Inspection on 03/01/06 for Paks Trust Oaston Lodge

This inspection was carried out on 3rd January 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

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 18/07/05

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 3rd January 2006 09:30 Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 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.V277163.R01.S.doc Version 5.1 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.V277163.R01.S.doc Version 5.1 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.V277163.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. NVQ Level 4 That NVQ Level 4 in Care and Management is achieved by 2005. 18th July 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.V277163.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection follows on from one, which was carried out earlier this year and is in part informed by the findings on that occasion. The inspection visit took place during an evening and the following morning thus the Home was seen when all service users were present and when only some of them were on the premises. During the visit the inspector had conversations with service users and staff and more formal interviews with one of the senior carers and the Registered Manager in relation to how the Home is run and the care of service users. Relevant records were examined, including a sample of service users’ case records and fitness of the premises for its purpose and the level of material comfort that it provides were assessed. In terms of the context for the inspection, it should be noted that the Home accommodated both male and female service users at the time of the visit and all except one have been resident there for more than one year. Throughout the report service user represents those who are being cared for and the Home refers to Oaston Lodge. Where reference is made to the standards and the regulations this means the National Minimum Standards for Care Homes for Adults (18 – 65) and The Care Homes Regulations 2001, respectively. What the service does well: What has improved since the last inspection? The Registered Person has introduced a new annex to the Home’s assessment format for service users, which seeks to get a better understanding of their personal aspirations. Most rooms have been redecorated and where necessary carpets have been replaced. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 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.V277163.R01.S.doc Version 5.1 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 are receiving appropriate care and treatment informed by comprehensive and ongoing assessment of their circumstances and identification of their needs and aspirations. EVIDENCE: At the last inspection it was recognised that most service users had been resident at the Home for many years and therefore their original Care Management Assessments were either out of date or not available. However, all the service users are placed at the Home by the same local authority and in most cases there was a document: Care First Care Plan: Agreed Needs and Aims. This simply outlines what the placing authority ascertains the service users’ needs to be and what it requires the Home to do to fulfil those needs. In all cases there is a full and up-to-date assessment conducted by the Registered Manager the twelve-point framework specified in standard 2.3. These assessments take account of the information in the document mentioned above, but in sufficient detail cover all aspects of the service user’s life ranging from accommodation and personal care needs through cultural and faith requirements to method of communication and compatibility with others living at the Home. The assessment of service users health and personal care was assessed as being particularly detailed and reflects in precision with which service users day-to-day care is given. For example, where service users have medical conditions, these are accurately described and the needs arising from them are clearly highlighted. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 9 The assessments were observed to take account of service users’ disabilities, with specialist input from Speech and Language Therapists where there are communication and swallowing difficulties, and Occupational Therapist in relation to mobility and how to adapt the environment to meet particular need in this regard. There are three service users aged over 65 whose needs were recently assessed in this connection. In essence, the Home is ensuring that service users circumstances are assessed, their needs are identified and are reflected in a plan setting out how the individual will be cared for day-to-day and the impact that the care is intended to have. Although the example given here mostly relates to service users’ health, disabilities and personal care, the assessment and care planning process was observed to give requisite regard to their wider needs, i.e. their personal aspirations. In this connection, the Manager presented a recently developed questionnaire which will be used to provide more detailed and accurate information about each service users hopes, fears and personal goals as might contribute to their sense of fulfilment. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 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 Service users’ care is being provided within a system that carefully assesses their circumstances; identifies their needs and, so far as possible, finds out their wishes, feelings and aspirations in setting objectives for meeting those needs. Service users also benefit from the Home’s enabling ethos, which promotes self-determination and independence thus facilitating the service user to contribute to decisions about their lives and such acceptable risk taking as their condition permits. EVIDENCE: As was the case at the last inspection, the Home continues to plan service users care in a systematic way. They approach this by ensuring there is a comprehensive assessment of each service user’s circumstances in which their needs are identified and a plan is drawn up outlining what is to be done to meet those needs, how it will be done and what is to be achieved as a result. Each service user’s plan – a sample of three was examined on this occasion – gives a good account of the individual’s health and disabilities and their needs arising from these. