Inspection on 18/07/05 for Paks Trust Oaston Lodge

This inspection was carried out on 18th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Paks Trust Oaston Lodge 08/01/10

Paks Trust Oaston Lodge 25/08/07

Paks Trust Oaston Lodge 13/10/06

Paks Trust Oaston Lodge 03/01/06

Paks Trust Oaston Lodge 22/03/05

Paks Trust Oaston Lodge 30/11/04

Paks Trust Oaston Lodge 12/03/04

Paks Trust Oaston Lodge 16/09/03

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Paks Trust - Oaston Lodge Oaston Lodge 82 Oaston Road Nuneaton Warwickshire CV11 6LA Lead Inspector Warren Clarke Unannounced Inspection 18th July 2005 16:10 Paks Trust - Oaston Lodge DS0000004323.V249347.R02.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 Lodge DS0000004323.V249347.R02.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 Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Paks Trust - Oaston Lodge Address Oaston Lodge 82 Oaston Road Nuneaton Warwickshire CV11 6LA 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 Susan Elaine Dore Care Home 7 Category(ies) of Learning disability (7), Physical disability (2) registration, with number of places Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. NVQ Level 4 That NVQ Level 4 in Care and Management is achieved by 2005. 22 March 2005 Date of last inspection Brief Description of the Service: Oaston Lodge is a domestic style detached house in a semi industrial part of Nuneaton. Ground floor accommodation comprises of a lounge, kitchen, dining room, bathroom with toilet and two single bedrooms. Five further bedrooms and a small office/storage /craft room are situated on the first floor of the house. There is a mature garden that is wheelchair accessible with some raised beds and a barbecue. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced at 4.10 PM on 18/07/05 and was concluded on 22/07/05. That is it was done in two sessions, i.e., the first visit went on until approximately 10 pm and the second from 10.30 am to approximately 12.45 pm. In conducting the inspection account was taken of the findings of the last inspection visit, the premises were checked and service users records and those connected to the running of the Home (e.g., health and safety) were examined. The inspector also informally interviewed staff who were on duty – to check information and observations – and the Manager who arrived later to do the night shift. Conversations were held with service users who were able to communicate verbally, as this more informal approach was deemed most appropriate in the circumstances. For those who could not communicate verbally, the inspector introduced himself and spent time observing their interactions with staff and response to what was going on. The domestic scale of the building meant that the inspector was able to indirectly observe staff in carrying out their duties, without them being aware or discomforted by being deliberately observed. Accordingly, the inspector believes that much of what was seen in terms of service user:staff interactions were genuine and not skewed by the inspection process. What the service does well: What has improved since the last inspection? In response to some requirements advanced at the last inspection and some of the Registered Managers own initiatives, the following positive developments have happened since the last inspection:- Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 6 I. II. Service users on special diets are now being monitored by a dietician. The Registered Manager reported that, subsequent to the completion of this inspection visit, all service users have a contract, which sets out all the charges and terms and conditions of accommodation and care. The Manager reported at inspection that the windows at the front of the ground floor of the building have been repaired. Staff members have received training in one aspect of the conditions of old age. III. IV. 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 Lodge DS0000004323.V249347.R02.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 Lodge DS0000004323.V249347.R02.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): 2 Service users who were resident at the Home at the time of inspection were benefiting from detailed planning of their care all of which is underpinned by thorough assessment of their needs. This includes due regard being given to their personal aspirations where they are able to communicate this or informed assumptions where the individual does not have the capacity make his or her wishes and feelings known in the more complex quality of life issues. EVIDENCE: Most of those resident at the time of inspection had been so for many years thus their original single Care Management assessments were not available. That said, all except two had a summary of what appeared to be such an assessment, which were prepared by their placing authority and described as Care First Care Plan: Agreed Needs and Aims. These simply outline what the placing authority ascertains the service users’ needs to be and what it requires the Home to do to fulfil those needs. Particular attention was given to this in assessing the evidence since caring for individuals with any degree of precision necessitates a clear understanding of what they need. In the case of those resident at this Home, this means an understanding of their strengths, difficulties and their aspirations, which, if achieved, is likely to lead to selffulfilment. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 9 Remarkably and in addition to the assessment summary mentioned above, the Registered Manager had conducted an in-house assessment using the twelvepoint framework specified in standard 2.3. This covers all aspects of the service users life ranging from accommodation and personal care needs though cultural and faith requirements to method of communication and compatibility with others living at the Home. Alongside this assessment were found individual risk assessment the purpose of which was clearly stated as primarily to enhance the service users’ strengths and abilities whilst at the same time protecting them from avoidable danger in the activities and lifestyles that they seek to pursue. This information was seen in all service users records and in detail in the two cases, which were closely examined, was corroborated by some service users, staff and the Registered Manager told the inspector. It confirms that the outcome for the standard is met not just in terms of the assessment, but the use to which it is put in the service users individual care plans, i.e., the blueprint for their care. The only area where some development might be merited is in engaging the Speech and Language Service to assess or reassess the communication needs of those who are unable to make their needs known. This might have the effect of confirming or improving upon the existing communication methods being used. