CARE HOME ADULTS 18-65
Oakleigh Shutterton Lane Dawlish Warren Dawlish Devon EX7 0PD Lead Inspector
Clare Medlock Unannounced Inspection 8th November 2005 10:00 Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Oakleigh Address Shutterton Lane Dawlish Warren Dawlish Devon EX7 0PD 01626 866740 01626 864771 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) Mr Tony England Mrs Pamela England Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Staffing levels will reflect the increase in numbers at the home and will meet Care Homes Act 2000 requirements. 03/05/05 Date of last inspection 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 specialised 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 over two levels, which can be accessed by stairs. Each Service User has their own 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 keep ferrets and a cat. Activities arranged by the home include; keep fit, gymnasium, karaoke, gardening, cooking, sport and arts and crafts. Communal areas of the home include a lounge, a large additional kitchen, games room, gymnasium and an additional kitchen/multi purpose area. Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on Tuesday 8th November 2005. The inspection was unannounced, therefore not all standards were inspected on this occasion. It is recommended that the reader obtains the previous inspection report to gain a full picture of events at the home. The inspection consisted of speaking with all five residents and one member of staff. Both Providers were present for the inspection. 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 DS0000003763.V251596.R01.S.doc Version 5.0 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. Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 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 Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 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): 2 Residents and their families are given useful information prior to moving in, thoroughly assessed and are cared for by a skilled team of care staff. EVIDENCE: There have been no new admissions at the home since the last inspection. The Provider has devised a new pre admission questionnaire to complete prior to admission. This document was inspected and contains all information recommended. Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 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): 6,7,8,9 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 to day running of the home as part of a social learning programme. Two care plans and daily diaries were inspected on this occasion. All records were up to date.
Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 10 Staff were seen to allow residents varying amounts of time depending on their abilities. Progress with this was recorded in care plans and daily diaries. Residents are able to ‘call’ a residents meeting at anytime where they can discuss what they like and dislike about life at the home. One resident said she was still happy at the home and liked the staff. All information held regarding the residents is stored in a office/cupboard. Staff are aware of the importance of confidentiality. locked Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,14,16 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 spoken to on the day of inspection appeared to be happy and well cared for. Two residents stated that they have enjoyed a holiday abroad this year and liked going to the same place as before. Another resident informed the inspector about the recent Halloween and fireworks party where a bonfire was burnt and homemade cakes enjoyed. During the inspection residents were all seen embarking on ‘tasks’ which were appropriate for them to do. One resident was mowing the lawn, another was independently preparing the evening meal, another was picking potatoes and another ironing. All residents were given appropriate support and supervision.
Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 12 Residents were encouragement. seen to be given prompts as required, praise and Residents participate in the day to day running of the home. Each Resident has a flexible programme of tasks to achieve during the day and were observed doing these tasks during the course of the morning. These included putting their washing away and cleaning their bathroom. 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. One resident said that this year they had grown; gooseberries, melons, peppers, pumpkins, potatoes, carrots, lettuce, apples, pears, aubergines, tomatoes and others. 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 continue to reduce medication under the guidance of the Resident’s doctors. Residents seen on the day of inspection appeared relaxed and happy. One resident said they were still very happy at the home and liked the staff a lot. Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Elements of18,19, and elements of 20 Staff are aware of the Residents personal and health needs, and ensure these needs are met in a way that residents chose. 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. Observation confirmed that encouragement and prompts are used rather than help. 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. Discussion with the Provider and care plans confirmed that reviews are held with multidisciplinary health care professionals and individual health care needs are fully met. The medication system was not fully inspected on this occasion, however the Provider has produced a specimen signature and initials record to ensure staff are able to recognise who has given or prompted medication.
Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 14 Discussion with the Provider confirmed that good communication links are maintained with the General Practitioner as changes in medications are discussed. Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 now received training in respect of Adult Protection and reporting abuse. This helps protect Residents. EVIDENCE: The Commission for Social Care Inspection have not received any complaint about Oakleigh in the last year. Oakleigh have not received any complaints. Since the last inspection staff at the home have received Devon County Council Adult protection training. Staff spoken to said they found this useful and interesting. Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The home provides a comfortable, safe, clean environment for residents. EVIDENCE: A tour of the home confirmed that the home was clean, tidy and free from offensive odours. A new carpet throughout the hall stairs and landing and lounge area gives a bright fresh appearance and a new three piece suit has been purchased for the communal lounge. The building work has now been completed and work to improve the outside of the building has taken place, this has included a new gravel driveway. Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 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): Elements of 31, 32, and elements of 33 and 34 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. This has been improved by the introduction of a staff roles and responsibilities document which will be given out when new staff start at the home. 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. There have been no new staff working at the home since the last inspection. Staff absences have been covered by existing staff. The Provider has introduced an interview questionnaire to show recruitment practices within the home meet equal opportunities. Staff records confirm that staff have access to training relevant to their roles. Training attended since the last inspection included: Epilepsy awareness, mental health for Service Users with Learning difficulties, Understanding challenging behaviour, Autism, and Sexuality and Relationships for people with Learning difficulties.
Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 18 Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Elements of 37,38,39,42 The home is well managed and the Provider has a good relationship with Residents, relatives, and staff which results in a high standard of care and staff morale. EVIDENCE: The home is well managed. Staff spoken to said they were happy working at the home. Discussion with the Provider confirmed that information has been obtained about NVQ 4 training, although the deputy Manager will be attending this course in the future. The Providers have 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 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 are now obtained by a questionnaire although responses have not yet
Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 20 been received. It was suggested that this should extend to Health care Professionals including care managers. 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. Staff records and discussion with staff confirmed that staff have had training in manual handling. Records of fire drills and fire equipment checks were satisfactory, although it was not clear if all staff were up to date with fire safety training. Oakleigh have risk assessments both for individuals and for safe working practices, although these were not inspected on this occasion. Safety notices are posted on the notice board and information is available to service users in user-friendly formats. Accident records and restraint records were available but not inspected. A tour of the building confirmed that there were no identified hazards seen. Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 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. 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 3 x x x Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 3 12 x 13 x 14 3 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 x x CONDUCT AND MANAGEMENT OF THE HOME 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Oakleigh Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 3 3 x x 2 x DS0000003763.V251596.R01.S.doc Version 5.0 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA23 YA37 YA39 YA42 Good Practice Recommendations The providers should attend the Devon County Council Adult Protection Training The Provider should ensure the Manager commences her NVQ4 training as soon as she is back to work The Provider should consider extending the quality assurance questionnaires to health care professionals The Provider should ensure all staff are up to date with fire training Oakleigh DS0000003763.V251596.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Ashburton Office 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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