Inspection on 17/02/09 for Tall Oaks

This inspection was carried out on 17th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tall Oaks 18/09/06

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Treloar College

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tall Oaks 5 Pirbright Road Farnborough Hampshire GU14 7AB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Beverley Rand     Date: 1 7 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Tall Oaks 5 Pirbright Road Farnborough Hampshire GU14 7AB 01252378459 TBA pirbright@downingcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Downing (Acacia House) Limited care home 6 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 6 4 The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (MD) - maximum number of places 4. Date of last inspection Brief description of the care home Pirbright Care Home is a property situated in a residential area in Farnborough and is undistinguishable as a care home from other homes in the street. Downing (Acacia House) Limited oversees the service and the home is registered to accommodate six people under the age of 65 with a learning disability. Each service user has a single bedroom with en-suite facilities. Communal space includes a lounge/ dining room and a kitchen. Most of the doors are wide enough to accommodate wheelchairs easily. Care Homes for Adults (18-65 years) Page 4 of 27 Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. Before we visited the home we looked at the last inspection report and the Annual Quality Assurance Assessment. We also received two completed surveys: one from a service user and one from a social care professional. Both were positive about the experience of living at the home and working with the staff, respectively. The inspection took place over two days, due to recruitment records not being available for inspection on the first day, as the manager was not on duty. During the two days, we spoke with a service user, observed general practice within the home, spoke with staff, looked at records such as support plans and menus. On the second day, we spoke with the manager and looked at recruitment records. Care Homes for Adults (18-65 years) Page 6 of 27 The fees are arranged between the home and the funding authority. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager undertakes assessments to ensure the home can meet individual needs. Evidence: We looked at an assessment which had been completed by the manager. The assessment showed that the manager had sought information about individual needs before the person moved into the home. The AQAA states that prospective service users, along with their family and current care team are invited to the home as part of the admission process. The manager can then determine whether the home can meet their needs. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users make their own choices and are supported to take responsible risks. Evidence: We looked at two support plans and found them to be detailed, covering areas such as health needs, personal hygiene, communication, mobility, eating and drinking, cooking, cleaning, laundry, family, personal space, social and challenging behaviour, employment, road safety and hobbies. The plans gave a good level of detail to ensure that staff worked in a consistent way with service users. Examples included the order in which staff should support someone to wash and which toothpaste to use as well as strategies regarding the answering of questions. The manager has made referrals to, and based support plans on advice and strategies offered by the Community Learning Disability Team. We looked at daily records to see if the support provided matched the support plans and found that they did. This meant that staff were working with service users in ways which had been created by a multi-disciplinary team approach, thereby ensuring consistency. Reviews were completed formally and records kept. We received Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: a completed survey from a social care professional who said that, the home has responded extremely well, to a service user with particular needs. They also wrote that the, service is great at using a person centred approach with each individual and building a service around the person. The structure they have put in place for, (a service user) has been fantastic. Communication with families and professionals has been very good. We saw that service users made choices about how they spent their day and whether or not they joined other service users or stayed in their bedrooms. We also found that staff were trying to encourage service users to broaden their horizons but that they had to balance this with individual choice. We received a completed survey from a service user who said they could always choose what they do each day. Risk assessments were in place for various activities, which meant that service users were supported to undertake activities which involved risks, such as going out into the community. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have opportunities to undertake activities of their choice and have input to the choosing of menus. Evidence: The AQAA said that the home promoted individuality and the choice to develop their own skills through education, employment, recreational and cultural experiences. Service users have individual activity plans and on the day of the inspection all but one of the service users were out for part or all of the day. Some service users go to a day centre and other activities include visiting garden centres, going to pubs or the park, bowling, the library and so on. The home works with individuals to promote their interests and encourage them to access activities which interest them. The home ensures that staff support links with family members where possible. The Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: AQAA says that service users socialise with friends and family both at the care home and at family homes. We saw that service users could decide where they wanted to be when in the home. We also saw that staff were respectful of individuals routines, whilst working with guidelines provided by other professionals. Individual support plans show food preferences and needs, for example, the need to have food cut up. Staff told us that the weekly menu is drawn up each Sunday with the involvement of service users. Alternatives are available and a record is kept of the food eaten by each service user and food intake is monitored in line with individual assessed needs. Service users are involved with the preparation of food and drink and there is a low level worktop in the kitchen to assist with this. We spoke with a service user who told us that they had chosen the evening meal on the day of the inspection. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported in ways which meet their social and healthcare needs. Evidence: Service user support plans show details as to how service users prefer to be supported. During the inspection we heard staff listening and responding to service users with patience. Service users are encouraged to make their own healthcare appointments and one undertakes their care with regard to a particular piece of equipment. Health action plans are being developed with service users and healthcare professionals. We saw evidence in support plans which showed that service users visit their GP and had access to other professionals as necessary. Referrals are made to professionals such as the Occupational Therapist and the Community Learning Disability Team. The home has a detailed medication procedure in place. Medication was appropriately and securely stored. The home has improved the individual support plans for administering medication, when needed, including prescribed medication and homely remedies. The Medication Administration Records included a photograph of each Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: service user and there were not any gaps in the recording. Staff told us that staff had to undertake training before they were able to administer medication. The manager told us that the training is provided by a well known pharmacy and consists of three modules. We looked at the modules and they appeared to be detailed. Staff told us that they could take their time completing the modules. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users feel able to use the complaints procedure. Procedures are in place to protect service users. Evidence: The AQAA states that the home has, developed a user friendly complaints leaflet that residents have confidently used. We looked at the complaints book and found that the manager had responded as soon as possible and referrals to other professionals had been made if necessary. We received a completed survey from a service user who said they had a copy of the complaints procedure, as did their family, and that they knew who to talk to if they wished to complain. Staff have received training in safeguarding adults. The manager has made referrals to the local authority adult services where there have been concerns about service users. The manager has taken appropriate action in response to allegations which are being looked into by social services. Care Homes for Adults (18-65 years) Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a clean environment which is decorated to their taste. Evidence: We walked around the home and looked at the communal areas. Some of the bedroom doors were open and we saw that the rooms appeared larger than average and well decorated. Service users had filled their rooms with their own possessions and the rooms reflected their personal tast, for example, one service user told us their favourite colour, and we saw that their room was painted and furnished in that colour. The bedrooms all have an en-suite facility. Some service users have a key to their bedroom door. We spoke to a service user about the environment and they agreed the home is always nice and clean and that it was, gorgeous. The kitchen has a low level work surface so that service users who use a wheelchair can make a drink or take part in the preparation of food. The AQAA identified areas which the manager hopes to improve in the next twelve months. Service users have chosen to construct a sensory garden with a water feature. Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: We spoke with a staff member about protective clothing and they said that there were always plenty of gloves, which were all latex free. The home was clean. Care Homes for Adults (18-65 years) Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are not protected by robust recruitment procedures. Staff have access to training but there are gaps in the programme which may put service users at risk. Evidence: Since the previous inspection, a large number of staff have been recruited at the home. The AQAA stated that, no staff is employed without 2 references and a POVA check and does not work unsupervised until full CRB received, (this is a direct quote of the text). Further, in answer to the question, did all the people, who have started work in your home in the last twelve months have satisfactory pre-employment checks?, the AQAA has been ticked as, yes. On the first day of the inspection the recruitment records were not available for inspection. We subsequently returned to the home at a time arranged with the manager, so that we could see the records. We initially looked at four files, but what we found was of concern and so we looked at eight files in total. Of the eight files, only three had completed recruitment checks in place before new staff started working at the home. Of the remaining five files, two did not have a Protection of Vulnerable Adults check before the person started work. One file had no references at all and four had only one reference each before the person started work. Three files currently only have one reference instead of the required two. Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: We spoke to the manager about the recruitment process. She told us that the process was facilitated by another person in the organisation. This was evidenced by the paperwork which was addressed from, and received by, this other person. The manager also told us that she was on leave when some of the staff were recruited and on her return to work found that it was the first day for these staff. Out of ten support staff, four staff are currently working towards the National Vocational Quaification in care, (NVQ) level 3 and three are studying for level 2. The AQAA stated that, staff have completed most mandatory training this year. The manager provided us with a training matrix which showed that most staff had completed training in areas such as moving and handling, fire safety, safeguarding adults, first aid, autism and medication. Other training included mental capacity awareness, disability awareness and common induction standards. However, the records showed that one staff member had not done any of this training. The records also showed that none of the staff had received any training in food hygiene. Staff prepare all the meals and the manager told us they were trying to access this training but that she thought some staff may have had training previously. The records also showed that none of the staff had received any training about infection control. The lack of training in these areas means that staff may be undertaking tasks that they are not trained to do. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems do not ensure the best outcomes for service users. Quality assurance processes need to be further developed to ensure service users have opportunities to give their point of view. Evidence: The manager is registered and is qualified to manage the home. The manager completed the AQAA and identified areas which she plans to improve over the next twelve months. Positive feedback has been received about the way the home is managed. However, as detailed elsewhere, recruitment procedures are poor. Staff turnover has been high, as is reliance on agency staff. On the first day of the inspection, we saw that two agency staff were working, one of whom was working their first shift (they were reading support plans). On the second day of the inspection, there was a new staff member started on that day. Two referrals have been made under safeguarding adults procedures regarding alleged staff practice. We were told that the managers hours are split between management tasks and supporting service users on a practical level. She said that she has two days a week for management Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: tasks but that even on these days, she may need to support staff, practically. We did not have the opportunity to discuss quality assurance surveys with the manager, but the AQAA says under, what we could do better, quality assurance questionnaires to service users and families. The manager told us that monthly service users meetings were held and we saw some of the minutes, which were produced in pictures and words, and were given to service users. The manager holds monthly staff meetings where possible and undertakes supervision sessions with individual staff. The provider has undertaken Regulation 26 visits to the home, whereby they monitor quality through talking with service users, staff and the manager, and looking at various records. However, when we asked to look at the monthly visit records, the most recent available to us was dated August 2008. We asked whether there were any more recent records but were told that the reports had not been made available to her since August. She said the provider did visit the home on a regular basis. We looked at some of the visit records available but could not see any reference to the recruitment process, which has not been safe. The AQAA stated that the health and safety was, up to date and that health and safety certificates were available. We did not look at these certificates on this visit but the AQAA did show the dates when equipment had been serviced. This included checks on the fire equipment. Care Homes for Adults (18-65 years) Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 34 17 Records, as specified in 31/03/2009 Schedule 4, must be available at the home and be available for inspection at all times. To ensure that we can undertake a thorough inspection to ensure service users are protected. 2 34 19 Persons must not be employed to work at the care home unless they are fit to do so. The information and documents specified in Schedule 2 must be obtained before a person is allowed to work in the care home. To protect service users. 31/03/2009 3 35 18 Staff must receive training 30/04/2009 appropriate to the work they are to perform. To ensure service users are protected. Care Homes for Adults (18-65 years) Page 25 of 27 4 39 26 The manager must be provided with a written report pertaining to Regulation 26 visits. To monitor outcomes for service users on a regular basis. 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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