Inspection on 20/09/06 for Oakwood Home - Leonard Cheshire Disability

This inspection was carried out on 20th September 2006.

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 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oakwood Home - Leonard Cheshire... 27/08/08

Oakwood Home - Leonard Cheshire... 01/08/05

Oakwood Home - Leonard Cheshire... 19/01/05

Oakwood Home - Leonard Cheshire... 16/08/04

Oakwood Home - Leonard Cheshire... 15/03/04

Oakwood Home - Leonard Cheshire... 22/01/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Oakwood (Cheshire) Home Radford Close Offerton Stockport Cheshire SK2 5DL Lead Inspector Sylvia Brown Unannounced Inspection 20th September 2006 08:30 Oakwood (Cheshire) Home DS0000008604.V312247.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 Oakwood (Cheshire) Home DS0000008604.V312247.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. Oakwood (Cheshire) Home DS0000008604.V312247.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakwood (Cheshire) Home Address Radford Close Offerton Stockport Cheshire SK2 5DL 0161-419 9139 0161 419 9312 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) www.leonard-cheshire.org.uk Leonard Cheshire Care Home 16 Category(ies) of Learning disability (16), Learning disability over registration, with number 65 years of age (16), Physical disability (16), of places Physical disability over 65 years of age (16) Oakwood (Cheshire) Home DS0000008604.V312247.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 16 PD, up to 16 PD(E), up to 16 LD and up to 16 LD(E). Service users to include up to 16 with an Acquired Brain Injury for rehabilitation. 1st August 2005 Date of last inspection Brief Description of the Service: Oakwood is part of the Leonard Cheshire group. Leonard Cheshire is a registered charity. Oakwood is a specialised facility which caters for the rehabilitation needs of up to 15 adults, aged between 18 and 65, all of who have an acquired brain injury. The home is registered to provide care and accommodation for one person over the age of 65. Oakwood is one of a small number of specialist services in Britain which offers the kind of structured environment to enable people, after acquiring a brain injury, to return home and live as full a life as possible. As a consequence of these limited resources, the service users at Oakwood are from all parts of the United Kingdom. The objectives of Oakwood are to sufficiently rehabilitate service users to enable their return back into the community. Complex packages of care which are individually developed to enable each service user to regain skills and confidence through re-learning self caring routines, socialisation and education. The cost of the service is individual to the needs of the service user and the amount of support they require. Currently, the lowest fee at the home is £2,250.56. Oakwood (Cheshire) Home DS0000008604.V312247.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection site visit to Oakwood (Cheshire) was conducted as part of the overall inspection process of the home. It commenced at 10am and was conducted in one day. Time was spent with service users and observing their day-to-day rehabilitation programmes. Their care files were looked at and staff were spoken with regarding the support they provided. Comment cards were provided to both service users, their family and the staff team. At the time of writing, no comments had been received. Comments received during the appropriate, included in the report. inspection are, where applicable and Records were looked at concerning the running of the home, including health and safety records and management monitoring systems. What the service does well: What has improved since the last inspection? Since the last inspection the home has made some significant changes regarding the aims and objectives of the home and how they achieve it. The aims and objectives of the home have always been to provide a rehabilitation service, however some service users had lived at the home for a number of years and had reached their potential for rehabilitation. This meant that Oakwood had become their long-term home and they had no expectations and, in some instances, incentives to move on. As a consequence, a review of the service has been undertaken over a lengthy period of time with the outcome being that the home now admits people on time limited placements which have set gaols to ensure that those who want to work towards rehabilitation can do so in a timely manner. Those who do not want rehabilitation or cannot achieve agreed goals, are supported to find alternative care facilities that are suitable to meet their life-long needs. Oakwood (Cheshire) Home DS0000008604.V312247.R01.S.doc Version 5.2 Page 6 The changes to the service have culminated in a number of redundancies and changes in roles and responsibilities. The numbers of registered places are to be reduced and the home is to be significantly upgraded. Bedrooms are to be made into flats which will enable service users, as far as possible, to regain their independence and care for themselves. The main kitchen which used to provide all meals has been withdrawn as a service and a new service users’ kitchen had been installed. Service users can now take more control of their own lives and make meals for themselves and others. A new manager has been recruited and was undertaking acquired brain injury training on the day of the inspection site visit. The temporary manager, who has been managing the home for approximately 12 months, stated that the new manager is also completing a management induction programme. The new manager has yet to complete registration procedures with the Commission. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oakwood (Cheshire) Home DS0000008604.V312247.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 Oakwood (Cheshire) Home DS0000008604.V312247.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 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 excellent. Service users have their individual aspirations and needs assessed in detail. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: All service users have Individual Service Plans (ISP) in place. These are extensive documents which include details of service users’ individual and personal aspirations. ISP’s were looked at and found to contain information about the consultation processes with service users and their inclusion in all aspects of the planning process for rehabilitation. Assessments were in place from various professionals involved with the service user. Pre-placement assessments were completed and ongoing assessments are kept under review to ensure the service user is, as far as possible, working towards achieving set goals. Oakwood (Cheshire) Home DS0000008604.V312247.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 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 good. Service users’ rights to make decisions for themselves are respected. They are consulted on all aspects of their life, including taking risks. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The development of ISP’s are service-user led. They are consulted regarding their needs and what they feel committed to in achieving their rehabilitation. All placements are planned and have a set duration. As a consequence, goals are set to progress towards meeting rehabilitation within a set timeframe, as far as possible. Service users retain control over their lives and how they should be supported. Part of their rehabilitation will be to achieve various levels of self care and they will be encouraged to achieve this. Service users reluctant to work towards set goals, jeopardise their placement. Oakwood (Cheshire) Home DS0000008604.V312247.R01.S.doc Version 5.2 Page 10 Risk taking is managed with consideration of service users’ conditions and development to regain skills; however risk taking is an expected part of service users’ everyday life. Service users learn to cook and complete everyday activities, including becoming part of the wider community. Risks are identified within the ISP, as are management plans, which ensure, as far as possible, that service users are kept safe and protected. Service users were observed completing physical activities and everyday tasks such as cooking. They were appropriately supervised and supported to complete tasks safely. Oakwood (Cheshire) Home DS0000008604.V312247.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 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. Service users are supported to develop realistic lifestyles which are meaningful to them. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Service users are encouraged to regain everyday skills and take control for their own lives. Rehabilitation programmes include all aspects of a service user’s life, including age appropriate activities. The home is clear that it does not “entertain” service users, rather they are supported to live lives as they will be doing when they leave the service. Records detailed service users’ individual activities, both within and outside of the home. When spoken with, service users were satisfied with how they were developing their social skills and interests. Oakwood (Cheshire) Home DS0000008604.V312247.R01.S.doc Version 5.2 Page 12 Rehabilitation programmes include external activities which are beneficial to the service users and which support them to live and cope within the community. Plans are underway to increase the personal living space for service users. When completed, their new accommodation will be more suitable for service users to receive visitors in private. The facilities will also support them to prepare light snacks and drinks for their visitors and make visiting more relaxed and enjoyable. One service user currently occupies the ‘flat’ which has enabled his young family visit in more natural surroundings and enable them to have positive family time. Service users are supported to take responsibility for their own lives. All their rights as a person are promoted and they receive support to action those rights if and when they require. Risk taking is built into their rehabilitation programme, as is the management programme to manage those risks. Previously, the home employed a chef who served all main meals. However, since the review, that service is no longer available. All service users, as part of their rehabilitation programme, are expected to regain and/or obtain the skills to prepare their own meals. They have individual choice in what they wish to eat and, where possible, healthy eating is encouraged. Observations were that staff appropriately offered assistance to service users in meal preparation and hygiene standards were maintained. Two service users were observed using the kitchen and preparing their meals. Some support is extensive and time consuming for both the service user and staff. Praise was positively given and it was clear that service users enjoyed their time preparing meals. One service user stated they made meals or snacks for others and that cooking was something they enjoyed. Oakwood (Cheshire) Home DS0000008604.V312247.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 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 good. Service users have their personal and health care needs met appropriately. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Service users’ ISP’s detail their personal care needs and their preferred method of support. Support workers are allocated to oversee the support and rehabilitation of service users. Service user have the option of changing their support worker if they wish. Various medical professionals assist in the development of the care support packages, which include service users’ physical and emotional well being. Both have equal importance in the rehabilitation of service users. Records demonstrated consultation processes, reviewing and monitoring of all aspects of health for the service user. Service users have access to appropriate aids and equipment which support their needs and encourage maximum independence. Oakwood (Cheshire) Home DS0000008604.V312247.R01.S.doc Version 5.2 Page 14 Medication was generally administered to service users, however the home is developing rehabilitation programmes which will support service users to manage their own medication where possible. The home has developed efficient medication policy, procedure and practice guidance. Staff follow robust systems to make sure that medication records are fully completed, contain required entries and are signed by appropriate staff. Professional health care appointments and treatments are recorded. Service users receive optical, hearing, and chiropody support as they require. Speech therapy and various other complex health care support services are in place for those service users with complex and ongoing health issues. Oakwood (Cheshire) Home DS0000008604.V312247.