CARE HOME ADULTS 18-65
Smug Oak House Drop Lane Bricket Wood St Albans AL2 3TX Lead Inspector
Sheila Knopp Unannounced 24 May 2005 15.15 - 17.45 & 25 May 2005 14.4 0 - 17.00 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 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 Stationary 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 I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 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 ellamilburn@pentahact.org.uk PentaHact Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ella Milburn Care Home 10 Category(ies) of LD Learning Disability 10 registration, with number of places Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 13 January 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 I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector observed the interaction between service users and staff as they returned from their daytime activities. As this was the first visit to the home by this inspector and recognising the difficulties service users have with changes of routine and unfamiliar faces a further visit was arranged for the following day. The findings of this report are based on contact with 7 service users, informal contact with staff and private interviews with 3 staff and the manager. A relative who had been active in developing the original service and was still playing a major role within PentaHact was also able to contribute their view on the service. The inspector walked around the premises and garden. Records, which were relevant to this inspection, were examined. What the service does well: What has improved since the last inspection?
A person centred planning (PCP) approach to identifying care needs and the support required for individual service users is being introduced. Contact with an advocacy service has been developed to provide an external voice for individual service users.
Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 6 In recognition of the amount of time the home has now been open it was reported that a planned programme of refurbishment has been put in place. This has included redecoration and furnishing of bedrooms. At the time of the inspection the much needed replacement of the bathrooms and toilets was being carried out. This will upgrade worn out facilities and provide a more dignified environment for the residents. A detailed risk management plan was in place with service users spending longer at the day centre to reduce the effect of the disturbance in the home while this work is carried out. A programme of evening activities has been introduced to provide a more structured focus for individual service users. The manager acknowledges this needs to be kept under review and developed further Overall the home was found to be much cleaner and in better condition than described in the previous inspection report. 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 I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 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 standard(s) 2 The policies and procedures in place ensure that the assessments, which would be carried out prior to admission, would identify if the home can meet the needs of the individual. EVIDENCE: There have been no new admissions to Smug Oak House since 1991. However the policies and procedures examined demonstrated that detailed assessments would be carried out before admission. Relevant health and social care professionals would be contacted and asked to contribute. Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 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 standard(s) 6 & 7 The care plans in place enable staff to respond to the individual needs of the service users. Parents / representatives of the service user are involved in the review process. Advocacy services are available to provide independent support for service users. EVIDENCE: Standards 6-10 were fully met when the home was inspected on 13/1/05. The two care plans examined in detail demonstrated that there were regular reviews with parents and members of the multi-disciplinary team that has contact with the service users at Smug Oak House. As well as the annual Care Programme Approach review 6 monthly internal reviews are carried out. Staff report that they involve the service users parent / representative in the internal review. However following discussions during the inspection it was identified that feedback to parents/representatives on the progress of any agreed action plans may need tightening up in some cases. PentaHact are introducing new care plans based on a person centred planning approach (PCP). This will provide a more detailed way of recording the needs of the service user from their point of view.
Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 10 This is an intense process and service users and staff are being supported in this by a PCP team within the organisation. Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 11 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 standard(s) 11,12,13 &17 This inspection confirmed that service users had a planned personal development programme in place and that they had the opportunity to take part in appropriate leisure and community based activities. A dietician is involved in supporting residents to ensure they receive a diet suited to their needs. EVIDENCE: Standards 11 – 17 were fully met when the home was inspected on 13/1/05. Details of the planned activities for each service user are recorded in their care plan. The focus of the main part of the day during the week is the PentaHact day centre in Bricket Wood. An evening and weekend programme for individual service users has been developed. The key workers interviewed were able to describe arrangements to support individual service users in the local community and to make arrangements for the service users who spend time with their parents. The home has its own transport available and there are enough staff available able to drive the vehicles to ensure that planned programmes are maintained.
Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 12 On the first day of the inspection a service user and project worker had done the weekly shop. This demonstrated a variety of foods to suit individual preferences and cultural needs. Fresh fruit and snacks were available. Service users were assisting with meal preparation and one person had baked a cake with the support of staff. The care plans checked confirmed that the nutritional needs of service users are assessed and support from a dietician is provided. Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 13 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 standard(s) These Standards were not inspected on this occasion. EVIDENCE: Standards 18–20 were fully met when the home was inspected on 13/1/05 Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 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 standard(s) 22 & 23 People are given appropriate information to enable them to raise concerns. The manager is looking at ways of ensuring feedback is given in response to informal issues raised with staff. There is robust procedure in place for responding to responding to protection of vulnerable adult issues and protect the financial concerns of service users. EVIDENCE: No complaints have been received by CSCI since the last inspection and no issues have been raised by external health or social care workers. Following a visit to the home by an employee from PentaHact an internal complaint about the deployment of staff on a particular shift is being investigated. The last unannounced visit by a representative of the company took place over a weekend. The manager has identified the need to introduce contact sheets into each care plan so that informal concerns or comments made to staff by parents/representatives and other agencies involved with the service user can be recorded, acted upon and feedback given. This will also provide further information for the home’s quality review system. There is positive recording of unidentified knocks and bruises, which are fully investigated to ensure that service users are protected from harm. Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 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 standard(s) 24, 25, 27, 28 &30 Overall service users are provided with a safe comfortable environment. The planned programme of refurbishment will upgrade the facilities further and take away some of the institutional feel from the corridors. EVIDENCE: The manager provided details of what is included in the refurbishment plan and CSCI have requested a copy. PentHact need to ensure that worn and stained carpets and furniture in the lounges is upgraded. It is understood that work required in the kitchen and redecorating of the corridors has already been agreed. Laminate flooring has been installed with good effect on the ground floor. The bathrooms and toilets were all being refitted and tiled at the time of the inspection with suitable risk assessments in place to minimise the effect on the service users. Individual rooms have been redecorated and furnished. Protective equipment to protect service users and enable them to have access to videos, TV’s etc in their rooms is being made available.
Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 16 Individual windows above ground levels are restricted to prevent accidents. The majority of radiators are covered to protect service users from hot surfaces. Where they have not been covered the manager needs to ensure that risk assessments are carried out. The home was much cleaner and better organised than reported in the last inspection report. However there are areas where regular deep cleaning above the normal day-to-day cleaning is required. The internal and external windows were dirty. A recommendation to review the hours allocated to cleaning and to put in place a cleaning schedule has been made. The manager has identified some hours from the budget for the regular maintnence of the front garden. The lawns of the extensive gardens at the rear are maintained by contractors. It appears staff are responsible for the other areas. The patios were overgrown with weeds and the boarders are becoming overgrown. A recommendation to identify hours for gardening and remove old furniture, exercise equipment and soft furnishings from the patio areas and behind the shed to make this area attractive to use has been made. The manager would like a path from the patio area to the summerhouse. To support good infection control practices it is recommended that disposable towels are provided in the laundry. Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35, 36, Staff are provided in sufficient numbers to support the residents. However PentaHact have been asked to review the allocation of hours for cleaning and gardening so that these duties do not reduce the hours available to residents. The supervision, training and recruitment systems in place support good working practices and protect the residents. EVIDENCE: Additional staff have been recruited since the last inspection, which has improved continuity for residents and staff morale. The manager reported that there still vacancies for 5.2 whole time equivalent support workers. The rotas indicate that regular agency staff are used where the home is unable to provide internal cover. The rotas indicate that staff are provided to flexibly support the needs of the residents. Two staff are provided at night. Five staff are provided during the afternoon and evening. While the overall staff team reflect the culture and gender of the residents it was noted from the rotas that there are occasions each week when no female staff are available at night. As well as supporting service users staff are also expected to carry out the cleaning and maintain the patio areas and large borders in the garden. Smug Oak Lane is a large building with some quite inaccessible areas.
Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 18 It is recommended that PentaHact review the allocation of hours for these tasks and provide some additional support. The interviews with staff confirmed that induction and on-going training was provided to support the needs of the service users. Staff felt well supported and confirmed that there was an open atmosphere between team members and the manager. Staff receive regular formal supervision with senior staff. The personnel records for 2 new staff confirmed that the required checks to protect residents are carried out before individuals start work in the home. Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 42 Smug Oak Lane was found to be well managed. The quality assurance, health and safety systems and regular maintnence checks provide a safe environment for residents and staff. EVIDENCE: The registered manager is studying for an NVQ 4 in Care management, which will lead on to the Registered Care Managers Award. PentaHact have good quality assurance systems in place, which takes account of the views of others involved with the home. The manager reports she gives a copy of the development plan arising out of the annual review to parents / representatives and invites discussion. A copy is provided to CSCI. There are clear systems in place to support the management of resident’s finances. Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 20 The maintenance and fire safety records demonstrated that the required checks are carried out. Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x N/A Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 2 3 x 2 Standard No 11 12 13 14 15 16 17 3 3 3 x x x 3 Standard No 31 32 33 34 35 36 Score x x 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Smug Oak House Score x x x x Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x 3 x I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 22 Are there any outstanding requirements from the last inspection? Refurbishment of bathroooms and toilets in progress. 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 24 Regulation 23(2)(b) Requirement Provide CSCI with a copy of the development plan for the home, including timescales for upgrading of stained/worn lounge carpets and furniture Remove old furniture, broken execrcie equipment and debris from the patio areas and behind the shed. Weed patio areas. Provide details of arrangments to maintain the patio areas and borders. Clean internal and external windows. Provide a dispoable hand towel dispenser in the laundry. Review hours allocated to deep cleaning and maintence of garden patio areas and flower borders. Timescale for action 31.7.05 2. 24 23(2)(o) 30.6.05 3. 4. 5. 6. 24 24 30 33 & 24 23(2)(o) 23(2)(d) 13(3) 23(2)(d) 30.6.05 30.6.06 30.6.05 31.7.05 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 6 Good Practice Recommendations Ensure all staff involved with reviews provide
I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 23 Smug Oak House 2. 3. 33 42 parents/representatives with feed back on the progress of the action plans arising out of the CPA review and internal 6 month review. Review gender mix on night shift. Confirm risk asessments have been recorded for all uncovered radiators. Smug Oak House I52 s19528 smug oak v229038 240505 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Merbury House 1 Broadwater Road Welwyn Garden City AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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