Inspection on 21/11/07 for Smug Oak House

This inspection was carried out on 21st November 2007.

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 no outstanding requirements from the previous inspection report, but made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Smug Oak House 05/03/07

Smug Oak House 02/06/06

Smug Oak House 01/11/05

Smug Oak House 24/05/05

Smug Oak House 13/01/05

Smug Oak House 03/08/04

Smug Oak House 24/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Smug Oak House Drop Lane Bricket Wood St Albans Hertfordshire AL2 3TX Lead Inspector Julia Bradshaw Unannounced Inspection 21st November 2007 08:00 Smug Oak House DS0000019528.V354323.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 Smug Oak House DS0000019528.V354323.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. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Smug Oak House Address Drop Lane Bricket Wood St Albans Hertfordshire AL2 3TX 01923 857 223 01923 854 823 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 Adepta Christine Balachaudre (currently not registered) Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th March 2007 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 Adepta 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. Information regarding the service is available within the Service Users Guide and Statement of Purpose. The current fees for Smug Oak House are from £850 to £1100. For more details and a copy of the most recent CSCI inspection report please contact the manager. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day and was carried out early in the morning. This inspection also involved an expert by experience and her support worker. The purpose of using an expert by experience is for the service to be viewed from a person who is receiving a service and who can offer an alternative viewpoint on the service being provided. For the purpose of this inspection the expert by experience was asked to focus on the environment, speak to service users and staff. The expert by experience’s findings will be highlighted throughout the main body of this report. The inspection took approximately five hours and involved talking to service users, looking round the home and talking to staff, looking at records and care plans and discussions with the manager and operational manager. The current manager has only been in post for a period of one month and confirmed with the inspector that she will be applying to be the registered manager. What the service does well: What has improved since the last inspection? There were several issues relating to the environment at the last inspection. These have been addressed and generally these standards have improved, and all fire doors now fitted properly and safely. Unfortunately the home was without a manager from June until October and therefore standards have slipped and several requirements have been made as a result of inadequate management support. However the new manager in post appears to have a very clear understanding of the tasks and challenges that are required to bring the home up to the required standards. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 6 What they could do better: The information provided for service users must be produced in a format that is more easily understood, including pictorial information. There are currently inadequate systems in place to ensure that service users are safe and protected. Assessments and care plans must be available for inspection. These documents must evidence that the persons assessed needs have been reviewed and a relevant plan of care has been developed. This should all be completed with the service user or their representative to ensure that it is person centred and meets their needs. To ensure peoples safety records must be maintained to verify that peoples’ health needs have been assessed and are being met. The service must be run in the best interests of the people who live there and their wishes and needs must be taken into account and their dignity must be respected at all times. Restrictions placed on peoples’ liberty must be fully recorded including the rationale behind decisions to limit freedom or choice. Risk assessments must identify any known risks and record the steps needed to minimise any identified risk. To ensure that they are still current and appropriate these must be reviewed regularly. To ensure that people are provided with appropriate choice a range of food options should be provided and records maintained of any alternative foods provided. The people who use the service are not currently protected by the administration of medication practises. These need to be improved to ensure that staff follow the procedures in place and errors in administration are not made. The complaints procedure is not in a format accessible to the people who use the service. Staff have not had adequate training to safeguard people from harm. The environment needs to be improved to ensure that it meets the service users and offers a homely place to live. Issues that affect the safety of the people who live there must be addressed as a matter of priority. This includes the use of radiator covers where radiators pose a risk of scalding. The hot water must be delivered at safe temperatures to also limit the risk of accidental scalding. The fridge freezer temperatures must be maintained at safe temperatures to ensure food is kept safely. Staff must be provided with appropriate training and supervision to ensure that they are able to competently meet the service users changing needs. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 7 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. Smug Oak House DS0000019528.V354323.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 Smug Oak House DS0000019528.V354323.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 –5. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service cannot be assured that they will receive adequate information to make an informed choice about using the home. EVIDENCE: The current standards within the home in relation to both pre-admission assessments and on-going assessments were incomplete. There was inadequate information on the day of the inspection to confirm that service users are provided with individual contracts and that service user assessments have been completed and reviewed. The Statement of Purpose and Service User Guide are not produced in a format that is easily understood by the people using the service. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6 –10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service cannot be assured that their care plans will provide adequate information for staff to ensure that the appropriate care is provided in a person centred way. EVIDENCE: Three care plans were inspected and none of these were complete. There were risk assessments that had not been reviewed or updated. There was little evidence to confirm that service users have been fully involved in their care plans. Care plans had not been signed by the service user or their representative. Service user files examined did not contain service user contracts. Therefore a recommendation has been made in relation to this issue. These contracts and all information relating to service users should be produced in a ‘user friendly’ Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 11 format and be signed by either the service user or their representative to verify their involvement. However the new manager is planning to carry out an audit of all care plans and will be introducing PCP’s into the home, which will include the involvement of the service users. There was an immediate requirement made as a result of this inspection in relation to individual risk assessments being completed for people who are at risk of choking and therefore at risk. The company has a policy on confidentiality that staff are aware of and follow. Information is shared with partner agencies and others on a need to know basis. This topic is also covered during the induction of new staff. The home has a procedure for responding to a service user going missing. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11 –17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although people who use the service can expect staff to encourage and assist them to make a range of choices with regard to activities in and out of the home in order to integrate into the local community. Their choice around the home is currently being compromised by some of the restrictions placed on them, which may impact on their independence. EVIDENCE: All Service users attend the same daycentre within Bricket Wood and enjoy a variety of activities provided. However, there was limited information contained in the service user file in relation to assessment of need and activity programmes. Access to transport occurs with the use of the onsite transport. Staff support and encourage all service users to maintain and develop social, emotional, Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 13 communication and independent living skills. There has been a recent change to the current day care programme within the home and each service user now has one day off from the day centre a week in order to take part in the day to day tasks within the home and to enjoy social and leisure pursuits outside of the home. All service users are encouraged and supported to maintain links to the local community. The home is located in a rural area down a country lane on the outskirts of Bricket wood and St Albans is within 3 miles of the home Routines within the home are in place to promote service user independence. However, service uses are currently restricted in movement around the home, with all the main areas of the home locked or key coded. Whilst there is an acknowledgment that the service user living at the home could be at risk from being unsupervised there appears to be an inordinate amount of locked doors and staff carrying large bunches of keys on them which gives the home a sense of being an institution. This could be alleviated by risk assessing specific areas of the home, in order to reduce the number of doors that restrict service user movement. The current choice of meals appears quite limited and there was no evidence to suggest that people are offered an alternative to the one choice offered. The comment from one staff member was that “people eat what they are given”. Menus are not produced in a format that can be easily understood by every service user. Alternative foods that are provided are not being recorded. The expert by experience stated that: -‘Staff said the resident were able to choose when they could get up and go to bed. Residents are able to choose fruit and drink throughout the day. We saw a resident taking some fruit. We observed that there was no food menu and the residents did not have a choice. Staff cook set meals for the residents. Smug Oak has a welcoming atmosphere and service users may have visitors at any reasonable time’. The expert by experience found that: -‘ Service user said they played their music in their bedroom. Staff told us that some residents have weekend home visit, where they can go and have a break with their family. Staff told us the residents have holidays in pairs or single, they do not have holidays as a whole unit. Staff said some residents like to help with the house cores. Staff told us there is a day care centre, which residents can get to by mini bus, or can go with care worker by train. Staff informed us that if residents were unwell they had a choice if they attended the day care centre or not. A resident was seen trying to leave the home and a member of staff asked him where he was going, the staff member said to the resident that he was not allowed to go for a walk and as to come back here and sit down. This man was not given a choice to go for a walk and be accompanied by a member of staff. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 14 A member of staff was seen communicating with a service user who is nonverbal. The service user was smiling and seemed to be very happy. Staff said residents can choose to go to church if they wished. Staff said the residents go swimming and have a trampoline, can go bike riding. Residents are not allowed to smoke and have no choice even though residents smoke when they have a home visit. Staff told us the residents do not have money given to them but staff has money to support residents in buying clothes’. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 15 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 –20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service may not have their health care needs met as the written information maintained was not adequate to provide evidence that these needs are being met. EVIDENCE: All care provided is individual to each person needs with service users choices and preferences being promoted. However care plans have not been reviewed or updated adequately to confirm that the home is meeting the current health needs of the service users. This is a particular concern given the diverse and challenging needs of this service user group. Access is sought for appropriate input from specialists such as community nurses, consultants, GP, dentists, opticians and dieticians. The expert by experience stated that: -‘ Staff said all residents have a GP and are able to see a Dentist’. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 16 A medication policy is in place to support the safe administration, storage and receipt of medicines. All staff receives training prior to being deemed competent to administer medication. The manager is planning to carry out a full audit of the current medication systems as there have been several errors made with the administration of medication, with some staff not adhering to the current medication practices. The location of the medication cupboards within the lounge areas of the home gives an institutionalised feel and this area can also be noisy and busy and could cause distractions to staff when administering medication to people. There are plans to re-locate these cupboards to a separate medication room. There was insufficient information provided to confirm that all staff have received the appropriate medication training. The home uses a Dosette box system for safe administration. During a discussion with the manager it was agreed that all staff could benefit from medication training in order to ensure that staff have a full understanding of the medication they are administering and the underpinning knowledge of specific medication that they are administering. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 17 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 & 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service cannot be assured that they will be able to access the complaints procedure or that staff are appropriately trained to ensure that they are safeguarded from abuse. EVIDENCE: The Companies own in-house complaints procedure is used and contains all the elements to meet the standard. The expert by experience stated that;-‘Residents do not have any knowledge of complaints procedures. This needs to been done in picture format and explained to residents so all residents are aware of the complaints procedures’. The service users living at Smug Oak House have limited communication skills. Therefore it is imperative that all staff have a comprehensive knowledge of each service user and their understanding. This should be supported through other forms of communication in order to ensure that they are able to express any concerns or issues they may have about the service they are receiving. The new manager has recognised that this is an area that requires improvement. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 18 The training records were out of date and therefore there was inadequate evidence to confirm that all staff had received the necessary safeguarding training to ensure that service users are protected from abuse. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 19 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 –30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users cannot be assured that all parts of the environment and current practises are safe and do not put then at risk. EVIDENCE: Although some of the areas of the home appeared well decorated and comfortable, particularly service users bedrooms, there were parts of the home that require urgent attention. The home appeared extremely hot on arrival and further investigations discovered that the radiators in some parts of the home were extremely hot and did not have radiator covers fitted, therefore placing service users at risk from scalding - an immediate requirement was made. The lounge areas of the home were quite sparse and in a poor condition. There were several items of discarded furniture outside the kitchen area of the home, which were both unsightly and could present as a trip hazard. The new Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 20 manager stated that there were plans to improve the environment and a recent audit had been carried out to address these problems. The kitchen area currently contains files and documents that contain confidential information. There was a discussion held with the new manager regarding the amount of locked doors that are currently within the home. The inspector felt that this gives an institutional feel to the home and should be reviewed and risk assessed to see if this arrangement could be altered to give more freedom of movement to the service users within their own home but still ensuring service user safety. Some service users have keys to their rooms but again the manager stated that this arrangement would be reviewed as this appears to be tokenistic and an alternative system could give service users more freedom and accessing their rooms more realistic. The expert by experience stated that; - ‘Staff said the residents had a choice to bath or shower. There were no pictures to help choose if residents wished to have a bath or shower for those who are non- verbal. All rooms have locks and staff said some residents have keys although this was not observed while we were there. The home was very hot and there needs to be some air conditioning and fans’. Fridge and freezer temperatures are not being recorded regularly. Also the inspector discovered that the freezer temperature, when checked, was at an unsafe level. This was reported to the manager at the time of the inspection. The records indicated that the fridge and freezer temperatures were not being maintained within safe limits and the manager agreed to action this immediately. The home was clean and odour free on the day of the inspection. The cleaning of the home is carried out by the care staff and with service users assisting where possible. The expert by experience stated that; ‘The home was nice and clean and staff were seen to be very friendly to the residents. The garden has rubbish dumped in the back garden and was very unsafe for residents and is not safe, this needs to be removed before some one as an accident. We observed there were no pictures of service users and staff around the home’. The home benefits from having an enclosed garden area with various items of outside equipment for service user to enjoy in the warmer months. The fire records were checked and were found to be incomplete. The weekly records showed that checks were missed out from the 18/10/07 to the 10/11/07. The weekly fire escape checks were not completed for the same Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 21 period. There was a current fire risk assessment dated 8/11/07 and the annual fire inspection was carried out on the 29/10/07. There were gaps on the hot water temperature chart and the records indicated that the temperatures, on occasions, were outside of safe limits. This was pointed out to the manager. However the water temperature on the day of the inspection was recorded within safe limits. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 22 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): 31 – 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that there will be adequate staff numbers on duty to support them. However, these staff may not have received adequate training and supervision in able to provide appropriate support, which may leave people at risk. EVIDENCE: Three staff files examined contained photographs of the person, application forms, two positive references and CRB disclosures. Due to the home being without a manager since June 2007 standards relating to both staff training and staff supervision have slipped. Records relating to mandatory training could not evidence that staff have received the necessary training to ensure appropriately trained staff supports service users or that staff have been suitably or regularly supervised. However the new manager has made a concerted effort to improve both the regularity of supervisions and improve the opportunities for staff to access the appropriate training. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 23 Staff meetings have not been held regularly and minutes were inconsistent. All these areas are expected to improve before the next inspection is carried out due to having a new and highly motivated manager in post. Also discussions with staff on duty were encouraging and everyone spoken to appeared highly motivated and encouraged by the change in the management. The manager stated that there are currently two staff members who are subject to an internal investigation. The manager agreed to keep CSCI informed of any further developments or progress regarding these investigations. The home currently has five full time care staff vacancies. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 24 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 & 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The interests of the people who use the service have been compromised over the last few months from lack of clear management and leadership. EVIDENCE: The home has had a new manager in post for a period of just one month and there are several areas of the home that have been identified as needing improvement. The new manager appears highly motivated and committed to improving the home and the service to people living at Smug Oak House. However the current inspection that has been carried out cannot fail to identify the inadequate standards that have been discovered and the impact of these on the service users. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 25 The expert by experience stated that; - ‘We asked staff if the home had a weekly or monthly meeting with residents for them to talk about how they are feeling or what they do/don’t like. Staff said they did not hold any meetings with residents.’ The main issues identified throughout the report are that require attention are service user plans and risk assessments need updating and reviewing. The environment needs attention and in particular areas of the home that have been identified throughout this report that present as a risk to service users. Staff supervision and staff training are both areas that need improving. The manager has already endeavoured to improve these areas and it is hopeful these standards will have improved by the next inspection. Although the home has the required policies and procedures in place these are not always adhered to, in particular medication, health and safety practices and the securing of confidential records. The staff team have endeavoured to improve the standards of the home and have made a concerted effort to create comfortable and homely bedrooms in which service users can relax and enjoy. However communal areas still appear sparse and in poor condition. Self-monitoring systems are adequate but the manager is committed to further developing these. Health and safety standards must be improved in particular, the monitoring of hot water temperature, preventing service users from harm (radiators that are too hot and fridge/freezer temperatures not maintained at a safe level). Service users choice is currently compromised by some of the restrictions within the service, these include, limited choices of foods/menus planning, restrictions on the use of the telephones to one evening a week and restricted access to some parts of the building. All the aforementioned issues are expected to improve due to the new manager in post and the committed staff team. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 26 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 2 2 2 3 2 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 2 3 2 2 2 x Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 27 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. 1. Standard YA1 YA2 Regulation 4&5 14 Requirement Timescale for action 31/03/08 31/01/08 2. YA3 14 3. YA6 15 4. YA7 YA16 12 15 An up to date Statement of Purpose and Service User Guide must be available. (1) Evidence that a comprehensive assessment has been completed and that the service users have been involved in this process must be maintained. (2) An up to date assessment of each persons needs must be available and must have been reviewed to ensure that the service has identified and can appropriately meet service users needs. (1) Each service user must have a comprehensive and detailed plan of care in place. The service user and/or their representative must be involved in the preparation of the plan to ensure that it is person centred and meets their needs. (4)(a) Service user rights must be (1) & (2) respected at all times and any restrictions currently imposed on service users must be reassessed and reviewed. Where limitations are imposed on individuals the rationale for DS0000019528.V354323.R01.S.doc 31/01/08 14/01/08 14/01/08 Smug Oak House Version 5.2 Page 28 5. YA9 13(4)(c) 6. YA10 17(1)(b) 7. YA20 13(2) & 13(4)(c) 13(6) & 18(1)(c)(i) 13(4)(a) & (c) & 23(2)(b) 23(2)(b) & (e) 8. YA23 9. YA24 11. YA28 12. YA33 YA35 18(1)(c)(i) 13. YA36 18(2) 14. YA41 17 (1-4) Schedules 3 & 4. these limitations must be recorded. To ensure peoples safety individual risk assessments must be completed on any aspect of the service users care/life that may present as a risk. All information relating to service users must be securely maintained in order to ensure confidentiality is maintained at all times. The administration of medication practices used in the home must ensure service users are kept safe. All staff must receive safeguarding training in order to ensure that all service users are protected from abuse. Any radiator that present a risk to service users must be fitted with radiator covers to ensure service users are protected from scalding. The lounge/communal areas of the home must be improved in order to provide comfortable and homely environment for the people who live in the home. Staff must be provided with appropriate training and records must be maintained to demonstrate that the necessary training has been provided to ensure that staff are competent to support the service users assessed needs and aspirations. To ensure staff are adequately supported to meet service users needs all staff must receive appropriate supervision (The NMS state this is a minimum of six supervisions per year). All records must be maintained and be available for inspection in relation to the protection of service users and for the DS0000019528.V354323.R01.S.doc 31/12/07 31/12/07 31/12/07 31/01/08 31/12/07 29/02/08 29/02/08 31/12/07 31/12/07 Smug Oak House Version 5.2 Page 29 effective running of the service. 15. YA42 13(4)(a), (b) & (c). The environmental issues currently compromise the health and safety of the service users must be addressed including the removal of rubbish accumulating outside the kitchen door; hot water must be delivered at safe temperatures and records maintained and the fridge and freezer must be maintained a at a safe temperature and records maintained. To ensure the safety of both service users and staff all fire records must be completed accurately. 31/03/08 16. YA41 23(4) 31/12/07 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. 2. Refer to Standard YA5 YA17 Good Practice Recommendations The manager should endeavour to provide each service user with a service user guide and an individual contract – in a ‘user friendly’ format. Service user involvement and choice of food is currently restricted by the choice of meals and the format that these are presented in. Menus should be made available in a format accessible to service users. Smug Oak House DS0000019528.V354323.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. 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