Inspection on 03/01/08 for Oaktrees

This inspection was carried out on 3rd January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Oaktrees 01/03/07

Oaktrees 20/02/06

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Oaktrees Warboys Road Oldhurst Cambridgeshire PE28 3AA Lead Inspector Shirley Christopher Unannounced Inspection 3rd January 2008 10:00 Oaktrees DS0000065459.V357247.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 Oaktrees DS0000065459.V357247.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. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oaktrees Address Warboys Road Oldhurst Cambridgeshire PE28 3AA 01487 822878 01487 822878 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) CareTech Community Services (No.2) Ltd Ms Ann Footitt Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 2007 Brief Description of the Service: Oak Trees is a large detached house situated at the end of a cul-de-sac in the attractive village of Oldhurst. The home is set back from the road in mature tree lined gardens. The secluded rear garden gives people who live at the home a private, safe outdoor space. There is a large conservatory providing a lounge and a dining area, and there is an additional lounge. Bedrooms are found on the ground and first floors, are all for single occupation, and are decorated to reflect the occupants personalities. The village amenities are within walking distance but these are limited. All other amenities in local towns of St Ives, Huntingdon and March are accessed by the homes transport or local bus service. The fees for the service range from £1,100 to £1,625.00 a week. This does not include leisure or transport costs. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We, the Commission for Social Care Inspection carried out a key unannounced inspection to this service, arriving just after 10.00 am and leaving at 13.20. At the time of the inspection the registered manager was on duty. As part of the inspection we spoke to staff and the manager, looked at a number of records and looked round the home. We met the people who live at the home briefly as they were going out to organised daily activities. The manager had completed a detailed Annual Quality Assurance Assessment form, (AQAA) last summer and a copy was available during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Records were in place addressing how people’s needs are to be met. A monthly summary of needs was in place and written documentation was comprehensive. All staff must be familiar with how to meet people’s needs and with the policies around dealing with difficult or challenging behaviour. Any goals identified in people’s reviews must include a plan of action and timescales for action. Risk assessments seen for one person were basic. They looked at generic risk and did not reflect specific risks to this person. These should be modified. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 6 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. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to ‘test drive’ the home before admission and the home makes it clear how it will meet people’s needs and aspirations. EVIDENCE: The manager confirmed that the service user guide and statement of purpose was updated annually or when there had been a change to the service, such as a fee increase. The manager said in the last year, two people had moved into the home. We saw a pre- admission assessment in respect of one person. The manager stated that the assessment process was ongoing. This was supported by written documentation, which demonstrated that needs are kept under regular review. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support plans clearly identified people’s assessed and changing needs, but not all staff are familiar with these. EVIDENCE: We case tracked one person. The case file included an individual support plan, which detailed the person’s needs and how the home intended to meet these on a daily basis. The plan had been regularly reviewed and future goals had been set. From the information we saw it was not clear who was responsible for ensuring goals were put in to action and what the timescales for them were. Risk assessments were in place and had been reviewed. Risk assessments should be adapted to reflect the specific risks to the individual and look at specific activities and behaviour. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 10 The home is well staffed and people are supported in activities of daily living. We spoke to several staff who stated that some people who live at the home might exhibit challenging behaviour. All staff must be clear about how to deal with difficult behaviour and be aware of any protocol in place. Training in dealing with challenging behaviour must be given to all staff. One member of agency staff had completed training through the agency she was employed with in managing challenging behaviour, but this may be incompatible with the training provided by Care Tech. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to participate fully in the home and in the wider community according to their expressed choices and wishes. EVIDENCE: People’s social needs and preferred routines are documented. The home is sufficiently large to enable people to have time on their own or with others. All people have regular contact with family members and the manager stated that family members were supportive. Contact has in the past been made with advocacy agencies, but it was felt that at the present time people were sufficiently supported. On the day of inspection people were engaging in a range of activities appropriate to their needs. The home provides opportunities for people to Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 12 pursue leisure opportunities, learn new life skills and to have work experiences. Menus are recorded and people record their food intake. Weight records are recorded. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s health care needs are recorded and met through staff, health and social care agencies. EVIDENCE: Assistance is provided with personal care as required. This is documented in each person’s personal file. Health care needs are recorded and we saw evidence that needs are met in a comprehensive way. Input is provided through a range of health care professionals. One person’s record was case tracked including their medication. Medication is kept under review and the medication recording sheets were accurately completed. The back of the sheet is used to record any discrepancies. Photographs of each person are included on the MAR sheet. Training is provided to all staff and medication audits are completed internally. None of the people who live at Oaktrees administer their own medication, although one person administers their own insulin under supervision. Staff are appropriately Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 14 trained in the administration of rectal diazepam. A number of people are written up for medication when required, (PRN.) There are protocols in place for this, but these were brief. The manager stated that they were being rewritten and then being sent to the doctors for their signature. On the file we inspected the person’s last wishes in the event of their death were not recorded, but evidence was provided that this had been discussed. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safeguards are in place for the protection of vulnerable adults, including clear policies, risk assessments, quality assurance tools and staff training. EVIDENCE: The home has a clear safeguarding adults policy, which was reviewed last year. The home notified the appropriate agencies of an adult protection issue in 2007. Meetings were set up to deal with the issues in the most appropriate way. The manager stated that staff complete training in safeguarding, which is provided on a rolling programme. Safeguarding training should be provided within the induction period, wherever possible. The home has an accessible complaints procedure. No complaints have been received in the last twelve months. One member of staff is revising the complaints procedure, which is currently available in pictorial form to include symbols using widget. People have one to one meetings with their key workers at least once a month and can raise concerns. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Repairs to the home are not done adequately to ensure that people live in a safe, comfortable environment. EVIDENCE: The manager stated that she has access to a budget for maintenance for the property, which is owned by Care Tech. Local contractors carry out repairs. The home benefits from a very large secure garden. The home does not currently have a gardener although they have advertised. The people who live at the home help to maintain the garden. A recent audit, (less than 6 months ago) had been carried out by the fire prevention service and the environmental health services. They made no requirements or recommendations. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 17 We looked round the home and made the following observations. The home was clean, tidy and in a reasonable standard of maintenance. One bathroom was in need of decoration and one of the tiles around the bath was cracked. On the ground floor there were quite a lot of cracks around the door frame in the corridor leading to people’s bedrooms. Further cracks were seen in two people’s bedrooms both on the ground and first floor. Several bedrooms smelt damp and there was evidence of damp on the ceiling in one person’s room. The manager stated that some of the roof tiles were loose. A number of people had convector heaters to supplement the central heating system, as a number of bedrooms were described as quite cold. Care Tech should purchase additional heating. The door leading to the ground floor bedrooms did not shut tight. We have made a requirement with regards to the environment. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers are high and staff benefit from a good training programme and supervision. Temporary staff do not have adequate access to relevant training and supervision. EVIDENCE: On the day of inspection there were three staff in the morning. Two were from an employment agency. There were three staff in the afternoon and one member of staff working across the day. We spoke to the manager and several staff and we inspected one staff file. This provided evidence that good recruitment procedures and appropriate checks are in place before the employment of new staff. The criminal record (CRB) disclosure number is recorded but CRBs and staffs’ personal identification is held separately at central office. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 19 Evidence of staff training was provided and staff we spoke to stated training provided by Care Tech was comprehensive. The member of staff whose file we inspected had not completed training in first aid, or safeguarding adults, but had been in post less than six months. S/he was completing an initial qualification in ‘learning disabilities’. The manager stated that other training available included: autism, diabetics, communication, bereavement and empowerment. This is not a comprehensive list. Care staff who are employed by Care Tech are given training in the management of difficult behaviour, sometimes exhibited by the people who live at the home. This training had not been offered to all staff employed at the home on a permanent or temporary basis and must be to ensure continuation of care for people, and to ensure staff and people are protected. We have made a requirement. Details of each agency member of staff employed at the home must be requested from the agency and give details of training, experience and other pre requisite information such as CRB details. Presently the manager has a letter from the agency confirming that they employ all staff subject to pre requisite checks being completed. This is not satisfactory to meet the requirement. We inspected the staff rota which was satisfactory, but must include the surnames of all staff working there. Annual staff appraisals are completed and permanent staff receive regular monthly supervision, which is comprehensive. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Oaktrees and staff benefit from an experienced manager who provides good leadership and staff support. EVIDENCE: The manager is well qualified and experienced. She stated that she is well supported by her line manager, who regularly audits the service. She has achieved the Registered Manager’s Award and NVQ Level 4. She continues to undertake training where appropriate. She has completed a two-day training course in safeguarding adults. Training in equality and diversity is being provided initially for managers. We suggested to the manager that she may Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 21 wish to look for a course re sexuality as there is an identified need within the service to support young adults with their sexuality. The home has a quality assurance system in place, which is currently under review. When it is re implemented it will incorporate the views of the people who live at the home, staff, relatives and other professionals. Copies of the quality assurance audits of the service should be sent to the CSCI once completed. We checked a number of records and they were satisfactory. This included: files and financial records of people living at the home, fire records, a number of polices and procedures, medication records, staff rotas, staff files, and food intake charts. A visitors’ book was in place. Recent audits had been carried out by the environmental health and fire department and were satisfactory. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 X 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 3 X 3 x 3 X X 3 X Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP24 Regulation 23 2(b) Requirement The premises must be kept in a good state of repair both internally and externally, so that the people who live at the home have a comfortable place to live in. All staff must have specialist skills and experience to meet the needs of the people who live at the home. Staff must be aware of all the documentation/ guidance written to support people who live at the home and the manager must ensure that all staff employed through the agency have the necessary experience, skills and training to meet the requirements of the job. Timescale for action 30/01/08 2. OP32 18 (1) (a)(b)(c) 30/01/08 Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 24 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 Refer to Standard OP7 OP9 Good Practice Recommendations Personal goals for people should identify who is going to do what, how and in what time scale. Risk assessments should be specific to each person’s needs and behaviour. Oaktrees DS0000065459.V357247.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. 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