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 11 For example, the plans show what the person’s conditions are, the specialist involved and the agreed treatment strategy including medication and dietary regimens, and mobility and communication enhancement programmes, as relevant. The individual plans also show what is understood of how service users prefer to be supported in their activities in daily living. In this regard, their food preferences are noted together with any agreed special dietary requirements. How they are assisted with their ablutions and their particular lifestyle and individual routines such as the time they prefer to rise in the morning and retire to bed at night are all noted. In all cases, there was in service users individual plans, objectives for addressing those aspects of their needs, which are likely to contribute to a sense of fulfilment. That is, the opportunities for each service user to have social contact with others of similar age, interest and disabilities within and outside the Home, meaningful occupation, employment, education and training, and outlets for leisure pursuits. In short, the individual plans are holistic in contents, set measurable objectives for what is to be achieved and in the form of the Daily Activity Record assemble information to show the extent to which those care needs objectives are being met. As mentioned earlier, there was evidence of service users’ needs being assessed on an ongoing basis and their individual plans are reviewed and adjusted in accordance with their changing needs. In relation to how service users are enabled to make decisions about their lives 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. The manager pointed out and the inspector observed that service users currently resident all have learning disabilities to varying degree. Some are therefore able to assimilate information necessary to inform the more complex decisions in their lives, but the understanding and communication difficulties of others means that decisions are made for them taking account of observations of their responses to certain situations and approaches to their routine care. Currently none of the service users are involved in any local independent advocacy or self-advocacy groups, but for most their relatives and friends play a key role in this regard. The Manager reported that one service user for whom involvement with independent advocacy might be beneficial has been referred to the local advocacy service, but this has not proceeded much further owing to the currently limited capacity of the service to allocate advocates. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 12 One of the indicators of how service users might be shown to be making decisions about their own lives is whether they are enabled or supported to manage their own finances. Accordingly, this was looked at during the inspection. The manager explained that all service users currently resident were not able to manage their own financial affairs independently and therefore the Registered Provider acts as their appointee (i.e., receives their income). The Registered Provider then pays such fees as are incurred by service users including cost for transport provided by the Home. Each service user has two bank/building society accounts. All their income is deposited into one, their fees are paid and sums for personal living day-to-day expenses are transferred to another account, which the staff of the Home assists service users to manage. The inspector was not able to check any of the service users’ accounts on this occasion, as the Manager reported that passbooks for each service user’s personal allowance fund, which is administered at the Home, were at the Registered Provider’s office for audit. Further no records are kept at the Home relating to the accounts kept by the Registered Provider in relation to the service users income, expenditure and savings. With this in mind the Registered Person will need to arrange for all records relating to each service user’s finance to be kept at the Home so that staff can help them to understand their finances and to make such decisions about them, as they are able to make. Those records should include any invoices for care fees, transport charges, all income expenditure and balances, and evidence of independent audit. As mentioned earlier, a risk assessment for each service user has been conducted and documented. The guidance, which sets out how the risk assessments 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 at the last inspection and on this occasion, 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. The Manager also reported that risk assessment of another two service users concludes that they are safe to journey out unaccompanied and this has led to one of them securing employment and sheltered employment being sought for the other. 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.V277163.R01.S.doc Version 5.1 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): 13, 15, 16 and 17 Service users are being enabled to enjoy normal, full and participative lives by being part of the local community, by opportunities to establish friendships outside the Home and in maintaining family contact. Being encouraged to exercise their rights and to take on appropriate responsibilities as befits their adult status, further enhanced their self-esteem. They are sustained in this by being provided a wholesome diet, which contributes to their health and wellbeing. EVIDENCE: An assessment was made of the extent to which staff enables service users to be involved in the local community so as to promote normalisation and reduce isolation. The following was established: The Home is situated in an ordinary street with neighbouring private dwellings and therefore service users are able to meet and interact with neighbours with whom the Home enjoys good relations. A sister Home is also located in the same street, which enables service users to have social visits with others some of whom are of similar age and have disabilities in common. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 14 Being within less than a mile from the town centre service users are able to use all the local amenities: shops, post office, pubs, cinema, etc. The base for their day occupation activities is also in the local community and some service users attend the local Further Education College as part of those activities bringing them into contact with an even wider group of people. One service user works at a local supermarket and similarly has contact with a wide range of colleagues and customers. Although currently none of the service users are politically active, they are all registered to vote and the Manger reported that three opted to vote at the last election. The Manager also reported that service users are encouraged to become involved in local religious and cultural activities (usually as spectators) such as shows and the annual carnival. In this connection, it is understood that one service user has expressed a wish to attend one of the Town’s football team matches and this is being arranged. In addition to the opportunities cited above, which enable service users to meet with others and to form and maintain friendships, most have regular contact with relatives or others who are important to them. With this evidence in mind, it was concluded that the Home is satisfying the requirements to enable service users to be part of the local community and to establish and maintain contact with their family and such other friendships and relationships as they choose. 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. The correspondence is then left in the service user’s possession to keep or discard, as appropriate. Service users also retain in their possession a copy of their individual plan. 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. As was the case at the last inspection, it was noticeable 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. Some of the light hearted and often humorous exchanges, which were observed suggest that service users feel safe and at ease with staff and that there is mutual acceptance and respect. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 15 There was no evidence to suggest that service users are prohibited from any areas of the Home, which are 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 to promote independence. With regard to rules on smoking, alcohol and drugs, no concerns were reported or detected in relation to the latter two. The smoking rule, which confines service users who smoke to do so in the dining room remains the same despite the observations, which were made at the last inspection. That is, service users who do not smoke also use the dining room and their health and comfort might become affected by those who smoke. There is no obvious area in the Home where those who smoke might use without affecting the others, but in order to safeguard the health and safety of those who do not smoke, the Registered Person must find a solution. A record of meals provided for service users continues to be kept in the form of menus. A note is also kept in each service user’s daily record of what they have actually eaten. At the last inspection it was pointed out that the record of meals provided is intended to enable an assessment of the wholesomeness of service users’ diet in terms of nutrition and variety, and contrary to its incomplete form, should be presented in detail. Although there was evidence to show that the Manager had taken steps to address this, there are still instances where there are gaps in the details. That said, the current menus, as presented, show that the service users are receiving a wholesome and varied diet with reasonable choice, as derived from the evidence below. The menus show that a typical weekday menu consists of a continental breakfast (cereals, toast, preserves, etc); lunch: egg, bacon beans, bread, and dinner: liver casserole or chicken breast and a selection of vegetables. As this example shows, the meals are traditional British fare, which service users enjoy. It was observed from the menus and service users records that their diet is monitored and where there are prescribed regimens these were being followed. Throughout the inspection, service users who were not able to make their own drinks were regularly offered drinks by staff. Stores of food, which were seen, were sufficient in quantity, variety and quality. This included tinned, frozen and fresh foods, such as fruit and vegetables. The quantity and variety of food seen was also in keeping with the menu forecast and taking account of how regularly grocery shopping is done. A mealtime was observed and service users were seen to fully participate in it as a pleasurable event. Some volunteered to set the table, clear away and wash up. Service users dined together and the whole event was unhurried and relaxed. One service user commenting to the inspector about the food, said: “it’s very good and staff look after us”. Another cited a new member of staff who is rated as a particularly good cook who makes lovely meals and cakes. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 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’ health and wellbeing are being promoted and safeguarded by the precise care, support and treatment they receive dictated by their agreed individual plans, which take account of their wishes, feelings and safety. They also benefit from the Home’s care regime that takes careful account of their privacy, dignity and keenness to promote choice and independence. EVIDENCE: Examination of service users records, i.e., the assessments, individual plans and Daily Activity Record together with staff’s explanations and the inspector’s direct observations, provided evidence of the staff continuing to give careful consideration to how service users’ personal care and health needs are to be met on a day-to-day 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. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 17 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. As cited earlier, service users in accordance with their daily commitments as agreed in their individual plans, (e.g., work) establish their own routines thus get up and go to bed at times of their choice. They also, with guidance from staff as necessary, choose both the clothes that they purchase and what they wear. For those who are not able to verbalise their preferences and need assistance to dress, staff explained that they present them with at least two sets of clothing from which to choose each day, ensuring options in colour, style etc. In such cases they have come to understand service users’ personal means of indicating preference through smiles, frowns, touching the garments, etc. This approach was deemed successful, as all the service users were observed to have their own style; they were clean, comfortably and appropriately dressed for the time of day and tidily groomed. Whilst the staff rota suggests that there are sufficient numbers of staff available to permit service user some choice in who works with them and assists with their personal care, this is limited in one respect. That is the staff team is all females and 43 of the service users are males meaning that if they preferred to be tended by male staff this is currently not an option. From direct observations during the inspection, it was noted that service users have the personal aids that they need and that aids such as hoists and a stair lift are available to those with mobility difficulties. Similarly, service users’ records and other relevant documents revealed that, where necessary, arrangements are made for them to receive support, advice and treatment from specialists. These include physiotherapists/occupational therapist and the Speech and language Service to promote their mobility, independence and communication, respectively. The service users assessments, individual plans and Daily Activity Record show that there is a good understanding of their physical and emotional needs and clear strategies for meeting them. All service users are registered with local GPs from whom they receive a good service, e.g., they respond to emergencies and conduct six monthly reviews of those with ongoing conditions and are on medication. The records also showed that where appropriate service users are referred to specialists in regard to both their physical and mental health, and continue to be monitored and, as necessary, receive dental, optical and foot care. The Home is expected to enable service users to keep and administer their own medication unless otherwise dictated by risk assessment, and ensure the safe custody and administration of all drugs kept on the premises in line with promoting their health. At inspection it was observed that one service user Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 18 was assessed as safe to keep and administer her medication subject to certain safeguards, such as being provided with a secure container for a days supply. The inspector also noted that there is a medication policy and procedure, which promotes service users taking control of their own medication when possible and the care staff must take to administer drugs safely. Staff training records provided at the last inspection, which the Manager said have not been changed since, show that 50 of staff have received training in the safe custody and administration of medication. This includes all the senior care workers and provides for at least one member of staff on any shift who has been so trained. The Manager reported that those who have not been trained are not permitted to undertake this task, but training has been arranged for the whole staff team. Current medication records and drugs in store were checked. The records were found to be up-to-date and were reconciled with the quantities of medication in store. At the last inspection a requirement was made for the current drugs cupboard to be replaced by one of the type capable of storing controlled drugs and which complies with the guidance of the Royal Pharmaceutical Society of Great Britain. The Manager explained that such a cupboard was ordered and delivered but was too small for the amount of items it needs to store so arrangements are being made for one that is more suitable. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 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): 22 and 23 Service users interests are being promoted and safeguarded by the Home’s open ethos, its primary focus on them and a genuine desire to ensure they are content within its safe environment. EVIDENCE: As was the case at the last inspection, the Home has a formal complaints procedure, which conforms the requirements of standard 22 in terms of to whom service users (or their representatives) should direct their complaints, the process for dealing with them and the timescale for so doing. The complaints procedure document, has been specifically adapted to the needs of service users being pictorially illustrated and with the photographs and names of key persons to whom they might wish to take their complaints or concerns. The ethos of the Home – i.e., staff’s keenness to engage service users - is one in which there is a genuine attempt to ensure they are happy and content. The inspector is therefore satisfied of the likelihood that views or concerns expressed by service users are listened to and would be resolved at an early and informal stage. A complaints register, which is kept in compliance with the standards shows that no complaints have been recorded since the last inspection and staff members on duty at the time of inspection were not aware of any being made. The Registered Person has sought to ensure that service users are protected from abuse, neglect or unfavourable treatment, by ensuring that all staff receive basic training in understanding the nature of abuse of vulnerable adults and how they are expected to act to prevent and, as relevant, respond to any instance of actual or suspected abuse. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 20 This is augmented by the Home’s own vulnerable adults abuse procedure: Guidance To Care Staff – Abuse Of Vulnerable Adults, which staff are expected to follow in the event of witnessing or suspecting any such abuse. The Guidance is complimented by the whistle blowing policy and defines the various forms of abuse. Service users have also been provided with information tailored to their needs, which is intended to alert them to forms of abuse and who to approach if they believe they are being abused. 