Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 25/08/07 for Paks Trust Oaston Lodge

Also see our care home review for Paks Trust Oaston Lodge for more information

This inspection was carried out on 25th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

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

People who might want to live at this home have the information needed to decide if the home is right for them. All questionnaires completed by residents (some with help from staff) say they received enough information about the home in order to decide if it was the right place for them. Staff were watched helping residents to make choices about day-to-day matters, such as what meals to have, and what they wanted to do on that day. Lots of documents have been produced in large print pictorial formats as aids to communication to help residents make choices and to keep them informed. Residents living at this home are supported to join in activities as per their needs and wishes. As one resident explained, "I go to different places, day services and out for walks". A lunchtime meal was observed and staff were seen to sit with residents and give help where needed in such a way that maintained the resident`s dignity and safety. There was lots of laughter and encouragement given by staff to residents making this an enjoyable and social affair for everyone.The home is good at making sure residents stay healthy. One resident told the inspector, "I was on a low fat diet and have lost nearly three stone since living here and come off my cholesterol tablets. Staff have taken me to have my ears syringed two or three times, they are good like that". All of the questionnaires completed by residents and returned to the CSCI state people know who to speak to if unhappy, with extra comments made including `I would speak to the manager or my key worker or any other member of staff` and `I tell people if I`m not happy or don`t like something`. Generally residents live in a safe, well-maintained and comfortable environment that encourages independence. Bedrooms were freshly decorated, furnished to a good standard and contained personal possessions, photographs and other effects.

What has improved since the last inspection?

Since the last inspection the home has changed its registration category to reflect the age range of people living there and information regarding this is now also included in the service user guide (a book that tells people how the service works). The home now employs a male member of staff as well as female staff, in order to reflect the mix of people living at the home. Staff that the inspector spoke to say they have completed accredited medication training and are awaiting certification.

What the care home could do better:

The home must reduce the risk of danger for a named resident who uses bedrails. They must provide covers and write an assessment for the named resident that tells staff how any dangers can be limited. They must also arrange for a suitably qualified person such as an Occupational Therapist to undertake an assessment of the bedrails. Risk assessments must be completed based on residents individual needs and capabilities and reviewed within agreed timescales to ensure risks are managed and residents are safeguarded. The home must make sure systems for management of invasive medication practices safeguard residents and comply with legislation.Records must be accessible at all times in order that the home can demonstrate that staff receive suitable training and support to meet the needs of residents. Either records must be accessible at all times or a proforma introduced that details all required information, that is agreed with the CSCI, in order that the home can demonstrate it is safeguarding residents with its recruitment practices. Several good practice recommendations were also made, which are detailed at the back of this report.

CARE HOME ADULTS 18-65 Paks Trust Oaston Lodge Oaston Lodge 82 Oaston Road Nuneaton Warwickshire CV11 6LA Lead Inspector Lesley Webb Key Unannounced Inspection 25th August 2007 10:00 Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paks Trust Oaston Lodge Address Oaston Lodge 82 Oaston Road Nuneaton Warwickshire CV11 6LA 02476 742204 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 (4), Learning disability over registration, with number 65 years of age (3), Physical disability (2) of places Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. NVQ Level 4 That NVQ Level 4 in Care and Management is achieved by 2005. That the home may accommodate three existing service users over the age of 65 years and with a learning disability. 13th October 2006 Date of last inspection Brief Description of the Service: Oaston Lodge is a domestic style detached house in a residential area of Nuneaton and close to the towns shops and leisure facilities. Ground floor accommodation comprises of a lounge, kitchen, dining room, shower room with toilet and two single bedrooms. Five further bedrooms and a small office 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 and parking to the front of the property. The current scale of charges is £538 - £637. Additional costs for hairdressing, chiropody, toiletries, holidays and social activities have to be met by service users. Transport costs are charged per mile. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this visit over one day from 10am until 4.30pm with the home being given no notice. During the visit time was spent talking to staff, watching how residents were treated and examining records before giving feedback about the inspection to the senior person on duty. The people who live at this home have different needs. We talked to people living at the home, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for two people. This is called case tracking. The people chosen were male and female and have different life styles and care needs. The home provides long term care for people with learning and physical disabilities, who may be of an older age. We were not able to talk to some of the people living at the home. Therefore we watched behaviours and the care given by staff as well as looking at information supplied by the home before the inspection in order to decide on the standards of service provided. The inspector would like to thank everyone for making her welcome and for the help they gave during the visit. What the service does well: People who might want to live at this home have the information needed to decide if the home is right for them. All questionnaires completed by residents (some with help from staff) say they received enough information about the home in order to decide if it was the right place for them. Staff were watched helping residents to make choices about day-to-day matters, such as what meals to have, and what they wanted to do on that day. Lots of documents have been produced in large print pictorial formats as aids to communication to help residents make choices and to keep them informed. Residents living at this home are supported to join in activities as per their needs and wishes. As one resident explained, I go to different places, day services and out for walks. A lunchtime meal was observed and staff were seen to sit with residents and give help where needed in such a way that maintained the resident’s dignity and safety. There was lots of laughter and encouragement given by staff to residents making this an enjoyable and social affair for everyone. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 6 The home is good at making sure residents stay healthy. One resident told the inspector, I was on a low fat diet and have lost nearly three stone since living here and come off my cholesterol tablets. Staff have taken me to have my ears syringed two or three times, they are good like that. All of the questionnaires completed by residents and returned to the CSCI state people know who to speak to if unhappy, with extra comments made including I would speak to the manager or my key worker or any other member of staff and I tell people if I’m not happy or dont like something. Generally residents live in a safe, well-maintained and comfortable environment that encourages independence. Bedrooms were freshly decorated, furnished to a good standard and contained personal possessions, photographs and other effects. What has improved since the last inspection? What they could do better: The home must reduce the risk of danger for a named resident who uses bedrails. They must provide covers and write an assessment for the named resident that tells staff how any dangers can be limited. They must also arrange for a suitably qualified person such as an Occupational Therapist to undertake an assessment of the bedrails. Risk assessments must be completed based on residents individual needs and capabilities and reviewed within agreed timescales to ensure risks are managed and residents are safeguarded. The home must make sure systems for management of invasive medication practices safeguard residents and comply with legislation. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 7 Records must be accessible at all times in order that the home can demonstrate that staff receive suitable training and support to meet the needs of residents. Either records must be accessible at all times or a proforma introduced that details all required information, that is agreed with the CSCI, in order that the home can demonstrate it is safeguarding residents with its recruitment practices. Several good practice recommendations were also made, which are detailed at the back of this report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 8 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.V345657.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to decide if the home can meet their needs. They have their needs assessed and a contract that clearly tells them about the service they will receive. EVIDENCE: Information supplied by the home prior to the inspection states as what the home does well we have an up to date statement of purpose, new service users only admitted after full assessment undertaken by people competent to do so. The manager must show that the home has the capacity to meet the individuals needs, prospective service users should have the opportunity to introductory visits before making a decision, all service users have written and pictorial contract. Examination of records and discussions with staff confirm this information to be accurate. There are no vacancies at the home and it has remained fully occupied for some time. The last person to be admitted to the home was over twelve months ago and has settled in well, thereby demonstrating that management operate a successful admission procedure. As this person explained, I used to come here for dinner, I was lonely in my flat, social services offered me other places to live but I wanted to live here, I like it here. There are assessment tools in place in order for new residents’ needs to be thoroughly assessed prior to admission. The homes admissions Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 10 policies ensure prospective new residents would receive sufficient information on which to base decisions on the homes suitability. All questionnaires completed by residents (some with assistance of staff) confirm they received enough information about the home in order to decide on its suitability. As at previous inspections observation of care practices and discussions with staff clearly demonstrate that the service is meeting and understanding the changing needs of the of the older people living in the home and the impact growing older may have on a persons lifestyle. The pace of daily routines and daily activities was seen to be appropriate to current needs and records show that involvement and independence as people grow older, i.e. in shopping and home activities, continues to be promoted. Since the last inspection a requirement to vary the registration category to reflect the age range of people living there has been met and information regarding this is now also included in the service user guide. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to make decisions about their lives. Improvements to some records relating to care planning and risk assessments will ensure needs are monitored and managed effectively and offer further assurances to residents. EVIDENCE: Care plans of two residents were examined. Some elements of these were excellent in providing detailed guidelines for staff in supporting residents and the home uses a recognised person centred planning approach with care plans reproduced in formats suitable for individuals. Further work however must be undertaken to ensure documents are completed in full and dated to ensure records evidence needs are current and are being appropriately managed. For example one persons care planning documentation was not dated when completed so the inspector was unable to ascertain if this related to the persons current needs and sections relating to assessment of skills and needs, Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 12 action plan and monitoring and review were blank. Evidence was found that plans are amended following professional input with dates and signatures in place for these however further work is required to ensure reviews take place within the agreed timescales. For example one person lifestyle choice documentation dated 13/12/05 states to be reviewed on an annual basis but no evidence of this occurring could be found. When assessing review processes staff confirmed that annual reviews involving other professionals including social workers take place however records were not in place to evidence this. As at previous inspections members of staff were observed encouraging residents to make choices about day-to-day matters, such as what meals to have, and what they wanted to do on that day. People’s ability to exercise choice and to make informed decisions is variable, according to their degree of learning disability and communication needs. It was therefore pleasing to find that many documents have been produced in large print pictorial formats as aids to communication. When asking staff if residents or key worker meetings take place staff said that these have in the past but that due to two residents recently spending a lot of time in hospital and staff spending a lot of time with them these have not been taking place. This information was confirmed by one resident that the inspector spoke to who stated, Not had a residents meeting for a long time because two clients in and out of hospital and staff have to go with them. It is recommended that meetings be reinstated as mechanisms for involving residents in decision making. Records on residents’ files indicate that the staff and manager act as advocates for residents who are unable to give consent (for example authorisation for flu injections). The home should seek advice regarding this to ensure it complies with the Mental Capacity Act and to ensure residents rights are promoted. All staff that were spoken to demonstrated good knowledge and understanding of involving people with communication needs in decision-making processes and were observed supporting residents to make choices, for example with regards to meals, drinks and activities. The inspector was not able to check any of the service users’ financial records at this inspection due to the manager not being present and being the only person having access to this information. The inspector questioned how residents could access their own personal monies if the manager in not on duty with a member of staff explaining that petty cash is used which is reimbursed by the manager on behalf of residents when she is on duty. The inspector recommends the home review this practice in order that residents have access to their own monies at all times and their rights are not compromised. As with care planning, generally risk assessments processes and documentation is appropriate. Some improvements however must be undertaken to ensure risk assessments are completed based on residents individual needs and capabilities and not generic as is the case for many Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 13 assessments seen and that risk assessments are reviewed within agreed timescales. For example one persons risk assessment for going out alone is dated March 2004 and states review March 2005 but no evidence of this could be found and another assessment for falls states review July 2005 but again no evidence of this could be found. It was also noted that one person has a risk assessment for falls that states to follow a management strategy but this was missing, with staff unable to locate it (other assessments however did contain the appropriate protocols). A wheelchair risk assessment has been established but this is generalised and not based on individual residents needs and capabilities, does not include health and safety checks undertaken by staff, servicing of the equipment, use of foot plates and how staff should use the equipment safely in the community with regard to ramps and dropped kerbs etc. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices about their life style, and supported to develop life skills. Social, educational, cultural and recreational activities meet individuals’ expectations. EVIDENCE: Information supplied by the home prior to the inspection states we give opportunities for personal development by maintaining and developing social, emotional, communication and living skills. We offer a choice of recreational, social and cultural activities, meals and holidays. Evidence gained through examination of records, observation of practices and discussions with residents and staff confirm this information to be accurate. For example on arrival to the home some residents were up and about while others were still in bed with staff explaining that there are no set times of rising at weekends, residents were observed moving freely around the home with no apparent restrictions and one resident informed the inspector that they are employed at a local Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 15 supermarket for two days each week. Activity records confirm residents’ attendance at day services, activities and health appointments. Two residents informed the inspector about a holiday they are going on shortly and of another that one had been on earlier in the year. Residents living at this home are supported to participate in activities as per their needs and wishes. As one resident explained, I go to different places, day services and out for walks. All of the questionnaires completed by residents’ state they always make decisions about what they do and can do what they want during the day, evenings and weekends. Additional comments include I choose my day service days, my meals, my TV programmes and I sometimes go into town at weekends but sometimes I’m tired. There are two designated smoking areas in the home, one outside for staff use and one of the shared rooms, (the dining room), for residents who smoke. Written procedures are in place in large print, picture format informing residents that smoking is not permitted during meal times in the dining room and both staff and residents were seen asking a resident to stop smoking during the lunch time meal (which they did after several requests). As in previous inspections there is no obvious area in the home where those who smoke might do so without affecting other residents, but in order to safeguard the health and safety of those who do not smoke the home should look at seeking other solutions such as the provision of a conservatory at the rear of the property. It is also recommended that the home seek advice from the Environmental Health Department with regards to passive smoking and implement any recommendations in order that the health and wellbeing of people is promoted. Mealtimes are relaxed and unhurried. A lunchtime meal was observed and staff were seen to sit with residents and give assistance where needed in such a way that maintained the resident’s dignity and safety. There was lots of laughter and encouragement given by staff to residents making this an enjoyable and social affair for residents and residents were seen to be offered a choice of meals. Specialist foods such as thickening agents to assist swallowing and dietary compliments for older people are provided as necessary, and one of the lunchtime meals provided included a soft option for those that required it. The lunchtime meals were very well presented and appeared appetizing. Residents confirmed their enjoyment. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Further improvements to some areas of medication will offer further safeguards to residents. EVIDENCE: Residents receive personal support in the way they prefer and require as evidenced through observations during the inspection, discussions with staff and examination of records. For example, upon arrival at 10am not all residents were up and dressed. Residents arose at varying times and entered the dining room when they felt ready for breakfast. There was no prompting or coercion by staff to eat their breakfast or get dressed by a specific time, which is commendable. Daily reports completed by staff demonstrated that residents go to bed at varying times. The home now employs male and female staff, which reflects the gender composition of the service user group. There is a designated key worker system to promote continuity of care and support Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 17 for residents. Residents were all smart in their appearance, their clothes were clean and fresh and appropriate to their individual lifestyle and needs. As at previous inspections care plans looked at recorded all identified healthcare needs and health-care records continued to evidence residents have ready access to a GP and other health professionals locally including, physiotherapists, psychiatrists, dentists, speech and language therapists, occupational therapists and chiropodists. One resident informed the inspector of their satisfaction regarding support with health needs, stating, I was on a low fat diet and have lost nearly three stone since living here and come off my cholesterol tablets. Staff have taken me to have my ears syringed two or three times, they are good like that. Medicine is stored in a metal cabinet that is kept in the staff sleeping room. At the time of inspection the lock on the medication cabinet was broken and requires repairing to ensure medication is secure (it was however noted the room used to store medication was locked throughout the inspection and staff confirmed this is always the case). The home uses a monitored dosage system for the management of medication with records of medication entering, being returned to the supplying pharmacist and for the administration of medication to be correct. It was pleasing to find that a photograph of each resident is retained with his or her records. There are a range of policies and procedures in place relating to administration, covert practices, training and disposal. No policy for the use of homely remedies could be found despite an over the counter item being used for one resident. A member of staff stated that the General Practitioner had consented to this item being used but no records were available to demonstrate this. Records viewed indicate that some residents may require invasive interventions in order to maintain good health. Apart from a letter from a General Practitioner stating she is happy for the manager to undertake this task no other records are in place (for example care plans, risk