CARE HOME ADULTS 18-65
Oakleigh Shutterton Lane Dawlish Warren Dawlish EX7 0PD Lead Inspector
Clare Medlock Announced 3 May 2005
rd 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. Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Oakleigh Address Shutterton Lane, Dawlish Warren, Dawlish, Devon, EX7 0PD 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) 01626 866740 01626 864771 Mr Tony England, Mrs Pamela England Mrs Pamela England Care Home 6 Category(ies) of Learning disability (3) registration, with number of places Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Room `6` measuring 5.9 x 3.6 currently known as the Games/Day room on the ground floor will meet Care Homes Act 2000 requirements and be made habital before use. 2. The proprietors will inform the NCSC of occupancy of this room before the Service User occupies the room. 3. Staffing levels will reflect the increase in numbers at the home and will meet Care Homes Act 2000 requirements. Date of last inspection 30/11/04 Brief Description of the Service: Oakleigh is a large extended property situated on the outskirts of the seaside resort town of Dawlish. The home is registered for six Service Users of either gender who are below the age of 65. Oakleigh provides specialized residential care to Service Users who have learning difficulties with associated challenging behaviour. The Providers state that Rehabilitation at the home is based on gentle teaching principles within a framework of a social learning programme. The home is arranged on two levels, which can be accessed by stairs. Each Service User has a bedroom with nearby bathroom. The home is set in over three acres of land, which is used for activities such as gardening and tending to the homes many chickens, geese and ducks. The home also keeps ferrets, cats and a dog. Activities arranged by the home include; Keep fit, Gymnasium, Karaoke, gardening, cooking, sport, and arts and crafts. At the time of inspection planned building work had been completed. This work has provided a two-storey extension that includes a gymnasium, a larger kitchen and dining area. An extra bedroom has been built so that the existing spare bedroom can continue to be used as a games room. Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine announced inspection performed on Tuesday 3rd May 2005. This inspection consisted of speaking with Service Users (Who have requested to be called Residents), staff and management within the home. A tour of the premises was conducted. Care records, staff files, policies and procedures and other records were inspected. Five Residents, and four members of staff were spoken to. Not all standards were inspected on this occasion, therefore it is recommended that previous reports are obtained to gain a broader picture of events within the home. What the service does well:
The Staff at Oakleigh consistently provide a very good standard of social care. Care is based on the individual needs of the residents and a tailor made plan is drawn up with agreement of the residents, their families and care managers. Staff within the home encourage residents to participate in the day to day running of the home. Residents are able to make decisions with staff offering sensitive guidance and intervention where necessary. Oakleigh is a safe homely place to live. The established staff group provide stability for the residents. The staff have specialist training to make sure they are able to fully meet the needs of the residents. There is a genuine rapport and affection shown between Residents and staff and an awareness shown by staff regarding the Residents needs. The wide range of leisure activities are encouraged by staff at Oakleigh. These include: Using the home’s gym, gardening, visiting cafes and pubs, rabbiting, craft work, pool and snooker, karaoke, going out on the homes boat, cookery, craft sessions, carpentry, reading, writing, arithmetic sessions, darts, cycling, swimming, cricket, beach combing, fishing, picnics and sport. Residents at the home are able to have an annual holiday abroad. Residents are also able and encouraged to maintain contacts with family and friends. Maintaining a healthy lifestyle is encouraged within the home. The majority of the fruit and vegetables are grown in the garden by the staff and residents. The menus are varied and healthy. All residents are encouraged to keep fit and active, by using the gym equipment and participating in the outdoor activities. Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 6 Residents are able to say what they like and dislike about living at Oakleigh at the residents meetings. The home is well managed with the Providers working alongside staff. There are clear lines of leadership within the home with mutual respect shown between the Providers and staff group. Communication is good between the Providers and Commission for Social Care Inspection. 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 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 standard(s) 1,2,3,4 and 5 Residents and their families are given useful information prior to moving in. Residents are cared for by a skilled team of care staff. There is no tool to show that Residents are thoroughly assessed prior to admission. This means staff may not have all the information to decide if they can care for the individual before they move. This has the potential to place the Resident, other residents and staff at risk. EVIDENCE: Potential Residents, their families and Care Managers are given the Statement of Purpose and Service User Guide prior to admission and issued with a contract on admission. Discussion with the Provider and records confirmed that the Provider assesses potential residents very carefully prior to admission but does not write this information down. This method relies on memory and may mean staff may not have all the information to decide if they can care for the individual before they move. This has the potential to place the Resident, other residents and staff at risk. The Provider stated that although there is a space for an extra resident at present that this room has not been filled as the Provider wants to make sure residents are ‘right’ for the existing residents at Oakleigh.
Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 9 Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 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 standard(s) 6,7,8,9 and10 The care planning approach is good within the home and ensures that each resident has a tailor made plan of care that is specific to their needs. The relationship between the staff and residents is very good. This ensures residents feel safe when taking risks and feel valued when consulted about the choices available to them. EVIDENCE: All five Residents have a large colour coded file which contain care plans, reviews, and correspondence from health care professionals. All Residents have a daily diary where events are recorded on a daily basis. Each Care plan was different to the next as staff at Oakleigh recognise the individual needs and plan specific care around those needs. For example one resident gets awarded tokens for good behaviour which are exchanged for money or treats of the Residents choice. Whilst the care provided is sensitive the staff have behaviour management systems in place which provide safe and consistent boundaries and provide positive sanctions and rewards. Staff within the home support the residents with decision making giving advice and support as necessary. Residents are encouraged to participate in the day
Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 11 to day running of the home as part of a social learning programme. Staff were seen to allow residents varying amounts of time depending on their abilities. Residents are able to ‘call’ a residents meeting at anytime where they can discuss what they like and dislike about life at the home. All information held regarding the residents is stored in a office/cupboard. Staff are aware of the importance of confidentiality. locked Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 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 standard(s) 11,12,13,14,15,16 and 17. The extensive range of social activities are creative, well managed and varied. Residents have choice and control over their lives whilst living at the home. The meals provided at the home are very good with an emphasis on healthy eating and maintaining a healthy lifestyle. This approach has a positive effect on the health and well being of the residents. EVIDENCE: Residents are supported by a stable group of staff, who support the residents in all aspects of their life, whilst allowing appropriate risks to be taken. The wide range of leisure activities include: Using the home’s gym, gardening, visiting cafes and pubs, rabbiting, craft work, pool and snooker, karaoke, going out on the homes boat, cookery, craft sessions, carpentry, reading, writing, arithmetic sessions, darts, cycling, swimming, cricket, beach combing, fishing, picnics and sport. Residents at the home are able to have an annual holiday
Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 13 abroad. Residents are also able and encouraged to maintain contacts with family and friends. Residents participate in the day to day running of the home. Each Resident has a flexible programme of tasks to achieve during the day. These include cooking for the other residents, ironing, cleaning and helping maintain the garden area. Each resident is given encouragement and support to achieve these tasks. Maintaining a healthy lifestyle is encouraged within the home. The majority of the fruit and vegetables are grown in the garden by the staff and residents. The menus are varied and healthy. All residents are encouraged to keep fit and active, by using the gym equipment and participating in the outdoor activities. This healthy lifestyle has had the effect of Residents being able to carefully reduce medication under the guidance of the Resident’s doctors. Residents are able to say what they like and dislike about living at Oakleigh at the residents meetings. Records show that residents are able to ask for a meeting to be held. Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 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 standard(s) 18,19,20 and 21 The staff have a very good understanding of the Residents support needs. The health needs of residents are well met with evidence of good multidisciplinary working taking place on a regular basis. The systems for the management and administration of medications is good at Oakleigh with clear and comprehensive arrangements in place to ensure residents medication needs are met. EVIDENCE: All Service Users at Oakleigh appeared clean and neatly presented. Service Users all appeared independent although the Statement of Purpose states that should personal care be required it is provided by same gender staff. Discussion with the Provider confirmed that encouragement rather than help is required at times. Observation confirmed that the five Service Users within the home appeared well cared for, fit and healthy. All Service Users have access to health care professionals and health care specialists. Records confirmed that outpatient appointments are up held and communication with health care specialists is maintained. Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 15 Observation and discussion confirmed that all medicines are correctly handled and stored. The Provider confirmed that she has made some changes to this system since the last inspection. Discussion with the Provider confirmed that good communication links are maintained with the General Practitioner as changes in medications are discussed. Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The home have an effective complaints procedure with evidence to show that residents feel their views are listened to and acted upon. Staff at the home have not received sufficient training in respect of Adult Protection and reporting abuse. This has the potential to place Residents at risk. EVIDENCE: Resident Meeting Minutes demonstrate that Residents are able and have ‘called’ a meeting when there is something they wish to discuss. All Residents are given an opportunity to say what they like and dislike about living at the home. The Provider keeps a complaints record which shows what the complaint is and what action has been taken. The home have received one complaint which was not associated with the service, staff or residents. The Commission for Social Care Inspection have not received any complaints in the last three years. Discussion with the Provider and previous discussion with staff confirmed that staff in the home would always report any suspected abuse. The Home have Devon County Council Alerters Guide. However, the staff have not had formal training in identifying the types of abuse and how local guidance suggests allegations should be reported. The Provider had acted on this shortfall prior to the end of the inspection. Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29 and 30 Recent building work has significantly improved the appearance and function of this home. The home provides a comfortable, safe, clean environment for residents. EVIDENCE: The recent building work has increased shared space and has benefited the residents. It has not intended to increase registered numbers. The work has provided a larger kitchen, a dining area, a gym and larger games room. The second floor has provided larger bedroom and office. All work had been completed to a high standard and provided bright spacious rooms which retain the homely atmosphere. A tour of the home confirmed that the home was clean, tidy and free from offensive odours. Records confirmed that Oakleigh have policies and procedures with regard to hygiene and the control of infection, which reduces the spread of infection. Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35 and 36 The staff have a good understanding of the residents needs. This is evident from the positive relationships, which have been formed between the residents and established staff group. EVIDENCE: There are low levels of sickness and staff turnover within the home which provides stability for the Residents. Staff are aware of their roles and both staff and residents know where to go if there are problems. Staff are supported and supervised both formally and on a day to day basis. Staff within the home have regular training in subjects that are relevant to the residents needs. 50 of the care staff have NVQ Training Staff files contained evidence of Criminal Records Bureau checks, forms of identification and suitable references, to ensure residents are protected by the homes recruitment procedure. Discussion with the Provider confirmed that interview notes are not taken, which does not support equal opportunity. Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 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 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) 37,38,39,40,41,42 and 43 The Provider has a good understanding of the importance of developing a good relationship with Residents, relatives, which results in a high standard of care and staff morale. The Provider is supported well by the staff within the home, with all staff demonstrating an awareness of their roles and responsibilities. The home is well managed and provides a safe place to live. EVIDENCE: The home is well managed Discussion with the Provider confirmed that information has been obtained about NVQ 4 training. The Providers experience in owning and Managing Care Homes assists in ensuring Residents needs are understood and met. The Providers provide a clear sense of leadership and direction for staff. Observation and records confirmed that the management of the home is open, and that new ideas are listened to and considered. Resident meeting records
Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 20 confirmed that there are ways to enable Residents and staff to affect the way the service is run. Discussion with the Provider confirmed that the views of relatives, families and health care staff is not obtained at present. There was a calm relaxed atmosphere present throughout the inspection. The daily presence of the Providers means that any queries and concerns are dealt with in a prompt and efficient manner. Observation confirmed that a comprehensive set of policies and procedures which need to be reviewed and updated. The home’s existing records are secure, up to date and in good order. Oakleigh have risk assessments both for individuals and for safe working practices. Safety notices are posted and information is available to service users in user-friendly formats. Accident records and restraint records were maintained. Discussion with the Provider confirmed that staff have received first aid training, manual handling training. Records confirmed fire equipment is maintained and staff have received appropriate training. A tour of the building confirmed that there were no identified hazards seen. Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 3 3 3 Standard No 22 23
ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 4 3 3 4 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Oakleigh Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 2 2 3 3 3 D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 22 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. 2. Standard YA 6 YA23 Regulation 15(2b) 13(6) Requirement The Provider must ensure all Residents Care Plans are kept under review. The Provider must ensure all staff training in adult protection and ensure that all staff are aware of the correct local reporting procedures Timescale for action 01/10/05 01/10/05 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. 2. 3. 4. 5. Refer to Standard YA2 YA 20 YA 34 YA 37 YA 39 Good Practice Recommendations The Provider should devise a tool to use for the assessment of new Residents. This tool should include the information listed in standard 2. The Provider should obtain a signature example sheet for the medication system The Provider should devise an interview format to make sure the home support qequal opportunities The Provider should ensure that steps are taken to ensure that either the Providers or Manager have NVQ4 in management by 2005 The Provider should seek the views of relatives and care managers to obtain a view of the service provided at oakleigh
D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 23 Oakleigh 6. YA 40 The Provider should review the policies and procedures on an annual basis. Oakleigh D54-D07 S3763 Oakleigh V214694 030505 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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