CARE HOME ADULTS 18-65
Smug Oak House Drop Lane Bricket Wood St Albans Hertfordshire AL2 3TX Lead Inspector
Mrs Sheila Knopp Unannounced Inspection 1st November 2005 14:20 Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Smug Oak House Address Drop Lane Bricket Wood St Albans Hertfordshire AL2 3TX 01923 857 223 01923 857 223 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) www.pentahact.org.uk PentaHact Ella Milburn Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th May 2005 Brief Description of the Service: Smug Oak House offers a purpose built residential service for 10 adults with Autistic Spectrum Disorders and other associated needs. The house has been divided into three units, one for 5 residents, one for 4 and one for 1. This was done to help staff accommodate the differing needs of the residents. The residents all attend a nearby day centre that is also run by PentaHact and is a specialist centre for people with Autism. The house is in a very rural setting some distance from most amenities, but the house has its own transport and service users access the local community frequently. The slightly isolated setting of the home does in some ways suit the particular needs of the service users. The service offered is specialised and individually tailored to meet the very complex needs of the residents all but one of whom have lived there since it opened, in fact the service was set up and designed specifically for them. Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second of 2 planned unannounced inspections for the year April 2005 – March 2006. Key standards not inspected on this occasion can be found in the inspection report dated 24.5.05. This report reflects the observations made by the inspector during two visits carried out on 1.11.05 & 4.11.05. This inspection was planned over two days to provide minimum disruption for the service users and for them to be more familiar with the presence of the inspector. On the first day the inspector spent time with residents and staff as they retuned from their daytime activities. On the second visit a review of the premises and records was carried out. The second visit. Ms Crow Hurst, the new acting Operations Manager, was present for the second visit, which enabled the inspector to have a wider discussion regarding the company monitoring processes and development plan for Smug Oak House. The inspector had discussion with staff as part of a group and 3 staff individually. Three care plans were reviewed. A total of 7 hours has been allocated to this inspection. Comment cards were completed and returned to the Commission by 7 relatives. Their comments were reviewed as part of this inspection and are included in this report. Four out of seven relatives stated they were satisfied with the overall care provided. Three relatives indicated they were not always satisfied. Three out of four relatives felt they were not always kept informed of important matters. Five relatives felt there were sufficient numbers of staff on duty. Three people felt unable to comment on this on this area. No complaints have been received by the Commission between inspections. What the service does well:
Overall a high level of satisfaction with the service provided is expressed by relatives who returned comment cards to the Commission. A relative commented on the wonderful holiday an individual had been on. Another relative added the additional comments that ‘staff are very thoughtful and considerate’, ‘the care and attention my relative receives is excellent’. PentaHact are closely involved in setting management targets and reviewing standards which have a direct impact on the quality of life for residents. During the time the inspector was at Smug Oak House the service users appeared to be at ease as they moved about the home and garden and interacted with staff. Staff were observed to be consistent and patient in their approach to service users. Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected. EVIDENCE: Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 9 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): 9 Staff at Smug Oak House, day centre staff and the representatives of service users are involved in supporting them to maintain and develop their independence. Activities and lifestyle choices and opportunities are subject to risk assessments which are recorded as part of the care plan. Clearly the move to Person Centred Planning (PCP) will expand the horizons for individual service users once this gets going. EVIDENCE: Details of risk assessments within care plans were seen. These also form part of the information handed over on a day to day basis so staff can reduce the impact of any changes in behaviour which may put the service user at risk. As a result of applying a PCP approach the allocation of staff will be need to be reviewed as it develops to enable needs to be met more individually. This is an area being looked at by PentaHact as part of their review of the service. The manager has identified the need for staff to have their annual update in behavioural management procedures (SCIP). Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 10 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): 15 Service users are supported to maintain links with family and friends. However this is an area that PentaHact have identified for further development. EVIDENCE: All 7 relatives who returned comment cards to the Commission felt welcome in the home at all times and confirmed that they could visit in private. A relative added the additional comment that they have a good relationship with staff in which the interests of the individual service user are put first. Service users are supported to attend social occasions to meet with friends. Staff were able to describe the cultural and religious needs of service users. It is the intention of the home to move towards the introduction of Person Centred Planning (PCP) but this has only so far been started for one service user. The aim of PCP is to enable people to live the lives they want to in their communities and involves bringing together key people identified as being important in that person’s life. Three out of 7 relatives felt they were not always kept informed of important matters.
Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 11 This raised the question of how awareness and understanding of PCP was being developed with family members who have close contact with their relative? PentaHact have identified the need to develop links with other homes so service users are able to maintain links with friends they see during the day and make new ones, as part of their review. Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 12 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 & 20 Service users are provided with support to achieve a level of personal care which promotes their dignity and individuality. The information provided from discussions with staff and a review of health care records confirmed the health needs of residents are appropriately met by providing access to a range of health care professionals. Staff demonstrated good awareness of changes occurring that would indicate a service user was unwell. A spot check of the medication systems identified that suitable processes for administering, checking and auditing medicines was in place. The care plans need reviewing to ensure the format used provides clear evidence of reviewing and updating to demonstrate that the current needs of individual service users are being met. EVIDENCE: The service users all looked well and individual arrangements are made for clothes shopping and visits to the hairdresser etc which supports their individuality. The staff group reflect the diversity of the service users.
Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 13 A key worker discussed the action taken to respond to changes in the behaviour of a service user which led to their health needs being considered at an early stage and appropriate treatment being provided. Individual residents are being supported by a range of health care professionals including the Community Learning Disability Team. Details of recent contact with a dietician, physiotherapist and dentist were identified from staff interviews. A relative reported they had notices a marked improvement in the individuals ‘life style in the last year’ and that they had ‘responded well, seemed less anxious and coping with life better’. As a result of the medication incidents which were reported to the Commission staff have undergone further training and assessment in administering medicines. The Commission requested but has not yet received a report from PentaHact on conclusion of their investigation into missing medication. The concern was that the incident was not initially reported to the correct authorities. Two staff are now signing for medication given and regular audits of stock balances are being carried out to ensure safe practices are being followed. The Person Centred Planning format seen did not provide clear evidence of the reviewing and up dating processes. Parts of the plan need to reflect professional responsibilities towards service users as well as the individual’s own plans and aspirations. Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 14 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 Not fully inspected. However it was identified that the manager was not keeping a clear record of the action taken in response to complaints. EVIDENCE: Details of complaints made to the manager were recorded but there were no details of the investigation, action taken and outcome in the central record (NMS 22.7). The 4 complaints related to an external issue and did not reflect on the care and support provided to service users. No complaints have been received by the Commission. Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 15 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 There is a refurbishment plan in place for Smug Oak House to ensure service users live in a well maintained and comfortable home. EVIDENCE: Since the last inspection the refurbishment programme has continued with extensive work being carried to modernise the bathrooms, decorate a lounge and upgrade one of the kitchens. The en-suite shower room of an identified service user needs attention to remove mould and reduce condensation, which appears to be caused by leaking pipe work. Staff have identified ways of making this room more accessible to the service user and these need to be considered in any plans. The vanity units in each of the bedrooms now need to be replaced as the surface is coming off the laminated covered board and looks unsightly. Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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): 33 EVIDENCE: On the first day of inspection 5 staff came on duty to support the 9 service users as they came back from their day services support. The rota examined demonstrated that 4 staff are provided in the morning and 5 in the afternoon and evening. The staffing arrangements enabled 2 staff to take 3 service users swimming Staff identified that due to implementation of the working time directive more agency staff are being used where staff used to cover shifts. During the week of the inspection there were 12 occasions when agency staff were working with permanent staff. The agency member of staff interviewed by the inspector had the appropriate experience required to support the service users at Smug Oak. The home receives information from the agency on individual staff that are booked. Agency staff that are new to the home work an induction shift. An interview with a member of staff who was new at the time of the last inspection identified that they were receiving the required training and feeling confident in their role. Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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): Not inspected. EVIDENCE: The manager anticipates completion of the Registered Managers Award by April 2006. CSCI guidance is that managers should achieve this award within 2 years of registration. Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 Score 2 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x x x 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Smug Oak House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x DS0000019528.V262914.R01.S.doc Version 5.0 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA22 YA24 Regulation 22(8) 23(2)(b) Timescale for action Set up a complaints log to record 23/12/05 details of the complaint, action taken and outcome. Provide timescales for the 23/12/05 complete refurbishment of the identified en suite shower room Requirement 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 Provide CSCI with timescales for completion of the review of care plans. Smug Oak House DS0000019528.V262914.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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