CARE HOME ADULTS 18-65
Paks Trust - Oaston Road, 66 66 Oaston Road Nuneaton Warwickshire CV11 6JZ Lead Inspector
Maggie Arnold Announced Inspection 24th November 2005 09:30 Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 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 Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 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. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Paks Trust - Oaston Road, 66 Address 66 Oaston Road Nuneaton Warwickshire CV11 6JZ 02476 742201 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) PAKS Trust Alan John Sheppard Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd February 2005 Brief Description of the Service: The property is a 5 bed roomed narrow and tall Victorian end of terrace house on the edge of Nuneaton in a semi industrialised zone. It has a lounge, kitchen diner and lean to/ conservatory room. Off the kitchen there is a shower room and separate toilet. There is a small back garden. Every one has a single bedroom. The staircase in the house is narrow. The ground floor has one bedroom. On the first floor there are two residents’ bedrooms and a bathroom. The other two bedrooms and a separate toilet are on the top floor. Staff use one of the communal rooms to ‘sleep in’ overnight. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The manager was given a few days notice of this inspection. The inspection took place between 9.30am and 2.00pm. The manager and two residents were at home at the time of the inspection. The main focus of the inspection was to talk to residents, review the developments in care plans that have taken place since the previous inspection and look at residents and staff files. Eleven of the National Minimum Standards for Care Homes for Adults 18-65 were looked at during the course of the inspection. This resulted in two statutory requirements being issued and four good practice recommendations being made. What the service does well: What has improved since the last inspection?
A number of improvements have taken place since the previous inspection. The previously designated smoking room has been allocated as the staff sleeping in room. This has allowed greater privacy for both residents and staff. The manager advised that one of the bedrooms has been redecorated. Additionally work is in progress to improve the residents care plans and accompanying records. The manager is to liaise with another of the Trust’s homes that is also in the process of developing care plans. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 6 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.
Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 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 Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 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): 5 The present contracts/terms and conditions do not contain sufficient detail to ensure that residents are fully aware of the agreement they are entering into and that their interests are protected. EVIDENCE: Residents are provided with written contract. The inspector looked at one resident’s contract. The contract was not sufficiently detailed to ensure that the resident was clear about what they are agreeing to and that their interests are protected by the document. One example of the lack of clarity is the section regarding terminating the placement. The document advises that notice of the termination of the placement may be given in the event of the resident breaching the terms of the contract. There are no details of the home’s terms and conditions. The document was not signed or dated by either party. Nor was there any documentary evidence to show who had supported the resident in making the decision to agree to the contract. The home must ensure that residents have contracts that clearly state the terms and conditions of the placement and the possible outcome of failing to comply with the conditions of the placement. Advice was given as to how the contracts may be improved and a discussion took place regarding the information to be included in the home’s terms and conditions. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 9 In order to improve the contract/terms and conditions it is recommended that the home refer to the Office of Fair Trading publication titled ‘ Guidance on unfair terms in care home contracts’. It is strongly recommended that a suitably qualified person draw up the contract. This will help to ensure that the document will protect the best interests of all parties. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 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 Work is in progress to ensure that robust care plans and accompanying risk assessments are in place. This will ensure that staff are fully aware of the residents’ needs and personal goals. Residents are supported to make decisions about their lives. This helps to promote confidence and self-determination. EVIDENCE: There is an outstanding requirement for the home to develop individual resident care plans. Arrangements had been made for the inspector to look at care plans being developed by the manager of another PAKS Trust home during the course of this inspection. Both managers had made a good start on the work. The inspector gave constructive feedback regarding the separate sample care plans and suggested that consideration be given to amalgamating the best parts of the two draft care plans and risk assessments. It is strongly recommended that the manager refer to Standards 2 and 6 of the Care Homes Regulations; National Minimum Standards 2001 for further guidance. Care plans will be looked at again during the course of the next inspection.
Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 11 Two residents were at home at the time of the inspection. Discussions with the residents and manager combined with records seen and observations throughout the course of the visit confirmed that residents are encouraged to make decisions about their lives. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 12 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): 16 The home is managed in a way that respects residents’ rights and responsibilities and promotes individual choices. This fosters self-determination and personal development. EVIDENCE: At the time of the inspection there were two residents in the home. One resident was due to go shopping and the other resident had a commitment to do a few hours voluntary work later in the day. Other residents had already left for a day care centre. Time spent with both residents and discussions with the manager indicated that, within the constraints of group living, the home’s daily routines promote individual choice. For example, one of the residents prefers a later start to the day and was still in bed when the inspector arrived. Staff had left breakfast ready for them. Residents also have a choice as to whether to stay in the communal areas or spend time in their own rooms. Bedrooms and bathrooms doors are lockable and staff and other residents only enter with the resident’s permission.
Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 13 Should they wish, residents may see their visitors in their bedroom. Alternatively visitors can be seen in the communal areas or, if they wish for more privacy in the small room that serves as a staff sleeping-in room at night. Subject to risk assessments residents’ are involved in the day-to-day housekeeping tasks. This includes being responsible for looking after their bedrooms, laundry tasks, helping with meals preparation and clearing away after meals. For example, one of the residents was seen to wash and put away the dishes they had used for breakfast. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 14 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): 20 The safety and well being of residents is protected by the home’s procedures for dealing with medication. EVIDENCE: None of the present residents are responsible for the management of their own medication. Policies and procedures are in place to ensure the safe management and dispensing of medication. These documents were not seen on this occasion. The home has a monitored dosage system and accompanying medication administration record (MAR) sheets for the recording and safe administration of medication. There were no controlled drugs in the home at the time of the inspection. A check of the MAR sheets and medication found it all to be in good order. The medication is securely stored in a locked cupboard and only administered by suitably trained staff. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 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): 23 The best interests of the residents are compromised by the poor recording procedures for the residents’ personal allowances. EVIDENCE: The Home endeavours to safeguard the safety and well being of the residents through a variety of means, for example, staff recruitment and induction procedures, training and various policies and procedures. Records and balances of resident’s monies were checked. Although the balance of monies was correct, written records were poor resulting in the present system not fully meeting the Care Standards Act 2000: Care Homes Regulations 2001: Schedule 4 (9). For example, staff record details of monies taken to give to or spend on behalf of the residents on bits of paper which are then collected and cross checked and recorded by the manager on a weekly basis. Advice was given as to how the present system might be improved. These have been detailed in the summary of this report under the heading ‘What they could do better’. It should be noted that there is no suggestion of the misappropriation of resident’s monies. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 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, 27,28 & 30 Residents benefit from a homely and comfortable environment that is clean and hygienic. EVIDENCE: The manager has reviewed the needs of the current residents and confirmed in writing that the layout of the three-storey home does not present any physical problems to any individual. Communal areas consist of a good-sized kitchen cum dining area and smaller lounge plus a ground floor shower and toilets facility and 1st floor bathroom. The manager advised that a plumber was due later in the day to repair the faulty shower. The decoration and furniture is domestic in style and size. All of the areas seen were clean and free from offensive odours. Since the previous inspection the home has re-allocated what was the smoking room into a staff sleeping in room. Previously night staff had slept on a bed settee in the communal lounge. This wasn’t ideal as the kitchen and downstairs toilet and shower facilities can only be accessed via the lounge. Consideration is being given to an allocated smoking area. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 17 All of the residents have their own bedrooms, which are fitted with a wash hand basin. One resident showed the inspector around her bedroom and the communal bathroom and toilet facilities. The bedroom was warm, clean and comfortable. The room was decorated with various photographs, pictures and cuddly toys that reflected the hobbies and interests of the occupant. One resident was still in bed and the other residents were not in the home so no other bedrooms were viewed on this occasion. The manager advised that one of the bedrooms had been redecorated since the last inspection, which took place in February 2005. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 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): 34 The home’s recruitment policies and procedures help to protect the residents and works towards ensuring that they receive appropriate staff support. EVIDENCE: No care staff were present during the course of the inspection. One staff file was examined and found to be in good order. PAKs Trust have an equal opportunities interviewing process and a copy of the interviewing process was on file. There was also evidence that the manager had followed up an employment gap in the application form. Copies of documents required in accordance with the Care Standards Act 2000: Care Homes Regulations 2001 were seen. It is recommended that copies of documents such as criminal bureau checks, birth certificates and passports are signed and dated by the person who had seen the original copies. The file also contained a copy of the Trust’s Confidentiality Policy that had been signed and dated by the staff member. The manager is not involved in the initial staff recruitment process. The Trust’s Head Office undertakes this task. The Head Office selects a person whom they think is suitable to fill the vacancy and forwards the manager the relevant paperwork. The manager meets the potential staff member prior to him or her
Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 19 commencing work at the home. This helps to ensure that the person is compatible with the residents and existing team. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 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): 42 This standard was not fully inspected on this occasion. EVIDENCE: All areas of the home seen were clean and well ordered. There was no evidence of hazards such as unattended possible harmful items such as cleaning products. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 21 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 x x x 2 Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x x x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x 3 3 x 3 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score x x x 3 x x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Paks Trust - Oaston Road, 66 Score x x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x DS0000004457.V269413.R01.S.doc Version 5.0 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 5(1)(b) Requirement Timescale for action 31/03/06 2 YA23 17(2) Sch 4(9) 13(6) Residents must be provided with written terms and conditions in respect of the accommodation provided. The home is required to maintain 28/02/06 accurate records of money returned to or spent on behalf of the residents. 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 YA5 Good Practice Recommendations It is recommended that the home refer to the Office of Fair Trading publication titled ‘ Guidance on unfair terms in care home contracts’ for further guidance. It is strongly recommended that a suitably qualified person draw up the contract. This will help to ensure that the document will protect the best interests of all parties. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 23 2 3 4 YA6 YA23 YA34 It is strongly recommended that the manager refer to Standards 2 and 6 of the Care Homes Regulations; National Minimum Standards 2001 for further guidance. The home should consider the recommendations detailed in full in the summary of this report. It is recommended that copies of documents such as criminal bureau checks, birth certificates and passports are signed and dated by the person who had seen the original copies. Paks Trust - Oaston Road, 66 DS0000004457.V269413.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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