Inspection on 06/02/07 for Oakley Square Project

This inspection was carried out on 6th February 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oakley Square Project 15/02/06

Oakley Square Project 09/09/05

Oakley Square Project 22/02/05

Oakley Square Project 28/10/04

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

CARE HOME ADULTS 18-65 Oakley Square Project 69 Oakley Square London NW1 1NJ Lead Inspector Edi O’Farrell Unannounced Inspection 6 February 2007 09:20 th Oakley Square Project DS0000010344.V288147.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 Oakley Square Project DS0000010344.V288147.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. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakley Square Project Address 69 Oakley Square London NW1 1NJ 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) 020 7388 1112 0207 388 1114 Equinox Ms Gerdy Grafendorf Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15/02/06 Brief Description of the Service: 69 Oakley Square is a care home providing accommodation and care for up to eight women, who have a history of mental health problems, resulting in admissions to special hospitals, secure units, and prisons. The home provides a community base following discharge and assists service users to readjust to their new life. Service users remain at the project for between three and five years during which time they are supported to learn positive coping, and practical daily living, skills. The staff team work closely with multi-disciplinary clinical teams to try and maximise service users’ potential. The property is subject to management agreement with St Pancras and Humanist Housing Association who are responsible for the major repairs and most of the maintenance. The registered care service is managed by Equinox, which is a voluntary organisation, which manages a range of similar projects. The house is a five storey Victorian building in a residential street in Camden, situated opposite a small park. There is a small, enclosed garden to the rear. The property is situated between Camden Town Underground and Euston Station, which are within a ten-minute walk from the home. Mornington Crescent tube station is near by, and there are also several bus routes. Living accommodation for service users is over four floors. The house has eight single bedrooms, two lounges, one of which is non-smoking, a kitchen with a dining area, and activity rooms, two bathrooms and a shower room a single toilet plus two offices and a sleep in/meeting room for staff. As the home provides a mental health aftercare service there is no fee to the service users. The placing authority pays the full cost of £1,680 per week. Service users are self-catering, with support from staff where needed. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for this, unannounced, inspection took place on a weekday. Starting at 9.20 am it took a total of just over four hours, and was carried out by one inspector. Prior to the site visit all information held at our office had been reviewed. This included reports that have to be sent to us about serious incidents. The manager had completed a pre inspection questionnaire and a self-assessment. We sent eight service user surveys to the manager to distribute, no completed forms were returned. We used all the information to develop an inspection plan. During the site visit we tested the validity the information provided in the provider selfassessment. This was by examining written records, and speaking to two service users and two staff members, as well as the manager. Some parts of the building were toured. This included two bedrooms, with the service users’ agreement. We also spent time discussing our findings with the manager, and agreeing appropriate action. We sent a questionnaire to the manager following the inspection so she could let us know how she felt the inspection was handled. CSCI inspection reports are public documents once they have been agreed with the provider. We normally include details of needs and how the service responds to needs in our reports. This is in order to substantiate the judgements we make. In the case of this home, much of that information is extremely sensitive, and being written in a public document could cause distress and easily identify individual service users. We have therefore not included much of our evidence related to individual service users. What the service does well: ‘Can go and talk to them about anything, very nice, knowledgeable about needs, they get training to look after us. Sensitive to needs, good support’. Quote from two service users. The home provides a much-needed residential service for women who have been in institutional care for varying lengths of time. This includes secure psychiatric units, special hospitals, and prisons. It provides a safe place for the women to re-enter the community, and to learn positive coping, and daily living, skills. Case records demonstrated that staff had a sound knowledge of the needs of women with forensic histories and rehabilitation. Race, cultural, and religious heritage were seen as central to keyworking. This is particularly important in Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 6 this type of service, as negative self-image and low self-esteem are known factors in people who exhibit self-destructive behaviour. There is a strong commitment to meeting individual need. This includes the management of self-harm, and potential danger to the community. There is an emphasis on service users taking control and responsibility for their actions. This is within a very comprehensive risk assessment and risk management structure. This enables service users, who are often extremely vulnerable and from very disadvantaged backgrounds, to increase self-awareness, self-image, and self-confidence. This helps to reduce relapse and return to institutional life. The staff team is well trained, with the training programme being focused on the needs of individual service users. Three weekly group supervision, by a senior forensic psychologist, enables staff to reflect on practice. It also helps to ensure consistency in staff assisting service users when they are in crisis. The environment is homely, well furnished, and clean. Where prospective service users are due to move in they choose the colour scheme for their bedrooms. There is also an allowance for purchasing furniture to match their chosen lifestyle. This helps in the difficult move from institutional to community living. Record keeping is to a very high standard, and demonstrates staff