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.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 and 9 The system adopted by the Home for using assessment data to inform planning of service users’ individual care is systematic, coherent and leaves little to chance. The clarity of the process means that though the service users might not fully understand the concept of assessed and changing needs and personal goals, the care that constitutes their daily life experience gives them a sense of this. The whole ethos of the Home is one in which the service user is respected as an adult individual with his or her personality and interests and has a right to choice and self-determination limited only by any danger to self or others. EVIDENCE: Assessment and care planning forms in the Home are integrated in a way that shows what each service user’s needs have been assessed to be and what needs to be done to meet them. The evidence - that is, documents found among service users’ records – shows that in each case, the assessment identifies the service users needs in a range of areas, as outlined in the previous section of the report. For example, personal care needs and health care requirements. Also set out in the assessment document is what the Home intends to do to fulfil those needs. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 11 In a separate document titled the Daily Activity Record is noted all the activities, which happen or action taken on a daily basis to achieve the objectives, which have been set or the outcome desired. Taken together these represent the individual plan specified in standard 6.1. Further, the outcome for this standard is deemed to be satisfied because such a plan has been developed and implemented as required; that the process of developing the plan involves the service user and in the Daily Activity Record is noted the evidence, which shows that Home is actually doing what the plan declares must be done to achieve the proper care of the individual. Typically, the individual plans were seen to address needs arising from the service users learning disabilities, health care requirements as well as quality of life or lifestyles issues. In some instances, official letters, appointment cards and other documentation provided independent confirmation the accuracy and verity of information in the Daily Activity Records and some service users in talking to the inspector about their daily experience of life at the home provided indirect corroboration. Acting on one of the recommendations advanced at the last inspection, the Registered Manager reported that arrangements have been made to sign and date all new assessment/individual plans, so as to enable more accurate check of the frequency of review at the specified minimum frequency or in line with the individual’s changing circumstances. There was evidence of review, where relevant, of service users’ cases conducted on a joint basis by the Home and the placing authority. Some of the service users currently resident have severe learning and physical disabilities and because of this are, to some extent, limited in their ability to make independent decisions. That said, there was evidence in the records and in staff explanations of their approach to decision-making about matters affecting service users lives, which suggest that due regard is given to the individual’s right in this regard. For example, where service users are unable to communicate in words, pictures are used to illustrate information to be discussed at their care plan review at which they are always present unless they indicate that they do not wish to be. In matters of daily living staff were able to show that they have made deliberate effort to understand service users preferences in relation to routines such as rising and retiring to bed, food, clothes, etc. These are reflected in the care plan and have been cited here because they help to demonstrate that the Home seeks to promote and safeguard service users’ rights regardless of their disability or communication difficulties. Currently, three service users manage their finances with the support of the Registered Manager and four are reported to have individual accounts, but the registered provider is acting as appointee. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 12 Whilst evidence was provided of the relevant bank/building society accounts and records of income, expenditure and balance of those who are being supported to mange their finance, there was no documentary evidence of the reason for the support and the manner in which it is given, as required by standard 7.5. This is required so as to confirm that there are sound reasons for the support or tuition being given and that it is appropriate to the needs of the individual. In the case of those for whom the registered provider acts as appointee, it will be necessary for records to be kept at the Home to confirm that this arrangement has been approved by the Department of Work and Pensions; that income and expenditure are recorded and independently audited. As mentioned earlier, a risk assessment for each service user has been conducted and documented. The guidance accompanying the assessment, which sets out how it should be conducted, emphasises that it is an exercise for protecting and enabling the service user and not to unduly restrict his or her activities. This is borne out by an example cited by the Registered Manager in which the risk assessment recognises that a particular service user opts to journey out of the Home unaccompanied and without making staff aware. The risk assessment prescribes vigilance as a control measure, but permits the service user to exit the premises with staff providing discreet supervision. Among the Home’s procedures was one for unexplained absences. It was deemed relevant to the needs and vulnerability of service users, setting out reasonable steps that staff should take in the event of a service user’s unexplained absence. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Service users resident at the Home are enabled to have a good quality of life in which they are provided opportunities for employment or meaningful occupation. The same applies to their entertainment and leisure, and social interaction both within the Home and in the community. Service users did not appear in any way mal nourished and though the menus or record of food provided needs to be presented in greater detail, the necessary care is being taken with meals and mealtimes so that they are of health and social benefit to service users. EVIDENCE: At the time of inspection one service user was being supported in employment, six were involved in constructive day occupation in Day Centres provided by the local authority or the registered provider. Those who attend the Day Centre have opportunities to pursue education and art and crafts. In these settings they are also able to meet others of similar age and interests, to establish friendships and to enhance their social and personal development. Service users leisure interests are typical in that they are the kind of activities pursued by others in the community of similar age and culture. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 14 It was established from both staff and service users’ accounts that the latter enjoy socialising – going to the pub, playing dominoes and visiting places of interest and entertainment. It was observed that the Home is equipped with usual entertainment media such as radio and television, some service users having their own. This and activities such as barbecue in the garden, in good weather, forms part of the home entertainment. Incidentally, the garden has been carefully designed so that it is accessible to wheelchair users; it has raised flowerbeds and is planted to create interest as well as a pleasing outlook. That these provisions are made for service users was confirmed by some of them and in some instances confirmed by the inspector’s direct observations. At the time of inspection preparations were being made for the celebration of a service user’s birthday and by way of establishing that there are sufficient funds to provide a reasonable range of entertainment and leisure activities, the Manger in response to enquiry advised that approximately 12 of the weekly housekeeping is spent on entertainment and leisure pursuits. This is of course in addition to what service users choose to spend in this connection. The Home is in a mixed – residential and industrial – neighbourhood and, for the ambulant, within walking distance of the town centre and all its amenities. Service users are shown to be part of the community in that that some are employed within it and in all cases use its facilities. That is, depending on interest and need, some use places of worship, shops, pubs, banks, etc. The Home’s relationships with neighbours are said to be good and there have been no reports to the contrary. From this it was assumed that service users are integrated into the community and thereby might have a sense of belonging. In regard to civic duty, the Manager reported that all service users are registered to vote and a minority exercise their franchise. As outlined earlier, service users have opportunities to make and maintain friendships and no undue restrictions were found in relation to their contact with relatives or friends. Whilst some service users are visited by family or friends quite frequently, for others this is sporadic and, in these cases, the appointment, subject to the individual’s consent, of properly vetted befrienders or independent visitors might be of benefit to them. In keeping with the Home’s ethos of treating service users with respect and according the rights that befit their adult status, it was noted that measures have been taken to assure their privacy such as fitting locks to their bedroom door. In dealing with matters such as service users private mail, staff explained that though the service users rely on them to read and explain the contents of personal mail, they (the staff) make a point of passing the mail to the individual to open for him or herself. It was observed that informal forms of address (first names) are used by all, service users and staff. No deliberate checks were made as to whether service users have adopted this by choice, but they seem comfortable with it. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 15 It was noticeable throughout the inspection that staff members were keen to engage with service users either on an individual basis or as a group. This means that service users get ‘quality time’ when they are able to interact with staff on an equal basis rather than simply on the occasions when they are having their personal care needs tended. There was no evidence to suggest that service users are prohibited from any areas of the Home, which is intended for their use and there is no issue over their having any housekeeping responsibilities. It was seen that where some service users participated in housekeeping chores such as drying dishes, this was from choice or skills acquisition. With regard to rules on smoking, alcohol and drugs, no concerns were reported or detected in relation to the latter two. However, the smoking rule, which confines service users who smoke to do so in the dining room needs to be reviewed. This is necessary because service users who do not smoke also use the dining room and their health and comfort might become affected by the polluted atmosphere caused by cigarette smoke. A record of meals provided for service users was being kept in the form of menus, but these only noted what is served at dinner. In terms of what is provided for each day’s main hot meal of the day, it was assessed that it is varied in content, wholesome and nutritious and offers choice. However, in order to make a full assessment, it will be necessary for the menus, or records of food provided, to be kept in more detail. That is, the record must detail the contents of all meals – breakfast, lunch, dinner, etc. Stores of food, including fresh fruit and vegetables, were examined and were considered to be ample in quantity and variety. This supports what service users advised about getting sufficient to eat, the menu forecast and what the Manager and staff reported of what is made available at the meals, which were not recorded. At the time of inspection, the Home was catering for two service users on special diets, which were being monitored by a dietician adding further evidence of its ability to provide choice and respond to special dietary needs. