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Inspection on 23/08/05 for Oxclose Lane Care Home

Also see our care home review for Oxclose Lane Care Home for more information

This inspection was carried out on 23rd August 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Each service user is encouraged and supported to be as independent as possible are encouraged to develop skills and take part in a range of leisure activities. Support plans describe needs and there are some clear instructions for staff to follow. Service users are satisfied with the personal support they receive. The premises are generally fit for the purposes of the home and all service users are accommodated in single bedrooms. The ground floor is accessible to wheelchair users and three of the bedrooms and an adapted bathroom are on the ground floor.

What has improved since the last inspection?

No major changes have been made since the last inspection.

What the care home could do better:

Medication storage could be improved and staff must be reminded to sign for medication after it has been given or give an explanation of why it has not been given. There are a few things that need attention inside the home, such as the sofa that needs to be recovered and the shower door that has a hole in it. Also some thorough cleaning is needed, but generally the home is well maintained and kept clean by the service users themselves. There is just one staff member sleeping in at night and no staff awake. This seems to meet the needs of most service users most of the time, but a clear plan should be in place for times when 24-hour support is required.

CARE HOME ADULTS 18-65 Oxclose Lane Care Home 154-156 Oxclose Lane Arnold Nottingham NG5 6FF Lead Inspector Meryl Bailey Unannounced 23 August 2005 at 4:00 pm rd 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 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 Stationary 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. Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Oxclose Lane Care Home Address 154-156 Oxclose Lane Arnold Nottingham NG5 6FF 0115 967 0657 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Royal Mencap (Housing & Support Services) Ms Catherine Kimbley Care Home (CRH) 7 (Seven) Category(ies) of Learning disability (LD) - 7 (Seven) registration, with number of places Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 07/12/04 Brief Description of the Service: Oxclose Lane Care Home provides support including personal care and accommodation for seven people. It is located within close proximity to all community amenities. There are two lounge areas and a large kitchen/diner. All service users are accommodated in single bedrooms. The ground floor bathroom offers assisted bathing facilities. The ground floor is accessible to wheelchair users and three of the bedrooms are on this floor. There is no lift to the other four bedrooms. The care provider is Mencap Homes Foundation, but the premises are owned by Metropolitan Housing Association. Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted by one inspector during one evening. Six service users were seen and some were able to contribute their views. One was in hospital. The manager was not present as she was supporting the service user at hospital. Two staff were seen and their comments and views have been incorporated into this report. Information has also been taken from records. The communal areas of the home were inspected and three of the bedrooms and bathrooms were viewed. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 7 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 standard(s) 2 Needs are appropriately assessed. EVIDENCE: Pre-admission assessments of service users’ needs have been recorded and were found on their files. Some specialist assessments are also filed. Further information has been gathered and there is an indication that service users have been involved in planning their care and some have signed agreements. Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 8 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 standard(s) 6 and 9 Individual support plans give sufficient direction to staff and risks are assessed in determining support required. Dating the current plan would provide clarity of when information has been revised. EVIDENCE: Three support plans were examined and found to be comprehensive in outlining needs and specifying action required. There was evidence of updated information within the plans, but on two of the three plans there were no dates of when they were reviewed or updated. One had a date of December 2004, but had clearly been updated since then and there were some clear instructions for staff to follow. Detailed risk assessments were in place and records showed evidence of staff signatures to indicate the plans have been read and understood, which is good practice. Detailed risk assessments were included with the support plans. Risks identified were around daily tasks within the home aswell as outside activities. Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 9 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 standard(s) 12, 14, 16 and 17 Service users are encouraged to develop skills and take part in a range of leisure activities. Daily routines promote independence and service users choose when and what to eat. EVIDENCE: Some service users said they had been to day centre and one had been to work on the day of this inspection. Staff said that all service users are involved in some daytime activity, including day services, college and employment. Weekend and evening activities include shopping, cinema trips and one is supported to attend rock concerts. Two service users have had a holiday to Wales this year and two others were on holiday in Mablethorpe last week with two staff. A trip to Centre Parks has been arranged for another service user and staff said others would have day trips. One service user was seen cleaning communal areas and another was assisting with cooking the evening meal. Staff said that each service user is encouraged and supported to be as independent as possible with washing, ironing, cooking, changing bedding and cleaning their own bedrooms. Staff stated that they assisted as needed. There was a rota for daily tasks undertaken by service users. Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 10 Most service users are involved in planning the menu and others make their preferences known. The evening meal, including meat and vegetables, was cooked and eaten during this inspection. Four service users ate their meal together with the two staff at the dining table and clearly enjoyed their meal. Two others ate separately afterwards due to their specific needs and choices. Records are kept of meals taken. Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 11 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 standard(s) 18, 19 and 20 Service users are satisfied with the personal support they receive. Staff work with a range of professionals to meet the individual health needs, but current medication administration practices do not provide sufficient safeguards against errors being made. EVIDENCE: Personal care needs are clear within the support plans and some service users said they were satisfied with the support they receive with showers and baths. Some are totally independent in this area. Health needs vary and there was considerable evidence of multi professional involvement with one service user working together to meet specific and increasing health and care needs. There had been a need for staff to be awake throughout the night to meet these needs, but funding was not available to pay waking staff. Hospital admission alleviated the demand on staff, but contingency plans should be in place as the need for waking staff could arise at any time (see under standard 33). Staff were supporting this service user at the hospital on the day of inspection and other service users said they had support for medical appointments. These were also recorded on files. Support plans seen confirmed that service users requested their medication to be looked after and have signed consent forms. Medication was stored securely in a locked cupboard. A pre counted dosage system was in operation with some other mixed assorted medications were held in a box. Storage could be improved by separating these for each service Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 12 user. Medication Administration Sheets showed that staff had not always signed for the medication or given a reason code, which means they could not provide evidence that medication had always been taken. One member of staff was observed signing the sheet prior to administering some tablets. This is poor practise and staff must be reminded that signing the sheet is confirmation that the medication has been taken. Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 13 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 standard(s) Not assessed on this inspection. EVIDENCE: Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 14 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 standard(s) 24, 26, 27 and 30 The premises are generally fit for the purposes of the home, but some maintenance is required. Bedrooms are personalised to individual preferences and needs. Toilets and bathrooms are equipped to meet needs. Service users are involved in cleaning and maintaining their own environment though some areas need some further input from staff. EVIDENCE: The premises blended with housing in the local community and comprised of two adapted houses. There were two lounge areas and a large kitchen/diner. All service users were accommodated in single bedrooms, which were well furnished and personalised. One service user was choosing a new bed during this inspection. The ground floor was accessble to wheelchair users and three of the bedrooms are on the ground floor. There was no lift to the other four bedrooms, accessible via two separate flights of stairs. There were three separate toilets and three bathrooms within the home. There were assisted bathing facilities in the ground floor bathroom, whilst upstairs bathrooms had showers and bath. Maintenance of the premises was carried out by Metropolitan Housing Association and a system was in place for staff to report maintenance required. The home was generally clean and well maintained, but Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 15 the door to the shower was recently damaged and needs repair or replacement. One lounge had fairly new leather furniture, but the sofa in the other lounge had holes in the covers. Service users were given responsibility for cleaning all areas, but additional support was needed to ensure thorough cleaning of stairs. Also the bathrooms were found to have a small amount of mould around the bottom of tiles near to the shower base and bath. This needs to be removed with staff support. Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 The basic staffing levels are adequate to meet the regular needs of the service user group, but the limited level at night cannot meet changing needs. Clear contingency plans are needed to ensure individual needs can always be met. EVIDENCE: There were two staff on duty throughout the day from 7am to 10pm and one sleeping in over night. Staff work 24-hour shifts when sleeping in. When service users have been well this arrangement has been sufficient to meet their needs. However, records show that one service user has recently been awake for the majority of the night and calling out due to a progressive illness. The sleeping in staff have not been able to sleep through the night. Budget restrictions have prevented further staff being employed. Minutes of a meeting clarified alternative measures of using medication (sleeping tablets) and increasing day services to promote sleeping at night, but there were records of continued night disturbances and the need for full time supervision was clear. The situation was changed on the day of this inspection due to a planned hospital admission. Discussion with a service manager since this inspection has clarified that staff had the option of requesting cover in the morning if they had not been able to sleep. However, contingency plans for wakeful staff to be available in such circumstances should be in place. Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 A quality assurance system is in place. Action is taken to safeguard the health and safety of service users and staff, but further action is required. EVIDENCE: A quality assurance system had been used and was evidenced with completed questionnaires on service users’ files. A manager from another Mencap home had been involved in assisting service users to express their views and complete the written questionnaires. Portable Appliance Tests were completed August 2004 and are due to be repeated. The label on one radio showed that it had not been tested since 2003 and the manager must ensure all appliances are tested. Window openings were not restricted in the bedrooms viewed and it is recommended that all windows have fixed restrictors fitted so that they cannot be opened more than four inches. This would allow for ventilation whilst ensuring safety and security. An alarm system is in place to detect movement in the communal areas during the night and records of fire equipment tests are up to date. Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 3 x x 2 Standard No 11 12 13 14 15 16 17 x 4 x 3 x 4 3 Standard No 31 32 33 34 35 36 Score x x 2 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Oxclose Lane Care Home Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. 5. Standard YA 20 YA 24 YA 24 YA 30 YA 42 Regulation 13(2) 23(2)(b) 16(2)(c) 23(2)(d) 13(4)(a) Requirement Ensure all staff follow correct procedures when administering and recording medication. Repair or replace the shower room door. Recover or replace the sofa. Remove the mould around the bottom of tiles near to the shower base and bath. Ensure all electrical appliances are have an annual test. Timescale for action Immediate 23rd August 2005 31st October 2005 31st October 2005 30th September 2005 31st October 2005 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 YA 6 YA 20 YA 30 Good Practice Recommendations Clarify when support plans are reviewed and updated. Separate medication for each service user within the storage cupboard. Provide additional support to service users to ensure thorough cleaning, for example,of stairs. C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 20 Oxclose Lane Care Home 4. 5. YA 33 YA 42 Develop clear contingency plans for providing sufficient staff to meet changing needs, particularly wakeful night staff. Fit restrictors to all windows so that the gap is no more than four inches for safety and security. Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 21 Commission for Social Care Inspection Edgeley House Tottle Road Riverside Business Park Nottingham, NG2 1RT 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 Oxclose Lane Care Home C03 C53 S8731 Oxclose Lane V246515 230805 Stage 2.doc Version 1.40 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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