Inspection on 30/08/06 for Oakmead

This inspection was carried out on 30th August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oakmead 20/08/07

Oakmead 26/10/05

Oakmead 22/11/04

Oakmead 05/05/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Oakmead 19 Worlds End Lane Weston Turville Bucks HP22 5SA Lead Inspector Gill Wooldridge Unannounced Inspection 30th August 2006 1:00 Oakmead DS0000023075.V302375.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 Oakmead DS0000023075.V302375.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. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakmead Address 19 Worlds End Lane Weston Turville Bucks HP22 5SA 01296 615578 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) michelleread@parkside.org.uk Turnstone Support Limited Michelle Elaine Read Care Home 5 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 residents between 18 - 65 with a learning disability and/or physical disability 26th October 2005 Date of last inspection Brief Description of the Service: Oakmead is a small home providing care and accommodation for up to five younger residents with physical and learning disabilities. The home works with residents to ensure that they are as independent as their abilities enable them to be. This may mean that, further to assessments, residents could be supported to live independently in their own homes. At the time of this unannounced inspection, there were five residents, who all happened to be male, residing at Oakmead. The home is situated in the village of Weston Turville, close to the market towns of Wendover and Aylesbury. Residents avail themselves of the locally based amenities and are within a short journey of Aylesbury itself. Oakmead is a large detached dormer-bungalow, which has five single rooms and communal space situated on the ground floor. There is a dormer area to the bungalow where the office and sleeping-in accommodation for staff is situated. The home has its own vehicle to transport residents and there are ample parking facilities for approximately a further three vehicles at the front of the property. From the driveway there is easy access into the home and there is an enclosed garden to the rear of the property. The current scale of charges is £1,611.54. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days. The inspection consisted of discussions with residents, tracking their care and viewing other relevant information, observing staff interactions with residents and assessing all the key standards. The second day focused on the residual key standards not inspected during the first day and on studying information not available during the first day of the inspection. The opportunity to discuss issues with residents was taken on the second day of the inspection. All residents and many staff, including the senior support worker, were spoken with over the course of the two days. Both visits took place in the course of the early afternoon of 30th August and 4th September 2006. As part of the inspection process comment cards were received from residents’ relatives and health and social care professionals. All comments received were favourable. The inspector would like to thank the residents, staff and deputy manager for facilitating the inspection and for their hospitality. What the service does well: Most residents support plans were noted to be well considered and there is a link worker system in place. There are forums where residents can participate in the decision making process of the home. There are some detailed risk assessments that outline residents’ assessed vulnerabilities. Staff recording practices are generally good. The home is visited each month by an independent advocate. Residents are able to access a wide range of social and leisure amenities. The home benefits from good, supportive neighbours. Residents are able to invite friends and relatives into the home and visiting times are flexible. Privacy and dignity is promoted within the home. Staff described regular training, which influences their practice. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 6 The vulnerability of residents is safeguarded by policies, procedures and staff training. Residents appear confident of their position within the home. Oakmead provides residents with a comfortable environment. The home works in line with a clear system of recruitment. Staff described a supportive manager who recognises the value of regular supervision. Medication procedures within the home are robust. Residents and staff did not appear phased by the inspection process. Staff interactions with residents were positive and spontaneous. What has improved since the last inspection? What they could do better: One support plan needs to be updated to reflect the resident’s present situation. Residents’ goals should be part of all care plans. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 7 Medication procedures need to be more robust with a more detailed audit with records maintained. Some risk assessments must be reviewed more frequently. A senior staff induction must be developed into a format to ensure that senior staff understand their responsibilities to residents and record. Confidentiality and the home’s adult protection policy should be in a format for residents to understand more fully. Quality assurance systems need to be developed further and involve residents to ensure that the service is resident focused. The organisation should review its internal recruitment procedures to ensure that it is in line with current PoVA Regulations and best practice. 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. Oakmead DS0000023075.V302375.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 Oakmead DS0000023075.V302375.