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. These measures together with the Home’s whistle blowing policy were concluded as being reasonable and likely to be effective in protecting service users from abuse. However, though staff confirmed that they had recently seen a copy of the local multi-agency Protection of Vulnerable Adult Protection Procedures and had some training in this regard, a copy of the procedures could not be found at the time of inspection. It will be necessary for those procedures to be available to staff in the Home at all times and for the Registered Person to ensure that the Home’s procedure is compatible with them. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 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 in the Home continue to benefit from a homely environment, which takes full account of their disabilities and affords them a high degree of comfort and a good material standard of living. EVIDENCE: At the last inspection the Home was deemed fit for its purpose, but the Registered Person was required to attend to the following in order meet standard 24 in full: 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. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 22 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. At this inspection visit it was observed that the hallway has been redecorated and the carpet has been replaced and covers fitted to the radiators in this area. The sitting room has also been repainted and all except one bedroom, which is any case in acceptable condition, have been redecorated. A grab rail has been fitted to the ground floor toilet and new hoist and shower chair installed in the shower room on the same floor. The Manager said that arrangements have been made for handrails to be fitted to the ground floor passageway, as was required at the last inspection and it is envisaged that this will be completed soon. One side of the building, which had become overgrown with weeds and strewn with debris has been cleared and the drain cover in this area has also been cleaned as directed. Although the Manager reported that the hot water temperature has been regulated, as required a hand test of it at the washbasins in service users’ bedrooms was experienced as unacceptably hot. The Manger said she did not realise that the temperature of the hot water at the washbasins needed to be regulated and as a result had only arranged for this to be done in the bathrooms. It is imperative that this is addressed, as there have elsewhere been scalding incidents where the hot water temperature has not been correctly regulated. The purpose of regulating the hot water temperature at the outlets to which service users have access is to prevent such incidents. Bedroom windows on the first floor are still not fitted with restrictors as required at the last inspection. The purpose for directing that restrictors be fitted is that there have elsewhere, been serious accidents where service users have attempted to climb out of their bedroom windows and therefore this has become a known risk. 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. This is to enable staff to practise good hygiene in preventing any spread of infection. It remains the case that the laundry, which is appropriately equipped, is separate from areas where food is prepared and consumed and from service users’ bedrooms thus ensuring there is no risk of contamination when it is necessary to deal with soiled laundry. 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. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 23 This is proving effective, in light of the clean conditions found at this and the previous inspection and no reports of any spread of infection or other contagious conditions. The hygiene measures outlined above, together with the arrangements for the storage and disposal of clinical waste, also contribute to control of infection. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 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 and 34 The Home’s committed staff team, the members of which have the basic competencies necessary to discharge their duties safely, is positively influencing service users’ quality of care and quality of life. Service users’ welfare is also being promoted, in part, by the measures taken to ensure that those employed to care for them are fit to do so. EVIDENCE: Staff records showed that the Registered Person takes care in recruiting those who are to look after service users’ in the Home. The applications of those who are employed suggest that they usually have some previous experience of caring for vulnerable adults, are supportive of the Home’s approach and either have the basic skills to care for service users safely or the potential to acquire those with training and supervision. The inspector’s assessment of staff members attributes both at this and the previous inspection is that they are caring persons who are approachable and have been able to establish a good rapport with service users. That is service users were seen to relate to them naturally without any signs of fear or discomfort. Some service users are not able to use conventional means of communicating, but staff members have come to understand their particular means of making their needs known and to be able to respond appropriately. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 25 As earlier outlined, staff appeared to genuinely enjoy their job caring for the service users; they are keen to engage with them devoting time to talk with each of them at times other than when they are assisting with their personal care. Nothing has been reported or observed to cast any doubt on staff’s reliability and honesty. The care activities detailed in service users’ records and observations of aspects of the care routine (e.g., giving of medication) at the time of inspection) suggests that staff have the skills and experience necessary to provide the care and treatment indicated in service users’ assessment and care plans. The records show that no-one currently employed at the Home is under 18 years old and, excluding the Home Manager who holds a National Vocational Qualification (NVQ) level 4, some 44 of care staff have been accredited at NVQ levels 2 or 3. It is anticipated that this ratio will increase when other staff members currently working towards NVQ become similarly accredited. Apart from the examples cited above, in relation to ensuring staff who are employed are fit to care for service users, it was noted from the records that the Registered Person is, as required, checking and keeping records of confirmation of staff’s identity, conducting Criminal Records Bureau checks and seeking written references. The Registered Provider, since the last inspection, has not notified the Commission of any concerns about the fitness of current employees or any of those who have left during this period and nothing was observed at inspection to give rise to such concern. This indicates that the measures, which are being taken, are proving effective. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 26 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): Service users’ health and safety are, except in two specific details being promoted and protected. They also, in practice, benefit from a variety of measures which are in place to monitor and assure quality, but these measures need to be consolidated into a coherent system. EVIDENCE: At the last inspection, the Registered Person was directed to develop and introduce a quality monitoring/quality assurance system with the intention of demonstrating achievement of the quality indicators of standard 39. That is, to show that the care given to service users and the way the home is run (the inputs) are having the desired effects (the impact) and are resulting in the planned outcomes. The Registered Person provided evidence of an attempt to do this in the form of a comprehensive questionnaire, which is to be administered to service users. Although the questionnaire will no doubt prove an effective ‘tool’ for gathering information in the process of service users’ assessment, it does not fulfil what is required. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 27 What is required is that the Registered Person ensures that there is an annual development plan for the Home. The plan should set out what is to be done to achieve the aims and outcomes for service users during the next twelve months. In addition to this, the plan will also be informed by the review of the quality of care, which includes survey of service users, staff and other stakeholders’ views (relatives, GPs and others who have an interest in the home and care of service uses. Checks were made of the measures taken to prevent accidents in the Home and to control other potential risk in the environment. In this connection records kept and other evidence such as invoices show that the fire alarm system and fire fighting equipment are serviced and checked at the frequency recommended by the Fire Service. There was evidence of a fire risk assessment, a fire procedure and fire drills. The records showed that a stair lift and hoists, used to assist service users with mobility difficulties were also serviced recently and, in the case of the stair lift, was seen to be in good working order. Only three accidents have been recorded since the last inspection, two involving service users who had falls, which did not result in any injury or necessitate any medical treatment. All the staff has received training in Manual handling and in First Aid training in order to be competent in the safe assistance of service users with mobility difficulties and to be able respond appropriately in the event of accidents or other medical emergencies. As cited earlier in at standard 24, for the safety of service users it is necessary that the Registered Person regulate the hot water temperature at all outlets to which service users have access so as to avoid the risk of burns. Window openings in service users bedrooms on the first floor must also be fitted with restrictors to control the risk of any service users attempting climb out and injuring themselves. Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X X X 2 X X 2 X Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 (2) Requirement The Registered Person must, as planned, install a medicine cabinet of metal, which conforms to the guidance of the Pharmaceutical Society of Great Britain and is capable of storing controlled drugs safely should it be necessary to store such drugs on the premises. The Registered Person must develop and introduce a quality monitoring and assurance system, which ought to contribute to the annual development plan specified in standard 39 and take account of the views of service users and other stakeholders. The outcome of any survey of service users’ views about their care and running of the Home must be sent to the Commission. The Registered Person must ensure that the hot water temperature at all outlets in the Home to which service users have access, are regulated to 43ºC. Timescale for action 31/03/06 2 YA39 24 12/05/06 3 YA42 13 (4) 28/02/06 Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 30 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 YA7 Good Practice Recommendations The Registered Person should ensure that all records of individual accounts of service users’ finances, and independent monitoring and audit of them are kept at the Home so that they are accessible to the service users and for inspection. The Registered Person should take steps to ensure that the effects of smoking a communal area of the home by some service users, do not affect the health and wellbeing of those who are not smokers. The Registered Person ensure that menus or records of food provided for service users are consistently presented in sufficient and accurate detail so as to enable monitoring of the variety and wholesomeness of meals. The Registered Person should seek to achieve some balance in the gender of the staff team to reflect the ratio of male service users and to choice of who work with them and assist with their intimate care. The Registered Person should ensure that staff have a working understanding of the local multi-agency Protection of Vulnerable Adults Procedures and ready access to a copy of it in the Home. 2 YA16 3 YA17 4 YA18 5 YA23 Paks Trust - Oaston Lodge DS0000004323.V277163.R01.S.doc Version 5.1 Page 31 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.V277163.R01.S.doc Version 5.1 Page 32 - 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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