understanding and knowledge of the service user group. The home is extremely well managed, with important tasks, such as health and safety and medication monitoring, being devolved to specific staff. The views of service users are sought on both an informal and formal basis. This is via individual keywork sessions, regular meetings, and formal surveys. Service users are also involved in the recruitment of new staff. What has improved since the last inspection? What they could do better: The level of voids (vacant places) over several months has resulted in decreased income. In order to address this one post, of administrator, has been frozen. In addition the assistant manager has been transferred to another project, as well as two other staff members. This has had an effect on the service, service users, and staff. Both service users and staff raised the loss of informal one to one time, such as going out for coffee. They felt that the social interaction had been important, and very different from the formal keywork sessions. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 7 One –to-one supervision had also slipped, as the manager had to cover the work of the administrator. Staff rotas were much more difficult to organise, with staff having to work long days, and have split days off. Working with this service user group is, at times, very intense, and adequate time off is important if staff are to continue to meet the needs of service users. 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. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 8 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 Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 4 & 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective service users have full information about the service at the referral stage. Their needs are comprehensively assessed, and they have opportunities to ‘test drive the home. EVIDENCE: There is an informative brochure, which clearly sets out the services that can, and cannot, be provided. The two service users spoken to confirmed that they had received full information about the home before being referred there. They described the pre-admission visits as ‘very helpful, as moving into the community can be a shock’. The written records also demonstrated the structured nature of referral, assessment, and introduction to the home, described in the provider selfassessment. Overnight stays, which increase in the period leading up to the planned move, follow a series of day, visits. This allows service users and staff time to get to know each other. It also forms part of the assessment and decision making process by the service user, their clinical team, and the home. Risk assessment, and multi-disciplinary working, is central to the process. The women referred to this home are exceptionally vulnerable to relapse at times of change, when their anxiety levels are high. The structured approach is Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 10 adapted to take account of the reactions of each prospective service user to each visit and overnight stay. Detailed records are taken of each visit and stay. The brochure, service user guide, and the visits are used to introduce prospective service users to life in the community. Referrals are from secure psychiatric units and prisons, where the women may have been for some considerable time. Moving into the home means that they have to retake up rights and responsibilities that that they have not had for many years. For example, budgeting and shopping, forming personal and intimate relationships, and making decisions about contacting family and old friends. Anxiety about this can easily be manifested in self-destructive and dangerous behaviour. The visit records demonstrated an individualised approach, where the needs and aspirations of each service user were central. The two files examined contained licence and support agreement. The service users, the key worker and the manager signed both. Women on the waiting list are visited monthly by a project worker and are encouraged to visit the home monthly. Prospective service users are encouraged to visit the home before a final decision to refer is made. A five year risk assessment history is required. Independent advocacy is encouraged at the assessment stage. The decision about admission is made by a panel, which includes clinical input and the home manager. Detailed, multidisciplinary, assessments were on file, and the information had been used to devise the care plans. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 11 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, 8, 9 & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Care plans and keyworking are central to this home’s model of service. This benefits service users by promoting independence, risk taking, and rehabilitation. EVIDENCE: Two case records were examined in detail, along with daily, and keywork session, records. They were to an exceptionally high standard. Pre-admission information, including that collected during the visits, was used to carry out risk assessment. Based on this a risk management strategy was formed. Both processes balanced the wishes and aspirations of the service user, with protection of the community, other service users, and themselves. Any restrictions, such as conditions of discharge from hospital, were included. Individual care plans were then drafted, and agreed with the service user, who signed them. Rights and responsibilities were clear, as were the expectations of both service users and staff. The care plans were reviewed, with the service user, and often with their clinical team, on a regular basis. Keyworker Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 12 sessions focused on the care plans and how service users were progressing in meeting their goals. Care Programme review minutes were on file, and any changes, such as lifting of restrictions, were immediately incorporated into revised care plans. The care plans seen clearly stated how staff should respond to service users in known risk situations, such as self-harm. The other records seen, and Regulation 37 notifications sent to CSCI since the last inspection, demonstrated that staff consistently follow the guidelines. Service users reported that they felt fully included in the life of the home. They described the residents’ meeting as useful for sorting out practicalities, and planning activities. This meeting had very recently been reduced from weekly to every two weeks, with their agreement. Staff and residents commented on how policies and procedures were discussed in this meeting, and all views taken account of. An example was the times that visitors were allowed to be in the home. Following discussion at the meeting the leaving time at weekends had been extended. Service users were fully involved in staff recruitment by interviewing prospective staff. Staff were very aware of the need for confidentiality regarding service users. This included service users signing consent forms before any information about them could be used in NVQ portfolios, or they be involved with NVQ assessments. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to engage in age, peer, and culturally, appropriate activities. Rights and responsibilities are given a high priority, as is future preferred lifestyle. Staff assist and support service users to learn positive coping strategies. EVIDENCE: The two service users spoken to said that staff encourage them to do voluntary work and educational and vocational courses. Both preferred to ‘do our own thing’. This was mainly shopping, relaxing, and trips down Camden High Road. They felt that staff respected their wishes in relation to chosen lifestyle, but also continued to try and find information about interesting local events. The notice board in the kitchen contained this type of information. The service users, and staff, felt that the deployment of some staff to another home had affected some activities. In particular, going out for a coffee. Both groups felt that the more informal atmosphere provided an Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 14 opportunity for a different focus than the formal keywork sessions. Staff felt that they saw a different side to service users, who in turn appreciated the support in social situations. This is dealt with further later in this report. Another effect of the voids, raised by service users, was the increase in household chores, and the fact that other service users did not always adhere to the rota. They felt that staff did not always follow this up, but could understand that confidentiality would mean that staff could not always explain why it might not be in the best interest of a particular service user for them to do so. The manager reported that staff had been included in the cleaning rota. Keyworker session records demonstrated that service users are encouraged to take full advantage of the activities that the home provides. This includes aromatherapy, shiatsu, games evenings, video nights, and planned outings if at least three service users want to organise an outing with support. Visits to local gyms had been arranged as well as attendance at day centres, employment projects and colleges. The focus of the service is on supporting service users to make the very difficult transition from closed institutions, such as secure psychiatric units and prisons, into the community. The preferred future lifestyle of each individual is seen as crucial to the care planning system, and the service offered. This includes staff providing information about potential impact of such choices. The women have often ended up in the institutions because of previous self-destructive behaviour, and/or presenting a danger to others. Keyworker session records clearly demonstrated how effectively staff and service users work together to develop healthy lifestyles, and avoid future destructive behaviour and relationships. As stated previously in this report, service users had agreed a visitor’s policy and were able to entertain family and friends at the home. Any restrictions on access, either imposed as a condition of discharge, or at the wishes of the service user, were included in the risk assessments and care plans. Keywork session records reviewed these on a regular basis. Discussion of intimate and personal relationships was recorded in keyworker records. This included safe sex, availability of contraception, and service users’ wishes in relation to re-establishing contact with relatives, including their children. All service users are self-catering, with staff support if needed. They are encouraged to write weekly menus and shopping lists. They hand in shop receipts to their keyworkers who check if they eat a healthy and varied diet at keyworker sessions. If there are any concerns staff book the service user for healthy eating session. This is a one to one with staff member planning Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 15 shopping, cooking and eating meal together. Evidence of this was seen in the case files examined. Information seen in case files, and supplied by service users, demonstrated that planning for leaving the home is integral to the service. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 16 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): 18, 19 & 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users’ healthcare and support needs are met. They are encouraged to take responsibility for this, including administering their own medication. EVIDENCE: All service users are subject to the Care Programme Approach (CPA). This is a national policy and procedure for people with serious and enduring mental health problems. It attempts to ensure that service users’ health and personal care needs are met in a co-ordinated, and where necessary, multiagency and disciplinary way. Copies of all CPA review were seen in the two files examined. Care plan changes had been made following decisions made in the review meetings. Keyworkers had followed these through in their weekly sessions. The home does not offer direct personal and intimate care, such as assisting with bathing. Staff do, however, support service users in meeting their own personal care and health needs. There were examples in the records seen of staff encouraging service users to access appropriate community services, such as GPs, Dentists, and district nurses. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 17 The home offers practical support, advice, and guidance for service users, but not counselling. Staff and service users were very clear that if this was required the staff would support service users to access specialist services. Service users said that staff worked closely with their community mental health nurses. They also said that it was their choice whether the nurse visited them at the home or they went to their base. The records seen supported this view, but also demonstrated that there was very good communication between the home and the nurses where necessary. All service users work towards self-medication in line with the medication policy and agreement of their clinical team. The policy and procedure was examined. It was comprehensive, and included risk assessment, and consent forms signed by the service users. A weekly audit of medication received and administered was carried out. There were always two members of staff administering medication, with the office door locked. The manager, and staff member who holds delegated responsibility for medication, reported that there was no longer a visiting pharmacist. There had been but this had ceased mid 2006. Because of this, and the complicated nature of the current recording system, a CSCI pharmacist will shortly carry out a separate inspection, in order to assist with service improvement. Their findings will be incorporated into the next key inspection report. The manager and staff welcomed this initiative. Compliance with medication is given a high priority at this home, because of the nature of known risk factors, when medication is not taken. In addition, service users are often on complex medication regimes, which may produce negative reactions. There was evidence in case records of staff persistence in trying to persuade service users to take medication. There was also evidence of staff contacting members of clinical teams where their persuasion was failing. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 18 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 excellent. This judgement has been made using available evidence including a visit to this service. Service users’ views are listened to, and they are protected from abuse, neglect, and self-harm, as far as possible. EVIDENCE: The complaint, incident, and accident, records were examined, and crossreferenced with case files. Two members of staff, and two service users were asked for their views. The information provided by the manager prior to the site visit was compared with the findings. All complaints and concerns are taken seriously and logged. The log details the nature of the complaint/concern, how it will be dealt with, and the outcome. Issues raised are then carried through into the keywork sessions. They are also discussed in staff and resident meetings. There is a zero tolerance of bullying and harassment, of either service users or staff. The evidence seen demonstrated that these types of issues are dealt with sensitively. Service users reported that staff are effective in mediating where there are disputes between service users. In response to a recommendation made at the last inspection staff have had further training in adult protection. They have also had training in domestic violence, self-harm, and other related subjects. The service user group at this home are in the high-risk category for self-harm, both physically, and emotionally. Case records, including keywork sessions, demonstrated that staff work closely with service users, and clinical teams, to reduce incidents. Care plans included appropriate action by staff in such situations. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 19 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable, homely, and clean, environment. EVIDENCE: Part of the building was toured, including two bedrooms, at the invitation of the service users. Both were very pleased with the environment of their bedrooms and the communal areas. Both had chosen the colour scheme of their rooms, and were appreciative of staff having bought furniture for them. One staff member was carrying out quality surveys with past service users. She reported that the homely environment was one of the things that people were commenting positively on. The home cannot accommodate people with mobility difficulties, as there are steps to the front door, and the accommodation is over five floors, with no lift. There are two bathrooms, one shower room, and one toilet. There is a smoking lounge, activity room, non-smoking lounge, and a large kitchen, where a lot of socialising goes on. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 20 The areas seen were clean. Some repainting was needed in hallways and stairwells, but as this has been included in the budget for the next financial year no requirement has been set. Progress on this will be checked at the next inspection. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 21 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 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a competent, well trained, and supported, staff team. However, recent reductions in staffing, in response to voids (vacancies), is resulting in a lowering of staff morale, and efficiency. EVIDENCE: Two staff members were spoken to, as well as the manager. Two service users were asked their views. The judgement is also based on the written records seen during the site visit, and Regulation 37 notification sent to CSCI since the last inspection. Service users said that the best thing about the home was the support they got from staff. They said ‘they are always available’, and ‘knowledgeable’. ‘Can go and talk to them about anything, very nice, knowledgeable about needs, they get training to look after us. Sensitive to needs, good support’. A requirement was set at last inspection to submit an overall training plan, which identified the training needs of each staff member and training which had been completed or was proposed to meet those needs. All staff have Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 22 recently had formal appraisals, which included identifying training needs. The annual training plan, due to be published shortly, is based on those needs. Training received since the last inspection was recorded in the two staff files seen. The training programme includes team training, which is service specific. This has added value in providing opportunities for team building, and a focus on the specific needs of the service users. Training during the past 12 months has included diversity, adult protection, first aid, hearing voices, working with adults who have been sexually abused, personality disorder, advanced drug awareness, fire warden, recruitment and selection, risk assessment, drug and alcohol, self-harm, and medication administration . Six members of staff have NVQ3, with four due to submit portfolios by May 2007. The home has therefore achieved the required standard. Further training is planned on personality disorder, dealing with violence and aggression, care planning and key working, and disability awareness training. A requirement was set at the last inspection to ensure that there was full and satisfactory information available for each member of staff to show that the recruitment and