CARE HOME ADULTS 18-65
Oaklands 183 Faversham Road Kennington Ashford Kent TN24 9AE Lead Inspector
Lois Tozer Key Unannounced Inspection 3rd April 2007 09:25 Oaklands DS0000065339.V328157.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 DS0000065339.V328157.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 DS0000065339.V328157.R01.S.doc Version 5.2 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 Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th February 2006 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 Sandra Lingham. 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 has 3 communal rooms, two lounges and one dining room. A shower room with WC is on the ground floor, and bathroom and WC on the 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. Previous reports are available from the home. The weekly fee for this service starts at £1000.28, rising to £1380.76. Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key site visit took place on 3rd April 2007 between 9:25am and 2:50pm. The manager, Mrs Sandra Lingham, service users and staff assisted with the process. Four people live at the home, and all gave some face-to-face feedback. All service user comment cards were received before the site visit. Service users had already arranged their day, and were slightly held up when the inspector arrived. The manager (who was on time off), came in to enable the visit to go ahead. The manager gave a tour of the communal areas and the garden. The inspection process consisted of information collected before and during the visit to the home. Other information seen included assessment and care plans, medication records, duty rota and employment paperwork. What the service does well:
The home has a friendly atmosphere and the communal areas are very homely. Service users are fully involved decision-making processes. People are getting out and about into the community. There are lots of opportunities for people to go to places they like and enjoy. People look forward to trips out, and they plan most of their own activities with staff support. Relationships (personal and with families) are supported, and people know that they can seek help from staff to see their friends. Personal interests are encouraged. Residents plan holidays to places that they really want to go to. People feel safe and well cared for. All service users are fully involved in preparing meals. The kitchen is freely available, and only a minimum of cupboards have locks. Positive things that service users said in their feedback were; I like - ‘Going out and my room’. ‘Yes, everything.’. ‘Everything is within easy reach, like the shops’. ‘Staff are nice, kind and good to you’. ‘Good’. Relatives and friends sent in generally positive feedback, all saying that they were satisfied with the overall standards of care provided. Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 Page 6 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 DS0000065339.V328157.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 DS0000065339.V328157.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Current service users aspirations and needs are assessed. EVIDENCE: There have been no new admissions to this home for many years. The admissions procedure was discussed, and the manager described that aspirations and needs would be carefully assessed. Existing service users have their needs and hopes for the future reviewed regularly. Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual plans do reflect changing needs and goals, but it is not clear on how much say people are having. People are supported to make personal decisions wherever possible. Risk assessing promotes an independent lifestyle. EVIDENCE: Each person has an individual plan. These are informative and describe the support a person needs and state the individual goals. These are useful to staff to provide a continuity of support, but they have not been fully developed in consultation with the individual in question. Staff, who have in-depth knowledge about the person have written the support guidance. Plans should be written in a way the person understands and can actively contribute into. The organisation has excellent templates for person centred planning. The manager hopes to seek training on this and help the team support service
Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 Page 10 users use this planning tool. As the home is using quite a lot of agency staff, a shortened version of individual support needs would be very beneficial. By comparison, decision-making is really well supported. People are increasing their involvement in the home, the community and leisure time. Day to day chores are shown in a picture format, which enables understanding. Advocacy and self-advocacy is being sought and promoted. General risk taking is also managed well, and restrictions are clearly explained and agreed with individuals. The manager sees that personal development will incur some risks, and so discusses how to reduce these with the individual and staff team. Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 Page 11 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 choose their own activities at home and within the community. Relationships are very well supported. Rights and responsibility taking in all daily life activities is encouraged. Healthy meals are chosen and prepared by residents with support from staff. EVIDENCE: All service users go to the day centre on a regular basis. They say that they enjoy this a lot and have met new people and are making new friends. There are lots of activities taking place in the community, such as gym, health clubs, pubs and eating out. People have developed and maintained skills for everyday living. Family and friends are welcome to visit and stay over. Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 Page 12 Service users say that they enjoy living here because its easy going, its close to shops and things they like to do and it has been their home for many years. They take an active role in running the home and planning events. The ‘Valuing people’ advocacy group has just become available, which two people may attend. Service users plan meals, and each has a cooking day. Healthy eating is promoted, and the type of food on the menu has been recently reviewed. Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to have their personal, physical and health needs met, but for some, it is not clear if this is given in the way they would prefer. Medication is managed safely, but no service users have been assessed to have greater control of this area of their lives. EVIDENCE: Feedback from service users said they are supported with respect and dignity in personal care. The guidance for staff on how to support people is clear, but it is not always the individual service user who has agreed what level of support they want. Use of pictures and easy words may be of benefit. A shortened version for agency staff would be beneficial too. The manager is working on this. Physical and emotional health needs are being well supported. Clear notes of outcomes are kept, and recommendations are followed. The company have a health action plan template that will help service users take more control and
Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 Page 14 responsibility over their lives. The manager plans to work with service users and implement this in the near future too. Medication management is safe and there are few discrepancies in the medication record sheet. Some short codes are being used oddly, which needs reviewing. Good practice in monitoring medication is in place. All staff and the manager have had training and benefit from a periodic competency assessment. As yet, no service user has been assessed to establish if they are able to take a greater part in medication administration. Such assessments should be take place. Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 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. 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 know staff will support them if they have a complaint. Staff understand the adult protection process. EVIDENCE: A long standing complaints system is in place, which all service users know and (some with support) are able to use. Individual complaints system workbooks are in place, but have not yet been used with the service users. It would be beneficial to support service users to learn about this, and develop a personalised system for people who cannot use text. Staff have had adult protection training, and service users say that they feel safe with the people who support them. There are clear systems, policies and procedures to support staff to ‘whistle-blow’. Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortable and reasonably homely, but is in need of material improvement and revision of shared space use. Potential hazards in the garden need to be made safe. The home is generally hygienic and clean, but some areas of damp need to be sorted out. EVIDENCE: The house is a very ordinary, homely place to live, but there are ongoing problems with decoration and some areas of damp. The organisation planned to improve the home with an extension and refurbishment. This has been put on hold, with no firm date for work to start. The development was in response to service user’s changing needs, so it is essential that some time-bound contingency plan be in place.
Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 Page 17 The kitchen ceiling has been recently removed for re-plastering, which is good, but there is still damp in the larder area. The shower room has a slight odour of damp. Excavation work in the garden (for the proposed extension) has resulted in two very deep holes remaining. These have not been covered well, and are a potential danger. Staff continue to sleep in the lounge. The manager reports that this does cause a service user some upset, as they are unable to use their lounge to watch TV when staff wish to sleep. A small room that was previously used for smoking is potentially available, and this could be considered as an alternative arrangement. Oaklands DS0000065339.V328157.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the right competencies and qualifications to support service users. Greater focus on from service user needs led training would enhance the service provided. Recruitment follows the correct procedures to ensure service users are safe. EVIDENCE: Fifty percent of the permanent staff team hold an NVQ 2 or higher qualification. Service users say they like the staff very much and get on well. All service users have planned holidays supported by staff they get on well with. All service users have a key worker. There is a high use of agency staff, which may have been a contributing factor to recent incident. Agency induction has focussed greatly on health and safety, and not sufficiently on the individuals being supported. Care plans are difficult for agency staff to information from quickly, they do not give the reader the essence of a person.
Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 Page 19 No communication training has been provided, although two service users have communication difficulties. Some key staff have had person centred planning training, but as yet, this has not been put into practice. Staff recruitment procedures are safe and sound. All relevant information is obtained prior to staff being employed. But service users are not fully involved in the recruitment process, although do get to meet prospective employees prior to their employment. This could be improved. Oaklands DS0000065339.V328157.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. The home is well run, with service users at the heart of development. Service users views are sought, but improvements in the way they are supported to express themselves would be beneficial. The heath and safety of the service users is well promoted. EVIDENCE: The new manager has maintained the ‘service user run’ ethos of the home. She has got to know the service users and staff, and all say that they are happy with her style. The manager is clear about her responsibilities and has the appropriate qualifications and experience to maintain and improve the service.
Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 Page 21 Quality assurance systems are in place, and many of these (meetings, talktimes, reviews, daily support feedback) are led by the service users and incorporated into the running and development of the home. Simplification of the questionnaires and communication aids for talk-time would be of benefit for some service users. They could potentially give more of their own opinion as staff would have less of an ‘interpretative’ role. Relatives and friends feedback is sought, and very positive feedback was received by CSCI. The health and welfare of service users is well managed. Most staff have up to date health and safety training, and there is always a staff with up to date first aid training available. Appliance checks are up to date and fire risk assessments have been reviewed. Oaklands DS0000065339.V328157.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 X 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 2 25 X 26 X 27 X 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 4 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 DS0000065339.V328157.R01.S.doc Version 5.2 Page 23 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 YA24 Regulation 13, 23 Requirement YA24 & YA30 Make a time bound action plan for environmental improvements to meet service users needs. Feed back to service users Make sure the holes in the garden are not a danger to people. Review and assess staff sleep in arrangements. Agency staff must have an induction that enables them to know all service users. Timescale for action 14/05/07 2 3 4 YA24 YA28 YA35 13 23 18 01/05/07 01/05/07 01/05/07 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. 2 3 Refer to Standard YA20 YA22 YA34 Good Practice Recommendations Service users to be supported to take a greater part in the management and administration of their medication. YA18 & YA22 – Use easy to use health action plan and complaints system. Service users have an active role in recruitment of staff. Oaklands DS0000065339.V328157.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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
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