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Service users are benefiting from the Home’s care regime that gives due regard to their privacy, dignity and the promotion of choice and independence. Careful assessment of service users needs and staff’s working in effective partnership with health care professionals, ensures that service users health care needs are being met. EVIDENCE: From the two cases, which were examined closely, other records and staff explanations, there was evidence of careful consideration being given to service users’ personal care needs and how these are to be met on a day-today basis. It was noted that unless specifically required there were no inflexible care regimens and service users were able to exercise reasonable choice. For example, they rise from, and retire to, bed at times of their choice and one service user with significant physical disability was seen to be permitted to use an unconventional means of moving about the Home. This is despite more conventional mobility aids being provided. It was gleaned from observations, i.e., bathroom and toilet doors being shut when staff members assist service users with their ablutions and toilet, that personal care support is provided in private. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 17 However, since the Home is a relatively small one and the staffing is on a similar scale, it was inferred that there might be some limitation, particularly for male service users, on choosing staff of the same gender to support them in their general and intimate care. Currently the establishment of eight staff, including the Manager, is all females. With this in mind, it will be necessary for the registered person, in future staff recruitment, to seek to achieve a higher ratio of male staff. In relation to choice, service users who were able to advance a view and this was supported by staff’s account, indicated that they are able to choose their own clothes, but guidance is sometimes given in respect of the appropriateness of attire. For example, guidance might be given about colour co-ordination and the relevance of the clothing to the weather conditions and the occasion. It was also noted that clear information is available on what has been established as the preferred approach to the personal care support of those who are unable to communicate this. At the time of inspection, it was noted that all service users were appropriately and comfortably dressed, clean and acceptably groomed. Record of assessments, care plans and other documentation provided abundant evidence of service users being supported to receive the primary and specialist services that they need for their physical and emotional health. All service users are registered with GPs from whom they are reported to receive a good service. Where necessary, there was evidence of service users’ conditions being monitored by relevant health care professionals and that arrangements have been made for them to have regular dental and optical checks. At the last inspection there were concerns about the lack provision of aids to assist service users with their mobility both specifically and generally. This led to a requirement for an assessment of the Home’s environment to be conducted by an Occupational Therapist (OT). The Manager reported that such an assessment has been carried out in regard to a particular service user and generally. It was also reported that the OT made no recommendations in relation to the particular service users or the general home environment. The Registered Manager nevertheless still needs to submit the OT’s report to the Commission as specified in the requirement. The Home currently accommodates service users aged 65 and therefore the Manager will need to continue to monitor their condition and decide whether, as their needs change from those primarily linked to learning disability to those of old age, the Home is equipped to meet them and seek a variation of the category of registration accordingly. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 18 The Home has an acceptable medication policy, which enables service users, subject to assessment of risk, to control their own medication. Some six of the seven staff members at the Home have received training in the safe custody and administration of medication and the medication procedure that the Home has adopted is monitored by the pharmacy normally used for dispensing service users’ medication. The last such monitoring visit was on 27/10/04. This shows that reasonable steps have been taken to ensure that medication is being dealt with safely. Two critical observations arose from examination of the Home’s medication system. First was that one member of staff did not fully understand the recording system and claimed that this is usually carried out by the Manager and another senior member of staff. In the circumstances, it will be necessary for all staff members to have a good working knowledge of the Home’s medication procedure, including being able to reconcile the quantities of medication recorded as given against that which is left in storage. If the claim that medication is recorded by the two aforementioned persons is accurate then it seems likely that the records are not always being completed on a contemporaneous basis, which is not acceptable and would need to be addressed. Second is that the existing medication cupboard, which is being used for other storage, needs to be substituted for one of a type specified in standard 20.7, i.e., a metal cabinet with the necessary design features, recommended by the Pharmaceutical Society of Great Britain, capable of storing controlled drugs should it be necessary to store such drugs on the premises. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The Home assures service users that their views will be listened to and that they will be protected from abuse, other forms of adverse treatment or neglect. Policies and procedures in place in this regard are sound and have been re-produced in forms that service users are likely to understand. EVIDENCE: Among the portfolio of policies and procedures and guidance, which were examined, was the Home’s complaints procedure, which sets out clearly the process for receiving, looking into and responding within a specified time, service users’ concerns or any that might be made on their behalf. The complaints procedure had been reproduced in pictorial form depicting circumstances in which they might be unhappy, dissatisfied or concerned. The complaints procedure document, which has been designed specifically for service users, also includes pictures and the names of key persons to whom they might wish to take their complaints or concerns. With this and the general ethos of the Home, which is one in which staff are keen to ensure that service users are happy and content, the inspector is satisfied that all reasonable care has been taken to ensure that service users are listened to and their views and concerns are taken seriously. The measures taken also reassure service users that they can take their concerns to others outside the Home if necessary, and it was encouraging to note that the Manager monitors the complaints register from which it has been noted that there have been no complaints since the last inspection. The Manager produced as evidence a procedure titled: Guidance To Care Staff – Abuse Of Vulnerable Adults, which they are expected to follow in the event of witnessing or suspecting any such abuse. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 20 The Guidance is complimented by the whistle blowing policy and defines the various forms of abuse. In a similar way to that which is explained above in relation to complaints, the Manager selected from one of the service users’ records a booklet, that depicts the forms of abuse (sexual, physical, emotional, etc), which is used to help service users to protect themselves and to be able to report any abuse or ill treatment they might encounter. As a further evidence of how seriously the Home takes the Protection Of Vulnerable Adults (POVA), the Manager made the inspector aware of an agreed protocol for the event of a particular service user making an allegation of abuse. The protocol is necessary because the service user is said to have made spurious allegations of abuse in the past to gain attention. Accordingly, the protocol seeks to both protect the service users and avoid reinforcement of the undesired behaviour. The Manager advised the inspector that there have been no incidents of abuse reported or suspected and that there have been no instances in which it has been necessary for staff to resort to physical intervention with service users. In this connection some staff have received training in safe physical restraint and the essence of the Home’s policy on dealing with verbal and physical aggression from service users is to employ de-escalation strategies, e.g., diverting the service from this type of behaviour. On this occasion no checks were made of whether the Home’s POVA procedure is compatible with those agreed and issued for the local area or whether a copy of them are kept at the Home. If this is not the case, the registered person is advised to ensure that it is, as this will be examined at the next inspection. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Service users are afforded a comfortable, homely and safe environment, both in their private and communal living space. The Home is well-maintained and is adapted and equipped to meet service users individual and needs in common. Furthermore, service users health and safety are being safeguarded by staff members’ scrupulous attention to matters of cleanliness and hygiene in the Home. EVIDENCE: The Home is detached and of two storey construction and is not conspicuous in the neighbourhood. On the ground floor are: a shower room with toilet, a separate toilet (used almost exclusively by staff and visitors), kitchen and sitting rooms, dining room and two bedrooms. A stairlift, which was seen to be in working order, provides service users access to the first floor where there are five further bedrooms, bathroom and a multi-purpose room, which is used as office and staff sleeping-in facility. The bedrooms were not measured, but are understood to conform to the specified space requirements. The bathroom on the first floor is fitted with a hoist and there are grab rails by the toilets. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 22 Both the shower room and the bathroom and shower room are well equipped, but they present as stark and uninviting and would benefit from homely adornments to make them appear less clinical. The bedrooms on the ground floor are appropriate for those with more significant physical disabilities and they are close to the shower room, toilet and communal areas. This means that service users in these rooms have ease of access to all the facilities that they need. All the bedrooms are in good decorative order, acceptably furnished and equipped, where relevant, with the aids necessary to promote service users independence and safety. It was noted that they provide sufficient storage for their occupant’s possessions and though in all cases do not contain all the items specified in standard 26.2, all have TV and except one, have a washbasin. In short, service users’ bedrooms are properly equipped, comfortable and reflect their individual tastes and interest. Service users are provided with a secure cabinet in which to keep copies of the personal records and any other possessions that they wish not to hand over for safekeeping, but which they can keep securely. The sitting and dining rooms are comfortable and in line with the Home’s planned maintenance arrangements, the former is due to be redecorated in a few week’s time when the service users go away on holiday and the worn carpet in the hallway is also to be replaced then. For service users’ comfort, the sitting, and dining rooms are adjacent and near enough to the kitchen so that service users can see and smell food in preparation and to engage with staff when they are cooking. This was actually observed and again highlights the reassuring domesticity there is about the Home. It was noted there were ramps to facilitate wheelchair access to the Home and rear garden, which as earlier reported is being maintained in excellent condition and provides an additional communal facility for service users. The Manager advised that the Home provides transport specifically designed for wheelchair using passengers and that dining furniture of suitable dimensions has been purchased to accommodate the needs of service users with physical disabilities. The Home is fitted with central heating and is sufficiently lit by both natural and artificial light. There were no concerns about ventilation and floor coverings, (except for that which is due to be replaced), curtains beds and bedding were found in acceptable condition. The following are other deficits which were found and which the registered person will be required to address:- Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 23 1. The side of the building onto which the rear door of the kitchen leads needs to be tidied and the drain cover in this area cleaned. It seems likely that if the whole of this area were to be paved, it would prove easier to keep clean. 