assessments, staff and residents consent). The home must ensure systems for management of invasive practices safeguard residents and comply with legislation. It is strongly recommended that the home obtain the CSCI guidance regarding invasive practices in care homes and implement the content of this to ensure residents are protected by the homes records and to demonstrate the homes practices comply with relevant legislation. Another resident currently has medication secondary dispensed by the home in order that they can have medication administered at a day centre. A record is maintained where the daycentre sign to say they have administered medication, however it is recommended the home seek advice regarding the practice of secondary dispensing, again to ensure its systems safeguard residents and comply with legislation. When examining the medication stored in the home staff confirmed the temperature within the medication cabinet is not monitored. The inspector recommends action be taken to rectify this as some medication was seen to state requiring storing below 25 degrees Celsius. Without monitoring of the temperature within the cabinet the home cannot be confident medication is being stored in line with manufactures instructions. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 18 Staff that the inspector spoke to confirmed they have undertaken accredited medication training and are awaiting certification. It is recommended that the home obtain CSCI guidance ‘medication training for staff in residential homes’ and implement suggested competency assessments to ensure staff’s practices reflects the knowledge gained through training and to promote good practice. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to express their concerns and have access to a robust and effective complaints procedure. Generally systems appear to protect residents from abuse and harm. EVIDENCE: As at previous inspections residents have access to a pictorial format complaints procedure that informs them of their rights to complain. All of the questionnaires completed by residents and returned to the CSCI state people know who to speak to if unhappy, with additional comments made including I would speak to the manager or my key worker or any other member of staff and I tell people if I’m not happy or dont like something. Staff also demonstrated knowledge and understanding regarding supporting residents to raise concerns. For example one person explained, The person I key work is non verbal so I raise concerns on his behalf, by looking at his moods and facial gestures. As mentioned earlier in this report residents meetings have not taken place for a considerable time. It is recommended these be reintroduced as an additional aid for residents to raise concerns. Policies and procedures for the protection of vulnerable adults were sampled with many produced in large print pictorial format as aids to communication for residents, for which the home should be congratulated. In the main the contents of the protection policies appear appropriate, however it is strongly recommended the home reviews the contents if its abuse policy to ensure its Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 20 complies with local authority adult protection guidelines and the Mental Capacity Act as one part of this states all reports of abuse no matter how minor should immediately be investigated and acted upon by the person in charge and if service user is unable to make an informed decision person in charge should discuss with close relatives or guardians. It was also noted that the homes policy does not inform staff that if an allegation is made the CSCI must be informed nor had the policy been signed and dated despite an area allowing for this. Improvements in these areas would offer further safeguards to residents. As mentioned earlier in this report the inspector was unable to assess if the homes systems for managing residents’ finances offer sufficient safeguards, as records were inaccessible. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 to 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally residents live in a safe, well-maintained and comfortable environment that encourages independence. EVIDENCE: A tour of the premises was undertaken including the viewing of residents’ bedrooms. The communal areas were bright and airy with comfortable and homely furnishings. Bedrooms were freshly decorated, furnished to a good standard and contained personal possessions, photographs and other effects. When viewing residents bedrooms the inspector was concerned to find an excessive gap between bedrails and the bed frame for one resident and that no rail covers are in use. The inspector attempted to rectify the gap but the rails became loose again immediately due to them appearing incompatible with the bed. Due to the potential risk of injury to the resident an Immediate Requirement form was issued with the home instructed to take action to minimise the potential risk of harm to the resident. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 22 As at previous inspections specialist equipment is provided including hoists, weighing chair, walking frame and commode and grab rails in order to meet the physical needs of individuals. The laundry area is well equipped and clean and tidy and away from food preparation areas. Equipment for managing the control of infection is provided, i.e., disposable gloves and aprons, and mops and buckets were labelled for use in appropriate areas. It was noted by the inspector that no written procedure for the sanitising of mops and their storage is currently in place. It is recommended that a system for storage and sanitising of mops be introduced to ensure infection control standards are promoted further. It is also recommended that the home obtain the recently updated guidance ‘Infection Control Guidance in Care Homes’ again to ensure its systems for the management of infection protect residents. The homes infection control policy was viewed and states that staff will receive training in this area as part of their induction and then be provided with training annually. The inspector was unable to assess if suitable numbers of staff have received infection control training due to records relating to training being inaccessible (this is discussed further in staffing and management sections of this report). Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Due to records being inaccessible the inspector was unable to ascertain if staff in the home are trained, recruited and supported in ways that offer protection to residents. EVIDENCE: As in previous inspections staff at this home present as interested in there jobs, motivated and committed to the welfare of the people living there. Staff spoken to were aware of residents’ individual needs and had a grasp of knowledge of disabilities and conditions of individuals in general. For example one person explained, residents may be non verbal but we know their mannerisms, for example one person will laugh a lot when he is happy, and his mood will change if he is in pain or frightened. All questionnaires completed by residents state staff always treat them well and listen and act on what they say. Information supplied by the home prior to the inspection states all new staff undertake induction, LDAF and NVQ training, regular supervisions and staff meetings, written references and CRB checks are gained for any new staff. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 24 The inspector was unable to assess if the homes training, recruitment and supervision procedures safeguard residents and support staff due to being unable to access any documentation relating to these areas. The inspector arrived at the home at 10am on a Saturday morning and stayed until 4.30pm. The senior on duty explained that records relating to training, recruitment and supervision are not accessible to anyone other than the manager who was not present during the inspection. The inspector explained that either records must be accessible at all times or a proforma introduced that details all required information, that is agreed with the CSCI, in order that the home can demonstrate it is safeguarding residents and that staff receive suitable training and support in order to meet the needs of residents. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is based on openness and respect. Generally effective monitoring ensures the health and safety of residents is maintained. EVIDENCE: The registered manager was not present during this inspection however feedback received from staff was extremely positive regarding the management of the home. For example one member of staff stated, The manager is very good, offers support and always finds time to listen. Quality monitoring systems appear appropriate at this home. Feedback is sought from stakeholders in the community and residents and a range of audits takes place within the home. Residents’ questionnaires were on file Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 26 completed with the help of staff. It was noted that many did not include the date of completion and therefore the inspector could not be sure residents views are obtained on a regular basis and form the basis of quality monitoring. The senior on duty was unsure if an annual development plan is in place and was not able to locate such a document. It is recommended that a development plan be devised incorporating all elements of the various quality assurance systems in place, reflecting upon aims and outcomes for residents and that the contents of this be made know to staff in order to further enhance the good monitoring systems already in place at the home. The home has a range of policies and procedures as required by regulation to ensure residents’ needs are met. It was noted that the home does not have a continence policy with the senior on duty not able to explain the reason for this. As some residents have specific needs in this area it is strongly recommended the home introduce a policy relating to this in order that residents needs are appropriately managed. Generally as mentioned throughout this report record keeping in the home is appropriate, offering safeguards to residents. As already mentioned the inspector was unable to look at the recruitment, supervision and training records of staff or the financial records and monies held on behalf of residents due to the inspection being undertaken at the weekend. This deficit must be explored by the home with a system introduced that allows for information being accessible and open to inspection at all times. It is recommended that the home obtain the latest guidance issued by the CSCI in relation to Regulation 37 notifications in order that it fulfils its legal obligations and systems promote effective monitoring of residents wellbeing. As when looking at accident records the inspector found that these are being completed appropriately but that in some instances Regulation 37 notifications have not been made in line with the latest guidance. Generally health and safety is well managed promoting the well being of residents. Risk assessments are in place for safe working practices and maintenance records of the building demonstrate that generally repairs are carried out within appropriate timescales. As mentioned in the environmental section of this report action must be taken to ensure bedrails do not pose a risk to resident’s health and wellbeing. A risk assessment is in place for the use of bedrails but this is not service user specific, is generalised and does not include instructions regarding maintenance. Improvements to this document should take place to ensure the risk to residents are reduced. As mentioned in the staffing section of the is report the inspection was unable to view staff training records and therefore could not assess if suitable numbers of staff have received training in areas relating to food hygiene, first aid, fire, moving and handling and health and safety. Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 3 2 3 X Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 28 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 YA9 Regulation 13(4) Requirement Timescale for action 01/11/07 2 YA20 13(2) 3 YA29 13(4) 4 YA29 13(4) Risk assessments must be completed based on residents individual needs and capabilities and reviewed within agreed timescales to ensure risks are appropriately managed and residents are safeguarded. The home must ensure systems 01/11/07 for management of invasive medication practices safeguard residents and comply with legislation. Improvements must be made 27/08/07 for the named resident and the use of bedrails to minimise the potential risk of harm. These must include providing appropriate covers and completing an individualised risk assessment. Improvements must be made 03/09/07 for the named resident and the use of bedrails to minimise the potential risk of harm. This must include making arrangements for a suitably qualified person such as an Occupational Therapist to undertake an assessment of the bedrails. DS0000004323.V345657.R01.S.doc Version 5.2 Paks Trust Oaston Lodge Page 29 5 YA32 18(1)(2) 6 YA34 19 7 YA41 17 Records must be accessible at 01/11/07 all times in order that the home can demonstrate that staff receive suitable training and support to meet the needs of residents. Either records must be 01/11/07 accessible at all times or a proforma introduced that details all required information, that is agreed with the CSCI, in order that the home can demonstrate it is safeguarding residents with its recruitment practices. The home must introduce a 01/11/07 system that allows for records required by regulation being accessible and open to inspection at all times in order that appropriate parties can be assured residents needs are being met by the home. 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 YA6 Good Practice Recommendations Care planning documents should be completed in full and dated to ensure records evidence needs are current and are being appropriately managed. Reviews should take place within the agreed timescales and records maintained to ensure residents’ needs are met in full. That residents meetings be reinstated as mechanisms for involving residents in decision-making. The home should seek advice regarding residents who are able to give consent and for the practice of staff undertaking this on their behalf to ensure systems comply with the Mental Capacity Act and to ensure residents rights are promoted. That the home reviews the practice of only the manager DS0000004323.V345657.R01.S.doc Version 5.2 Page 30 2 3 YA7 YA7 4 YA7 Paks Trust Oaston Lodge 5 YA16 able to access residents’ finances of an evening and weekend in order that residents have access to their own monies at all times and their rights are not compromised. In order to safeguard the health and safety of residents who do not smoke the home should look at seeking other solutions. The home should seek advice from the Environmental Health Department with regards to passive smoking and implement any recommendations in order that the health and wellbeing of people is promoted. The lock on the medication cabinet should be replaced to ensure medication is stored securely. A homely remedy medication policy should be introduced that includes obtaining written consent for the use of products in order to promote and safeguard residents’ health. That the home obtain the CSCI guidance regarding invasive practices in care homes and implement the content of this to ensure residents are protected by the homes records and to demonstrate the homes practices comply with relevant legislation. That the home seek advice regarding the practice of secondary dispensing, to ensure its systems safeguard residents and comply with legislation. That action be taken to monitor the temperature within the medication cabinet the home in order that the home can be confident medication is being stored in line with manufactures instructions. That the home obtain CSCI guidance ‘medication training for staff in residential homes’ and implement suggested competency assessments to ensure staff’s practices reflects the knowledge gained through training and to promote good practice. That the home reviews the contents if its abuse policy to ensure its complies with local authority adult protection guidelines and the Mental Capacity Act. That a system for storage and sanitising of mops be introduced to ensure infection control standards are promoted further. That the home obtain the recently updated guidance ‘Infection Control Guidance in Care Homes’ again to ensure its systems for the management of infection protect residents. That a development plan be devised incorporating all elements of the various quality assurance systems in DS0000004323.V345657.R01.S.doc Version 5.2 Page 31 6 YA20 7 YA20 8 9 YA20 YA20 10 YA20 11 12 YA23 YA30 13 YA39 Paks Trust Oaston Lodge place, reflecting upon aims and outcomes for residents and that the contents of this be made know to staff in order to further enhance the good monitoring systems already in place at the home. That the home ensure the views of residents and other interested parties be obtained on an annual basis and form the basis of quality monitoring systems. That the home introduces a continence policy in order that residents’ needs are appropriately managed. That the home obtain the latest guidance issued by the CSCI in relation to Regulation 37 notifications in order that it fulfils its legal obligations and systems promote effective monitoring of residents wellbeing. 14 15 YA40 YA41 Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Paks Trust Oaston Lodge DS0000004323.V345657.R01.S.doc Version 5.2 Page 33 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!