support and facilitate the maintenance of these contacts through visits, telephone contact etc. Staff have been Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 Page 11 supportive to service users in the development of personal relationships outside of the home, and have sought appropriate intervention from health and social care professionals where issues of consent and advocacy have become apparent. Service users are involved in the development of the menu on a weekly basis, they meet with staff and decide on the meals for the week, staff are aware of the need to ensure that a nutritionally balanced menu is provided and discuss this with service users. Service users take turns in the kitchen preparing and helping with meals. All service users are routinely weighed monthly. Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 Page 12 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): 20 The safety of service users could be compromised by the failure to ensure that all administering staff have received accredited medication training. The service is taking steps to provide opportunity for greater involvement by service users in the administration of their medications. Service users and staff would benefit from clear individualised guidelines for prescribed ‘as required’ medications. EVIDENCE: An outstanding requirement for staff to receive accredited medication training is still to be achieved, training has now been arranged for some staff to attend in April, however, all administering staff must attend accredited medication training in order for this standard to be met. Two recent medication errors have occurred and these have been recorded and dealt with in an appropriate manner. The home have been responsive to a previous recommendation to support individuals to develop a greater degree of self medication skills, by ordering personal medication cabinets for each service user, once these have been installed the home will look at ways of involving service users more in their medication regime. Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 Page 13 The inspector noted that two service users have prescribed PRN @as required’ medications, in discussion with the manager it would appear that there are no clear indicators given by either service user as to when this medication is to be used and it would seem good practice therefore to develop, individual prescribed ‘as required’ medication guidelines for these individuals to ensure consistency of administration by staff, and this is a recommendation. Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 Page 14 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 A complaints procedure is in place and displayed in the home for service users and other visitors to see. Service users have weekly meetings in which they are afforded opportunities to express their views. Systems are in place for the safe management of service user finances. Service users and staff benefit from the development of agreed behaviour management guidelines and these are routinely reviewed. EVIDENCE: No complaints have been received or recorded since the last inspection. Service users confirmed access to weekly meetings with staff. Challenging behaviours that may include both verbal and physical aggression are appropriately managed by the use of a range of de-escalation techniques and these are detailed in individualised behaviour management guidelines, these ensure all staff work consistently with service users concerned, and are agreed with the service users and any representatives. The home maintains a record of incidents and these are put into a monthly summary report and analysed by the home manager and staff to establish if there are causal links to behaviour incidents, care plans, risk assessments and behaviour guidelines may be updated to reflect changes in behaviour. Systems are in place for the safe management of service users personal monies, the inspector randomly chose one account to audit and the monies held by the home on the service users behalf were accurate and in keeping with records maintained by the home. Receipts are kept for audit purposes. Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 Page 15 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, 26,29, 30 Service users benefit from living in a clean and homely environment that encourages and supports them to express their personal taste and interests. Staff are proactive in seeking aids and adaptations for those service users who may be experiencing changes to their physical health. EVIDENCE: The home is maintained to a good standard of décor and cleanliness. A programme of routine maintenance is in place with priority given to more urgent works. Service users were interested in the inspection process and willing to allow the inspector to visit and view their bedrooms. These were clean, individualised and reflective of the taste and interests of the respective service user. Service users confirmed in discussion with the inspector their participation in the selection of their room décor, and are actively encouraged to express views and ideas in relation to update of communal areas too. Plans for building works and updating of the premises have not been discussed in any great detail with service users at this time until firm timescales have Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 Page 16 been established for commencing work, as staff feel they do not wish to unsettle service users needlessly over a long drawn out period. Specific sleep in accommodation and toilet and wash facilities for staff is to be addressed in the proposed building works and update to the premises, and will benefit both staff and service users. Home staff’ have been proactive in seeking assessment of the premises by an occupational therapist and a physiotherapist in response to the deterioration in mobility of one service user. As a result of these visits a second banister has now been installed on the main stair case, in addition some aids have been loaned to he home to assess their suitability and benefit for the effected service user, these were in evidence during the visit. The Home was clean and tidy on the day of the visit. Service users indicated in feedback to the inspector their involvement in household domestic tasks undertaken on their days at home from activities. Service users appeared satisfied with their participation in these routines. The home has a small laundry and discussion with staff indicated that soiled laundry is handled appropriately, this is an intermittent and minor problem at present, but consideration will need to be given during the upgrade of the premises as to whether a semi industrial model of washing machine with a sluicing cycle should be installed, and whether the premises upgrade will result in improved laundry facilities and space, which would benefit both staff and users who find the present space cramped when users are being supervised to undertake their own laundry. Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 Page 17 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): 32, 33,36 A sufficient and competent staff team who are appropriately assessed and supervised supports Service users’. EVIDENCE: Apart from the outstanding requirement in respect of medication training, all staff have achieved mandatory staff training. A staff-training matrix is in place, a quarterly training programme is sent to the home and it is the responsibility of the manager to discuss with staff their training needs and apply for training places within the advertised programme. An NVQ training programme is in place and all but one of the staff team has achieved or is undertaking NVQ qualification training. Staffing levels remain unchanged with two staff per shift in addition to the manager, during the weekday day between 9-5 pm. The home has a sleep in staff member; discussion with users and the manager indicated this arrangement is still appropriate. Three staff files viewed at inspection provided evidence of regular monthly supervision sessions for staff, the content of supervision records viewed were in keeping with that defined within the standard. Appraisals are held annually and the manager was present in order to undertake pre-arranged appraisal meetings with members of the staff team. Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 Page 18 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): 42 Improvements to the medication training of staff, and the implementation of routine health and safety checks for the electrical installation are needed to ensure that the safety and welfare of service users is not compromised. EVIDENCE: As already stated, in standard 20 all but one of the administering staff are not currently trained to an accredited standard and the manager who assesses overall staff competency has also not been trained to an accredited standard within the past five years, this lack of training could compromise user safety. The home routinely undertakes health and safety checks of services and equipment, however, there appears to have been some confusion as to the required frequency for servicing of the electrical installation, this was last inspected by a qualified electrician in 2001, at which time a recommendation was made that it be re-inspected one year later, and this is standard practice. Unfortunately, the home was operating under the mistaken belief that they did not need to re-inspect for five years and consequently this has been Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 Page 19 subsequently overlooked. The manager is aware of this discrepancy and has been seeking a resolution of this for some time, without success. It is a requirement of this inspection that within two months of this inspection an electrical inspection of the electrical installation within the property is undertaken and any remedial works as a result actioned, it is a further requirement that subsequent inspections of the electrical installation are carried out in compliance with the recommended timescales given by the inspecting qualified electrician. The home has implemented a new accident book compliant with the Data protection Act 1998, this is used for staff, service user accidents are recorded on an accident report form and this is them recorded on a monthly summary report of accidents. Accidents are filed in service user files. There have been a minimal number of accidents since the last inspection, one service user is experiencing reduced mobility and a system for falls monitoring is in place for this person, in discussion with the manager the inspector was satisfied that appropriate actions and interventions from other health professionals are in place for this individual. Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 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 3 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 4 4 3 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 4 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X X X X X X 2 X Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 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 Staff who administer medication to have training from an appropriately qualified source that covers the work they are required to undertake. (Previous timescales not achieved) Home to arrange for the inspection of the electrical installation of the premises and to address any remedial works identified as a result. Further inspections of the electrical installation are to be undertaken within the timescales recommended by the inspecting electrician Timescale for action 30/06/06 2 YA42 13(4) 23(2) (b) (c) 27/04/06 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 to be supported to take a greater part in the management and administration of their medication. DS0000065339.V281021.R01.S.doc Version 5.1 Page 22 Oaklands 2 YA20 Individual guidelines to be developed for ‘as required’ medications Oaklands DS0000065339.V281021.R01.S.doc Version 5.1 Page 23 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 © 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 DS0000065339.V281021.R01.S.doc Version 5.1 Page 24 - 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!