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The opportunity to visit the home prior to admission is an integral part of the admission process, which should mean that residents are orientated to the environment and have met, and are familiar with, staff and other residents before admission to the home. EVIDENCE: Residents and staff spoken with stated that there had been no new admission to the home since the last inspection. Documentation seen at the previous inspection indicated that the last admission to the home was a gradual process and the resident described enjoying living at Oakmead. This was confirmed again at this inspection. Although at the previous inspection the assessment sampled was detailed in parts, not all of the form was completed and there was no follow through care plan/support plan. This detail is now included. At the previous inspection staff and the managers described good practice with regard to the admission process. This good practice should be developed into guidelines for staff to support residents’ care. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 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 the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. One care plan/support plan needs to be developed to ensure that this represents the resident’s present situation. There are several forums where residents can participate in the decision making processes of the home. The lack of information in risk assessments has the potential to place residents at risk and restrict their independence. EVIDENCE: Three care plans were studied and the care of these residents tracked. Generally the detail was clear and residents’ personal goals were included in some care plans. In addition there was guidance as to how the goals can be achieved via staff support. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 11 A number of care plans were being updated with written notes on file. These notes should be incorporated fully into the care plans. Staff indicated that work is in progress regarding the care plans. The care plans indicated a lack of some signatures. However, some documentation is held in the residents’ bedroom and through discussions it is evident that they had been involved in the process. The format of some care plans needs to be developed further as described by staff and they need to be accessible to residents. At the previous inspection the use of some language was noted as inappropriate. This was not apparent in the documents studied at this inspection. At the previous inspection it was strongly recommended that the manager develop and support the process of person-centered planning. There was some evidence that this had been discussed with some residents and, in discussions with residents, it was unclear that they understood the concept. The process of person-centred planning should involve the people important to the resident. Although this was in a written format it was not clear that the residents had been involved in the process of identifying these people. One member of staff described having had training in this area but was not a facilitator. The organisation must support the process by training for residents and staff. Risk assessments identified the perceived hazards to residents and were inclusive of more control measures than noted at the previous inspection. However, this area of the residents’ care must be developed further to encourage residents’ further independence. The manager must ensure that no resident is restricted in their wishes or goals. Any perceived restriction of liberty must be discussed in a multi-disciplinarily forum. One resident’s present situation was not clearly described in their care plan or in a risk assessment. Although it was evident that the resident had been referred to support for a particular element of their care and there had been a recent review, there were no notes of the review meeting taken by staff and the service manager stated that they were waiting for the care manager’s minutes. It is strongly recommended that the home also takes notes of all meetings pertaining to residents’ care and hold these on file. Training in risk management for residents and staff should take place. Regular review of the documents along with discussion in a multi disciplinarily setting is necessary to support risk management. Residents are encouraged and enabled to make some decisions about the way they live their lives via monthly residents’ meetings. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 12 Two residents predominantly manage their own finances. One resident described that they don’t like staff to check very often and, ‘I will ask them to do so’. Secure facilities are provided within individual’s bedrooms so that residents are able to keep their monies and any valuables safely. An independent advocate visits the home regularly. One resident described the introduction of a new advocate. Staff described the residents taking a more active role in the discussions in formal and impromptu sessions. One resident described reporting a repair to a kitchen cupboard or drawer. He was supported by staff to do this which is noted as good practice. Residents hold their own front door and bedroom door keys and those who require support to use them receive it from staff. Residents, by virtue of their observed behaviours and verbal confirmation, clearly actively participate in the day-to-day running of the home and take part in the recruitment of staff during the informal stage. Oakmead DS0000023075.V302375.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are able to access a wide range of amenities which meet their social, leisure and spiritual needs. Visitors are encouraged and residents have regular contact with family and advocates which should ensure that residents have appropriate relationships. Residents are supported to develop their own menus and participate in some cooking tasks which promotes independence and choice, whilst at the same time reinforcing independent living skills. EVIDENCE: Residents described a number of community activities such as attending college, and social activities such as bowling and going to the pub. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 14 The residents are supported by a visiting Connect Team at Turnstone Support’s Aylesbury office, which supports the residents in a number of activities. Residents are encouraged and supported to carry out independent living skills such as laundering, vacuuming, etc. The Connect allocation for Oakmead is five hours per week and is allocated to individual residents to facilitate their choices, such as occasionally using the multi-sensory room at Turnstone and art and craft sessions. Residents described staff supporting them in these sessions. One resident described their hobbies and interests and this was evident from them showing the inspector their bedroom. One resident is in part-time employment on a one-year contract. Residents described social activities including visits to the local pubs, cinemas, library and the leisure amenities in Aylesbury. Residents also attend clubs and classes that appear to meet their individual aspirations. The home has its own transport, making access easier. Residents confirmed that they were well supported by staff in accessing community-based amenities and also talked animatedly about their forthcoming trips out and plans for their holidays. Two residents had been to Watford shopping and talked freely about their purchases; they had been supported by two staff members. Two staff had stayed in the home and facilitated a game of skittles and croquet, which the residents had initiated. Further to this, during a cup of tea, staff had encouraged residents to look at the newspaper and initiated a quiz to make this fun. One resident listening to his music appeared disinterested. However, they joined in with some great answers. It was strongly recommended at the previous inspection that the manager regularly assesses residents’ dependency needs. The home has some systems to support this. However, systems need to be developed further. This will ensure that resident’s individual social and recreational needs and a move to more independence are always fully met by the appropriate deployment of staff. There is a personal relationship and personal boundaries policy in place which has been studied previously. The manager described that good practice and positive reinforcement was discussed in staff meetings. Residents confirmed that they are able to invite friends and relatives into the home. One resident described having a girl friend. Sexual feelings are discussed appropriately and residents supported as necessary. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 15 During the inspection staff interactions were observed and one resident grabbed a member of staff inappropriately. This was handled sensitively and appropriately with firm boundaries. A few moments later the resident asked for a cuddle which was appropriate and this was willingly given by the member of staff. Staff practice was discussed later and their concerns for the resident’s behaviour are being explored. The detail described needs to be included in the resident’s care plan. Staff clearly understand about professional boundaries and positive reinforcement. There are no hard and fast rules for the residents although they are reminded about appointments, etc that need to be attended and the right that other residents have to a quiet environment during the course of the late evening and night. With the exception of other bedrooms, residents have unrestricted access to all areas of the home and garden. The detail of this was included in one resident’s care plan. The conditions of occupancy are outlined within the service users’ guide and contracts which are available in each resident’s bedroom - staff occasionally explain these to residents. Residents described family visits and going home as very important to them. This was detailed on an activity chart in one resident’s bedroom. Relatives’ comment cards received at the Commission indicated that the home is ‘exceptional’ and a further card stated that their relative receives ‘exceptional care’. One resident was overheard to be chatting to their family, and staff were heard to encourage them to do this as often as they wished. Although residents had completed comment cards and said that they only liked living in the home ‘sometimes’, when this was discussed with them it was not apparent why they said ‘sometimes’. Staff described that smoking is not permitted in the house and separate arrangements would be made for individuals who wish to smoke. Alcohol is permitted. Residents plan their own menus and, as part of the independent living skills initiative, do undertake some simple cooking tasks. Residents generally dine in the lounge/diner. Staff were noted to offer residents choices regarding lunch, and residents were encouraged to be involved in the preparation of the evening meal. Oakmead DS0000023075.V302375.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Healthcare support for residents is documented, which should mean that their health and well-being is promoted and protected. Medication procedures within the home are robust. However, staff practice is not consistent which has the potential to place residents at risk. Residents’ privacy was generally observed to be respected. EVIDENCE: Staff do not directly care for residents but do provide them with encouragement and support to live their lives as independently as possible. Residents are allocated a link worker who supports them to shop for clothing, undertake personal business, assists them with the independent living skills initiative and tempers the support given to them in line with personal goals. Bedrooms provide single room accommodation and, although they are not fitted with en-suite facilities, all are within close proximity of the communal bathrooms and toilets. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 17 Any direct care that is required by residents is identified on their individual plans and undertaken within the privacy of their bedrooms or bathrooms. It was noted that the promotion of residents’ independence, individuality and fulfilment was paramount, although not knowingly pressed upon them. The manager confirmed that all staff who are new to their posts are inducted to their roles. Further to induction and foundation training, staff undertake care practice training and NVQ, which promotes core values. Records viewed indicated that residents’ health care needs are met. Medicines are securely stored in an appropriate wall-mounted cupboard away from the residents’ living accommodation. Medications are not always administered in line with the organisation’s medication policy. Some inconsistencies noted showed that staff were, on occasions, writing over an entry and not always recording creams administered. Staff had filled in a number of gaps in the time between the days of the inspection. All staff are trained to the organisation’s core medication administration standards and thereafter receive update training regularly. At the previous inspection the manager was required to check the competency of staff practice in the administering of medication. Staff spoken to stated that the manager regularly checks their practice. The manager must develop further a medication audit system which addresses inconsistencies, ensuring that practice issues are addressed with staff and a record is maintained. Since the inspection the senior support worker has sent to the Commission an outline of how medication systems will be improved and that there are plans in place to move forward residents’ independence in managing their own medication. The manager must review the process of medication administered to residents to ensure best practice and ensure that there is a system for checking and counting medication received when residents return from leave at their family homes. Further to this the manager needs to review the storage of scheduled drugs such as Diazepam. Staff are strongly recommended to ensure that where they make hand written entries on Medication Administration Record sheets, these are supported by two staff signatures. The manager should remind staff not to use ‘typex’ on any care documents, including medication records. At the previous inspection the procedure for rectal diazepam was discussed and the procedure was to be developed further and a system be put in place to ensure that staff responsibilities are clear regarding this issue. Records indicated that this was now in place and one resident’s wishes were clearly described as part of the process. This is noted as good practice. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 18 Staff have started to discuss with residents the process of self medication. This must be supported by a risk management framework and discussions with the resident’s GP and other interested parties. One resident has a care plan and risk assessment in place for self-medicating although this has not yet been initiated. Control measures and risks need to be identified and the review of the process is advised as monthly or more frequently as the resident and staff decide. The manager has developed a protocol to protect one resident’s privacy regarding the use of an intercom system. Good practice guidelines and discussions with the residents to support their care is in place. However, the protocol needs to be developed further to ensure best practice. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There are some clear systems in place for enabling residents to make their opinions known of the service provided at the home, therefore making them feel valued, promoting their individuality and enhancing their self-esteem. There is a range of policies and procedures along with well informed staff. This should mean that residents are protected. EVIDENCE: There are separate policies and procedures that cover concerns, compliments and complaints. All were updated in November 2004. The policies have been replicated for residents’ ease of use, using symbols and the contents generally explained. Two concerns were noted in the appropriate folder and these were discussed with the senior support worker. The outcomes of these concerns were not clear although were described clearly by the senior support worker. Good recording and clear outcomes are necessary to ensure an audit trail. No comments or complaints have been received by the Commission during the last twelve months. Discussions with residents indicated that they had clear understanding of their rights and how their opinions could be voiced. Residents stated that they felt well supported by the staff and manager. From observations it is clear that residents are comfortable within Oakmead’s environment and are confident of their positions within the home. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 20 Oakmead currently has Careline advertised within the home. The office has a current Careline folder in place with a leaflet on the noticeboard, and all service users have a copy of the Careline leaflet in their service user guides, which they keep in their bedrooms.. Staff described actions that indicated that residents should be protected from abuse, by their actions and in line with the home’s policy, if any potential or actual abuse is suspected. Staff were also able to describe the signs of distress and behaviour that residents may exhibit if being abused. Residents store small amounts of money safely in lockable facilities. Two residents’ finances were checked and the records tallied with the amounts held. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Oakmead has a comfortable environment designed to meet their care and comfort needs. Standards of cleanliness at the home are good, meaning that residents live in an environment that is clean and hygienic, which should protect their health, safety and welfare. EVIDENCE: Oakmead is a dormer bungalow situated in a residential area of Weston Turville, which is close to the market towns of Wendover and Aylesbury. The home is set slightly away from the main road and has user-friendly access. The home has a communal lounge/diner, kitchen and laundry. Since the time of the last inspection the home has maintained its environment. With regard to the safety of the home please refer to Standard 42. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 22 Residents’ accommodation provides single rooms which are situated on the ground floor. Bedrooms showed evidence of individual personalities, hobbies and interests. Residents confirmed that they were happy with the private and communal areas within the home. There are two bathrooms, one with a walk-in shower facility. All areas on the ground floor are accessed via the large, bright entrance hall. Residents described having a new lounge carpet in recent weeks. The staff sleep-in accommodation and the home’s office are situated in the dormer part of the bungalow, away from residents’ areas. The home is well furnished throughout and has undergone some refurbishment, including the redecoration of one bedroom and the redecoration of some communal areas. All areas of the home were clean, tidy and free from offensive odours during the course of both days of the inspection. As part of the independent skills initiative residents are encouraged to maintain their own bedrooms and undertake their own laundry. The garden is used by the residents frequently with skittles and croquet encouraged and obviously enjoyed, with residents taking the lead in scoring. The garden is tidy and well maintained. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents generally benefit from well informed staff, which should ensure that their care and support needs are appropriately and effectively met. Recruitment procedures need to be developed to ensure best practice and ensure that residents are supported by safe systems. A continued emphasis on training should ensure that residents’ needs are met. EVIDENCE: The senior support worker described regular one-to-one sessions to support her development. However, it was not evident that there is a senior formal induction format. This practice area needs to be developed. It is acknowledged that the senior support worker had undertaken some training to support her in her role. It is acknowledged that the staff on duty were knowledgeable regarding the care of residents and indicated that they were aware of good practice, encouraging residents’ independence and risk taking. Further developments in best practice are to be encouraged and developed. This should be supported by training for residents and staff. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 24 Records viewed indicated that the agency staff used in the home do not have all the appropriate training to meet residents’ needs. This was discussed during the inspection. Rotas seen indicated that staffing levels are satisfactory to meet residents’ needs. The present staffing levels indicated three staff on duty in the day and evenings with one staff sleeping in at night, supported by a waking night staff. The senior support worker explained that if residents were on home leave at the weekend, then staffing levels are reduced. A contingency plan should be in place in case a resident returns to the home early. he service manager described residents’ recent reviews where it was decided that one resident’s one-to-one time could be reduced but still leaving appropriate time for one-to-one care, in fact around over 80 hours. This issue was discussed in light of the resident’s recent behaviour. Discussions took place regarding the balance between promoting residents’ independence and self-actualisation and supporting residents and disabling them with too much staff support. As described earlier in the report, it is strongly recommended that the manager assess regularly residents’ dependency needs and ensure that their individual social and recreational needs are met by the appropriate deployment of staff to encourage their independence. Records should be maintained. This should be discussed and reviewed again at the next inspection with residents, staff and the manager. Training and supervision described by staff spoken with appears to be given a high priority by the organisation and staff described feeling valued with excellent training. Five staff have gained their NVQ award Level 2 or 3 and there are three staff working towards their award. One staff member has completed a Learning Disability Award Framework [LDAF] award which is noted as good practice. Other staff described wishing to undertake LDAF training. The service manager stated that staff training is in line with LDAF. It is strongly recommended that LDAF training is offered to all staff. Training for agency staff was a requirement of the previous inspection to ensure that all staff have the skills to meet residents’ needs. The organisation needs to look at the supply of agency staff and ensure that all staff employed in the home have the necessary skills to meet residents’ needs. It is acknowledged that Turnstone has provided agency staff with some training. From studying the training matrix, not all staff have completed all the mandatory training. All newly appointed staff must have a programme of training in place which will need to be completed within six months. Any gaps in staff training must be identified and planned for in the coming months. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 25 Recruitment files of two staff were viewed and information held by the home from an agency was also studied. The two permanent staff files both had application forms, CRB clearances and two references. Induction and supervision records and some certificates were also on file. One member of staff was an internal transfer from another service within Turnstone. It is strongly recommended that the manager attains a recent photograph of all members of staff. The organisation should review its internal recruitment procedures to ensure that it is in line with current PoVA regulations and best practice which should include a reference from the previous manager. The home’s check list should also include checking the authenticity of references. This may also necessitate a review of the organisation’s recruitment policy. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 26 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): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is a relaxed atmosphere in the home which should ensure that residents benefit from a well run home. Quality assurance systems need to be developed to support the care of residents. Health and safety records need to be maintained more rigorously to ensure that shortfalls do not have the potential to place residents at risk. EVIDENCE: The manager appears to be supportive of staff and promotes residents’ independence in an apparent safe environment. This encourages comment and the staff team was receptive to ideas regarding good practice, discussed during the inspection. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 27 Turnstone Support has recently developed a formal system of quality assurance which needs to be developed to ensure that care plans and medication systems meet the standard and that residents are involved in the process. Monthly regulation 26 reports are sent to the Commission. The home’s accident/incident records generally showed some clear recording. This needs to be supported by an audit system and risk management plans to support the care of residents. At the previous inspection the manager was required to ensure that no fire door is held open except with a device agreed and approved by the fire department. It was noted that a door guard had been fitted and is supported by a risk assessment. The records of checks described in the risk assessment and other fire related documents showed some gaps. The senior support worker confirmed that these checks had taken place although had not been recorded. It is strongly recommended that staff are reminded of their accountability and instructions for staff to follow regarding their responsibilities regarding health and safety checks and that an an audit system supports the process. The manager confirmed in the pre-inspection questionnaire that the home does not have a Legionella certificate. The manager must check that the law does not require the home to have a Legionella certificate from an approved contractor. Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X 2 3 X 2 X X 2 X Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 YA9 Regulation 13 (4) (a) Requirement The manager must ensure that one resident’s individual risk assessment is developed and supported by staff training and a detailed care plan as detailed in the report. The manager must ensure that staff follow the home’s medication procedure. This must be supported by training for staff, developments in the home’ quality audit system and the manager reminding staff of their accountability with records maintained. The manager must ensure that agency staff and newly appointed staff are appropriately trained to meet residents’ needs. The manager must ensure that senior staff have an induction system that is supported by the appropriate forms. Timescale for action 30/09/06 2. YA20 13 (2) 30/11/06 3 YA35 18 (1) (a) 31/12/06 4 YA31 18 (1) (a) 31/12/06 Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA2 YA6 YA6 Good Practice Recommendations It is strongly recommended that the manager develops the admissions policy to reflect described staff practice. It is strongly recommended that all care plans are signed by residents or their representatives. It is strongly recommended that the manager develops the care planning process to encompass the good practice of person-centred planning and this is supported by training for residents and staff. It is strongly recommended that the manager develops the process of residents’ further independence. The manager should ensure that no resident is restricted in their wishes or goals. It is strongly recommended that the manager develop further a protocol for the use of the baby monitor. It is strongly recommended that the manager develops further the risk assessments to support residents in the process of self medication. This should be discussed with the resident’s GP and other interested parties. It is strongly recommended that the manager records clear outcomes regarding any complaints to ensure an audit trail. It is strongly recommended that the manager has a contingency plan in place regarding staffing levels, in case residents return to the registered home early from a weekend break. It is strongly recommended that the manager assess regularly residents’ dependency needs and ensures that their individual social and recreational needs are met by the appropriate deployment of staff to encourage residents’ independence. 4 YA9 5 6 YA18 YA20 7 YA22 8 YA33 9 YA33 Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 31 10 YA34 It is strongly recommended that the manager attains a recent photograph of all members of staff on file. The organisation should review its internal recruitment procedures to ensure that it is in line with current PoVA regulations and best practice, which should include a reference from the staff member’s previous manager. The home’s recruitments check list should also include checking the authenticity of references. This may also need a review of the organisation’s recruitment policy. 11 12 13 YA35 YA39 YA42 It is strongly recommended that the organisation plan to include LDAFF in their training prospectus. It is strongly recommended that the manager develop further the home’s quality audit systems. It is strongly recommended that the manager develop an audit system to review the home’s accident/incident records. This needs to be supported by a risk management plan to support the care of residents. It is strongly recommended that staff are reminded of their accountability and instructions for staff to follow regarding their responsibilities regarding recording health and safety checks and that an audit system supports the process. It is strongly recommended that the manager check that the home does not need a Legionella certificate from an approved contractor. 14 YA42 15 YA42 Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oakmead DS0000023075.V302375.R01.S.doc Version 5.2 Page 33 - 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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