selection process was robust and thorough. Personnel files are kept at head office, but a summary of personnel information is now being kept on site. The two checked on this visit had all required information. Case records demonstrated that staff had a sound knowledge of the needs of women with forensic histories and rehabilitation. Race, cultural, and religious heritage were seen as central to keyworking. This is particularly important in this type of service as negative self-image and low self-esteem are known factors in people who exhibit self-destructive behaviour. The staff team is culturally diverse, as is the service user group. It is an all female staff team, which is important, as many of the service users will have histories of abusive or violent relationships with men. The team receives three weekly group supervision provided by a senior forensic psychologist. These sessions are used to discuss the individual needs of service users, and how staff can work constructively, and consistently, with them. This is an excellent resource for this home, as many of the service users will push boundaries, particularly when their anxiety levels are high. This may result in self-harm, or harm to others, which staff have to manage safely, whilst also supporting the service user to take responsibility for their actions. The opportunity for reflection on practice is very positive for both the staff and the service. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 23 Staff reported that one-to-one supervision had been very regular till late last year. The manager confirmed that this was one element of staff support that had slipped, due to staffing changes. Individual appraisals had taken place for all staff, and one-to-one sessions had been held with a newer member of staff. Regular staff meetings, handovers, informal discussion, debriefings following serious incidents, and group supervision had continued. However, regular one-to-one supervision for all staff is important, particularly when working in this type of home. This is Requirement 1. The staffing changes were the temporary move of the assistant manager and two workers to other projects, and the freezing of the administrators post. These changes were made in response to the level of voids, and corresponding reduction in income. Service users and staff commented on the negative effects of these, temporary, arrangements. Service users and staff felt the loss of informal one to one time, such as going out for a coffee. Rotas had become more difficult to organise, resulting in some long days and split days off. This, and the uncertainty about the future of the home if the level of voids continued, was resulting in a lowering of staff morale. In the circumstances staff are to be commended for remaining so committed, and professional. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 24 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 & 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well managed home, which is run in their best interest. However, the level of voids, and subsequent staffing reductions, places the service at risk. EVIDENCE: Evidence in previous sections of this report demonstrates effective management. This includes excellent record keeping, risk assessment and management, and a committed and knowledgeable staff team. The provider self-assessment was comprehensive and informative. A very positive point being that the staff team had been involved in compiling it. Individual staff have delegated responsibility for important tasks, such as medication and health and safety. This helps in team working, commitment, and staff development, as well as ensuring that standards are maintained. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 25 A requirement was set at the last inspection that there must be a review of quality of care. This included an annual survey of service users and the production of a report, made available to the service users. The manager reported that such surveys are undertaken on a six monthly basis. A copy of the results of the most recent was seen pinned to the notice board in the kitchen. In addition one member of staff, as part of their personal development objectives, was carrying out a post-discharge quality survey. This was comprehensive, as it included women who had been readmitted to hospital, as well as those who had gone on to more independent lives. A sample of health and safety records were examined, and found to be in order. Regular in-house checks are carried out. Risk assessments were in place where needed. As stated earlier in this report the home has had a high level of voids for some months. This, obviously, affects income. To address this the provider had transferred some staff to other projects, and frozen one post. The manager reported that strenuous efforts had been made to seek new referrals. This included contacting all initial enquirers, who had not followed up by referral, and interim and secure units. There were women on the waiting list, whose needs the referral panel felt the home could meet. A combination of clinical disagreement and concern about costs were contributing to delays. The continuing voids, and staffing changes, have a negative effect on the service. Anxiety about the future of the project affects staff morale, and ultimately service users. The provider needs to demonstrate that they have contingency plans for the financial viability of this home. This is Requirement 2. Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 26 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 3 2 4 3 3 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 4 LIFESTYLES Standard No Score 11 4 12 4 13 3 14 3 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 X 4 X X 3 2 Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 27 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 YA36 Regulation 18 (2) Requirement The Registered Manager must ensure that staff receive appropriate one-to-one supervision. The Responsible Individual must provide the Commission with a written report on the financial viability of the home. This must include how they intend to ensure business continuity if the level of voids continues. Timescale for action 31/03/07 2 YA43 25 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU 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 © 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 Oakley Square Project DS0000010344.V288147.R01.S.doc Version 5.2 Page 29 - 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. 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