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 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. Service users are protected by adult protection policies and have access to written complaints procedures. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home has extensive adult protection procedures in place and staff training is ongoing. Written complaints procedures are in place and service users are provided with a copy of the procedures at the point of admission. Throughout the inspection service users were, in the main, satisfied with the services offered. Oakwood (Cheshire) Home DS0000008604.V312247.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30 Quality in this outcome area is adequate. Service users live in appropriate surroundings which are being developed to meet their rehabilitation needs. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Evaluation of the building identified that work has commenced to upgrade the whole building to ensure it is equipped, designed and meets the aims and objectives of the home. As stated in the summary, a new service user kitchen has been provided which is appropriately equipped and is suitable to support those who have a physical disability to complete everyday kitchen tasks. A service user laundry is planned which will further promote the independence of some service users. Service users’ bedrooms and en-suite facilities are to be totally upgraded. Service user numbers are to be reduced, enabling current bedrooms to be enlarged and equipped with up to date walk-in showers, small kitchens and increased living space. Oakwood (Cheshire) Home DS0000008604.V312247.R01.S.doc Version 5.2 Page 17 The planned refurbishment is to be completed by Spring 2007. Communal areas will receive upgrading once bedrooms have been completed and the communal space evaluated on how to best use the space. Currently, service users have access to aids and adaptations which support their physical needs. Oakwood (Cheshire) Home DS0000008604.V312247.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is good. Staff are appropriately recruited, trained and in numbers to meet the needs of service users. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Since the previous inspection, there have been considerable staffing changes. The home has and continues to recruit staff for various positions within the home. Robust procedures are followed which include completion of detailed application forms, formal interviewing and obtaining of statutory checks and references. Staff files included job descriptions, offers of employment, induction and further training records. New staff spoken with stated they were still learning and felt satisfied with the support they were receiving. One comment card from a staff member confirmed they had been instructed in the home’s policies and procedures and had received codes of conduct information, as stated by the General Social Care Council. The home provides a rolling programme of training which includes generic and specialised training to suit the aims and objectives of the home and service users’ individual needs. Oakwood (Cheshire) Home DS0000008604.V312247.R01.S.doc Version 5.2 Page 19 It was clear from information received that staff have not received appropriate formal supervision at the correct frequency, particularly new staff or those in new roles. They expressed a desire for more staff meetings and supervision which provides them with feedback on their development. Currently, due to the staffing changes which have created staff vacancies, agency staff are employed at the home. The acting manager stated that, where possible, the same agency staff are requested. She further stated that whilst recruitment and staff shortages continue, she is ensuring that agency staff do not exceed more that 50 of the staffing rota at any one time. Oakwood (Cheshire) Home DS0000008604.V312247.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 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. Oakwood (Cheshire) is a well managed and well run home which is meeting its stated aims and objectives. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The current acting manager has been a determined force in the development of the home to meet its stated aims and objectives. Over the past year, she, along with various other individuals within the organisation, has completely reviewed and analysed the service. Furthermore, she has implemented significant changes to ensure the home’s focus and services are solely aimed at the rehabilitation of service users. The service is now completely service user driven and systems are in place to meet set targets and goals with service users to enable their return to mainstream society. Oakwood (Cheshire) Home DS0000008604.V312247.R01.S.doc Version 5.2 Page 21 At the time of the inspection, the acting manager was nearing the end of her placement at the home and was preparing to move on. A new manager has been recruited and was undertaking management induction under the guidance of the acting manager. On the day of the inspection the manager was absent and attending training on Acquired Brain Injury. The manager has not been registered with the CSCI. Health and safety records were looked at and found to be in good order, with service users’ health and safety being promoted at all times. Oakwood (Cheshire) Home DS0000008604.V312247.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 X 2 4 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 2 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 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Oakwood (Cheshire) Home DS0000008604.V312247.R01.S.doc Version 5.2 Page 23 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 YA37 Regulation 8&9 Requirement The registered provider must submit an application for registration of a manager. Previous timescale of 06/06/06 not met. Timescale for action 01/11/06 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 Refer to Standard YA36 Good Practice Recommendations The registered person should ensure that all staff receive increased formal supervision during the transition stages and development of the home. 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