2. Handrails, which are currently absent, are required in all the internal passageways to promote ease of mobility for those with such difficulties. 3. The first floor service users’ bedrooms are not fitted with restrictors to stop them opening to the fullest extent. Restrictors therefore need to be fitted so as to enable sufficient ventilation, but prevent successful attempts in the event of any service user trying to climb out. 4. The hot water temperature in one of the first floor bedrooms was handtested by the inspector and experienced as scalding hot. Accordingly, it will be necessary for the registered person to regulate and monitor the hot water temperature, at all outlets to which service users have access, to 43º C. Note, the notice advising “Very hot water” is not a sufficient safety precaution in this regard. Throughout, the Home was found in clean condition and facilities, including gloves and protective clothing, and those for hand washing, are made available in all relevant areas as part of the Home’s practice for controlling spread of infection. Also in this regard, it was noted that the laundry, which is appropriately equipped is separate from areas where food is prepared and consumed. There is a cleaning schedule, which dictates that the kitchen, bathrooms, toilets and living rooms are cleaned daily and service users’ bedrooms weekly or more frequently if necessary resulting in the clean conditions which were seen at inspection. This together with acceptable measures for the storage and disposal of clinical waste are also intended to contribute to control of infection. They are also in accord with the Coventry and Warwickshire Health Protection Guidance for Control of Infection (November 2004,), which the Home has adopted. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 24 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 and 35 The staff team is cohesive and its members’ breadth of training, knowledge, experience and skills are sufficient to respond to service users’ individual and group needs. Moreover, service users’ welfare is safeguarded by the care, which the registered person demonstrates in the Home’s staff recruitment and selection process. EVIDENCE: Staff of the Home, as a collective, are deemed to have the competencies necessary to meet service users needs because their individual selection process, of which evidence was seen at inspection, carefully ascertains that they are fit both in terms of relevant experience and character. That is to say they are persons who are motivated to work with this service user group, have had previous experience of so doing or possess experience and skill which are relevant and transferable. The Home’s induction and foundation training, which is reflected in staff training and development profiles, shows that newly recruited staff members are apprised of the Homes purpose and the principles that underpin its care and treatment of service users. This combined with in-service training ensures that staff have a good working knowledge of the nature of service users common and individual disabilities and needs and the function of residential care in responding to these. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 25 As earlier mentioned, staff members were observed to be genuinely interested in service users and treated them with respect. They were seen to be patient and they made time to sit down and talk with service users, even when the only responses that they got were non-verbal. Observations at the time of inspection largely focused on the interactions between service users who were able to communicate verbally with staff. However, records and staff’s report of what they have come to establish as some service users non-verbal cues about how they are feeling and what they need, suggest that they (the staff) are good listeners and are sufficiently interested and motivated to detect these cues. Staff’s length of service at the Home varied from eighteen months to 10 years thus showing commitment, reliability and a degree a of permanence in the service users lives. Evidence of staff training provided and albeit limited observations of staff in practice, confirmed that they have the experience and skills necessary to intervene in the care and treatment of service users in the ways described in standard 32.3. That is they have received training in communication from specialist Speech and Language Therapists, they have a good understanding of the means by which those without the facility to communicate verbally or by means such Makaton, make their needs know. Furthermore, they are aware that some of those currently resident use aggression as part of their nonverbal repertoire. Since some of the service users have multiple disabilities and health conditions, staff members have to work closely with a wide range health care professionals. The records and staff members own accounts suggest that they are doing this effectively. For example, certain members of staff have been trained, by relevant health professionals involved, to carry out procedures such as giving enemas where this contributes to the efficient care and comfort of a particular service user. Currently only 21 of staff members hold a National Vocational Qualification (NVQ) in care, but given that two are undertaking this training programme and another is registered in the Learning Disability Award Framework (LDAF) it seems likely that the registered person is on course to achieve the required target of 50 by they year’s end. Staff records made available at inspection, a sample of which were checked, showed that care was being taken to protect service users by ensuring that persons employed at the Home have been rigorously vetted to establish their fitness to work with vulnerable adults. The indicators of compliance, which were observed in this regard are that: candidates were required to complete an application form detailing their employment history; Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 26 the manager is aware of the implications of any gaps in candidates employment history; candidates identity is verified; references are sought; staff do not commence until they have had a satisfactory CRB/POVA check; and, they are required to serve a six month’s probation. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 27 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): 38, 39 and 42 The Home’s management approach seems to have engendered cohesion and commitment in the staff team and consequently there is a relaxed but purposeful feel to the Home, an environment in which service users demeanour suggests that they feel safe and content. However, there is scope, for the registered person to build upon the work done to promote to service users the Home’s keenness to deal with their concerns, in a more pro-active way, i.e., by establishing a quality assurance system. EVIDENCE: Examination of the Home’s policies, procedures, guidance and practices together with the quality of service users care, aspects of which were observed, confirmed that the Home is well run. Furthermore, the standards, which are achieved both in relation to service users personal care and maintenance of the environment, demonstrate that there is clear leadership. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 28 From staff training profiles, it was seen that substantial investment has been made in their training which has also been regarded as an indication of the Manager’s commitment to a skilled staff team the members of which will from their training bring new ideas and collectively help the Home to keep up-todate with developments in practice. The care taken with promoting the complaints procedure to service users in appropriate format and permitting service users to retain copies of some of their records were taken as evidence of open and transparent management prescribed in standard 38.4 There was no evidence of an annual development plan for the Home, as required in standard 39.2 or of the quality assurance system referred to in standard 39.1. This has been highlighted at previous inspection including the last when a requirement was made in this connection. In case this has not been done because the Registered Person is unsure of what is required, it is suggested that the standard will be met if the following is achieved:1. A questionnaire (or customer satisfaction survey) in appropriate format is developed and administered to service users. Ideally, the questionnaire should be anonymous and independent assistance sought to aid service users to complete it. The help of the Speech and Language Service might prove invaluable in this regard. Once the questionnaires have been analysed, the outcome should be submitted to the Commission in written form together with any action to address any matters arising from the results. 2. That there is a system for continuously monitoring the Home’s own standards, which culminates in an annual development plan. This could be linked to the visits carried by the provider or his or her representative under regulation 26 and other audits such as the audit of the register of complaints and the accident records, which is carried out routinely by the Manager. This system should demonstrate evidence of service users’ contribution to the audit process. 3. The views about the running of the Home and its quality of care should be sought from service users families and professionals who visit or have an interest in care of service users accommodated in it. Once analysed the results of this should be shared with the contributors. 4. The information gleaned from the process of 1 to 3 above together with the review of the Statement of Purpose might be regarded as review of the quality of care required by regulation 24. 5. The annual development plan referred to at 2 above will naturally be influenced by information of what the Home is doing well and where there are deficits, as revealed by the processes at 1, 2 and 3 above. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 29 6. Action resulting from the aforementioned processes and the individual care planning process, should enable the Manager to demonstrate the “year on year development for each service user” required by standard 39.5. Checks were made of records and of policies, procedures and practices in relation to the aspects of health and safety set out in standard 42. That is: moving and handling, fire safety, first aid, food hygiene, safety maintenance of gas and electrical appliance and the storage and disposal of hazardous substances. The following was found:Moving and Handling: The records showed that all staff members currently employed at the Home have received training in moving and handling and the use of the hoists. It was noted that the track hoist was last checked on 01/04/05. The records also showed that the stair lift was checked on 30/03/05. This confirms that reasonable care has been taken to ensure that where service users need assistance to transfer this is likely to be done safely. First Aid: The training profiles of all those currently employed at the Home indicate that they have received training in first aid, which is still valid and a fist aid kit was seen to be provided. Staff should therefore be able to respond to minor accidents, keep an injured service user comfortable and prevent avoidable deterioration until qualified medical assistance arrives. Food Hygiene: On inspection there were no obvious breaches of food hygiene code; food was seen to be stored properly – cooked food being covered and placed away from that which is uncooked. It was also noted that the member of staff assigned to preparing a meal during the inspection, did this exclusively and was not required to carry out any personal care tasks. These and other measures such as all staff being trained in food hygiene were regarded as indicators of proper care being taken to reduce the risk of food contamination and the spread of infection. Fire Safety : In discharging their duty to make provision to prevent the risk of fire, it was noted that the registered persons have installed heat/smoke detection and systems, which the records show are being serviced and tested at the required intervals. For example, fire alarm tests were being carried out weekly, emergency lighting tested monthly and fire extinguishers were being checked annually. There was evidence of a fire risk assessment being conducted and that the Home is inspected by the Fire and Rescue Service, the last such inspection was on 29/06/05 and elicited no adverse observations. These, among other measures such as the registered person ensuring that all staff have received fire safety training and fire notices produced in a format appropriate to service users understanding confirms that the registered persons are fulfilling their duties in this regard. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 30 Maintenance of gas and electrical appliances, and the storage of hazardous substances: The Home’s logs and additional evidential documents such as invoices showed that the central heating boiler and gas cooker received safety checks on 12/07/05 and that the portable electrical appliance checks were being conducted annually as required, the last such check being conducted on 05/05/04. The check for this year is now due. In relation to hazardous substances, it was noted that there is a COSSH policy and that the manufacturers guidance on the use and response to misuse of substances such as cleaning material were kept at the Home. Moreover, it was observed that such substances are kept in a secure place thus limiting the risks associated with these substances. Accidents: As required the registered person keeps a record of accidents, which in this instance is titled Accident and Dangerous Occurrence Report. The record reveals that there were 6 incidents between 07/04/05 and 25/06/05; all of which were minor. Apart from the evidence above, there were many other examples such as specific risk assessments for service users (e.g., in relation to falls) and aspects of the Home’s environment and the tasks that staff members have to perform. This and training that the registered persons have ensured some staff receive in health and safety convince of performance that meets the required standards and thereby safeguards service users from harm. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 31 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 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Paks Trust - Oaston Lodge Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score x 3 1 x x 3 x DS0000004323.V249347.R02.S.doc Version 5.0 Page 32 Yes 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 16 Regulation 13 (4) Requirement The Registered Person must review the Home’s smoking policy with a view to introducing a rule, which protects service users who do not smoke from the effects of smoking by those who do. The Registered Person must submit the Occupational Therapist’s report, as specified in requirement 11 of the report of the last inspection, the greater part of which the Manager reported has been fulfilled. This replaces the aforementioned requirement for which the timescale for action was 01/06/05. Timescale for action 30/10/05 2 19 23 30/10/05 Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 33 3 19 and 21 14 (2) (a) (b) 4 20 13 (2) The Registered Person must 30/10/05 arrange for the re-assessment of service users who are currently resident and are aged 65 years and above. This is to ascertain whether their needs remain primarily associated with their learning disabilities or conditions of old age. If the latter is the case, the registered person must decide whether the Home can in the present and future meet those needs and seek to vary the category of registration accordingly. This supersedes the requirement 1 of the last inspection report for which the timescale for action was 01/07/05 The Registered Person must fulfil 30/10/05 the following:i). Ensure that all staff members understand the medication recording system sufficiently to be able to reconcile medication recorded as given or otherwise against that which is in store ii). Ensure that all medication given is recorded immediately it is given. iii). Install a medication cabinet of metal type, which conforms to the guidance of the Pharmaceutical Society of Great Britain and is capable of storing controlled drugs should it be necessary to store such drugs on the premises. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 34 5 24 23 The Registered Person must attend to the following: I. Using decoration and homely adornments, seek to make the bathroom and shower room more homely and inviting. Maintain in clean and tidy condition the area at the side of the building onto which the rear kitchen door opens. Paving this area might make it easier to keep clean and prevent the collection of debris around the drain cover. Fit handrails along the internal passageways to aid the mobility of service users with this difficulty. Regulate the hot water temperature to 43ºC at the taps that service users are likely to have 30/10/05 II. III. IV. Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 35 6 39 The Registered Person must: a) establish a quality assurance/quality monitoring system for the Home; b) ensure that the quality assurance system includes periodic administration of service users satisfaction surveys; c) seek the views of those with an interest in the Home (i.e., GPs, Physiotherapists, Community Nurses, Chiropodists, Day Centre staff, etc); d) submit to the Commission the analysed results of the service users survey; e) give feedback of the results to the contributors of the interested parties whose views have been sought; f) produce an annual development plan, which is informed by the quality assurance process and shows what measures are to be taken to address any identified deficits and to develop the quality of the service; and g) organise service users’ records so that they demonstrate progress made in their care and development annually. 30/10/05 Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 36 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 2 Good Practice Recommendations The Registered Person should engage the Speech and Language Service to assess or re-assess the communication needs of service users who cannot make their needs known verbally and do not use other agreed communication medium. The Registered Person should, subject to the relevant individuals’ consent, seek to recruit persons to act as Independent Visitors or Advocates for service users who have only infrequent visits from their families and friends. The Registered Person must keep a more detailed record of food provided for service users. This, typically, must show what was provided at breakfast, lunch, dinner and supper. It must also show the main constituents of the meal. The Registered Person is reminded that the annual check for the portable electrical equipment is due. 2 15 3 17 4 42 Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 37 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 © 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 Paks Trust - Oaston Lodge DS0000004323.V249347.R02.S.doc Version 5.0 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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