CARE HOME ADULTS 18-65
Oakes (The) 55 Railway Approach Laindon Basildon Essex SS15 6JX Lead Inspector
Patricia Stanton Key Inspection 10th July 2006 10:00 Oakes (The) DS0000018125.V300206.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 Oakes (The) DS0000018125.V300206.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. Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Oakes (The) Address 55 Railway Approach Laindon Basildon Essex SS15 6JX 01268 441096 01268 455103 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) Kingswood Care Services Limited Vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To provide care and accommodation to one service user who is 17 years of age and known to the Commission for Social Care Inspection. 12th January 2006 Date of last inspection Brief Description of the Service: The Oakes provides care and accommodation for up to six young adults with learning disabilities and complex needs such as autism/challenging behaviour. A high staffing is required to enable staff to meet the needs of the residents so they may access facilities in the community. The Oakes is a large detached house located in a wholly residential area in Laindon. There is a choice of one-day room, dining area and a kitchen diner. There are five single bedrooms; three with en suite facilities in addition there is a self-contained bedroom and dining area/lounge for one resident. The home has two vehicles for transporting residents to activities in the community. There is a secure garden with seating, patio and shed. Laindon shopping centre is within easy reach and the home is close to local amenities. Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The routine key unannounced inspection took place on the 10/07/2006. Four residents were spoken to, two of which were not able to verbalise plus three staff members, the registered provider and the new acting manager. Records and documents were looked at including requirements from the last inspection. Time was spent in the lounge and hall with residents taking note of their daily lives. The inspector would like to take this opportunity to thank the residents’, staff and acting manager for their cooperation during the inspection. What the service does well: What has improved since the last inspection?
The acting manager has improved administration procedures and medication administration and staff are much clearer about their roles and responsibilities. A survey was completed in July 2005 seeking the views and opinions of relatives and visiting professionals to help monitor the service. Staff have started to have regular supervision to help identify training needs. Staff personal files are now available at all times for inspection. The acting manager has improved access to the homes fire exit in the back garden. The acting manager has gained a qualification in Registered Managers Award. Residents’ money is stored appropriately. The acting manager has introduced a new shift leader work plan to ensure all of the homes tasks are completed on time.
Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, Relatives have the relevant information to make a choice about the home prior to admission to help them identify that individual aspirations are met in relation to residents and recreation. The homes service users guide has not been updated in a suitable format for residents. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this home. EVIDENCE: The home has started to produce a pictorial format service users guide for residents, which will include photos of staff/residents and details of how to complain with details of the CSCI, but this was not available at inspection. Residents appear to enjoy fulfilling lives with the support of staff that encourage them to participate in recreational activities and personal interest. Many residents attend educational schools/colleges and enjoy days out, annual holidays and time in the community. Residents have individual activity plans. Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10. Care plans reflect residents’ needs and residents are consulted and supported on all aspects of their care including reviews, however, consultation could be improved. Care plans and risk assessments are not regularly audited to ensure they meet residents changing needs. Recreational activities offered at the home are individualised and varied. Personal files are stored securely. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this home. EVIDENCE: Care plans examined were detailed and included all aspects of residents needs including social, emotional, self help, communication and behavioural assessments but there was no evidence of regular auditing to ensure plans reflected residents changing needs and risk assessments were not up to date. Plans included residents’ goals and information regarding their daily life and personal interests. Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 10 Residents accommodated attend local colleges and schools to continue education and enjoy going out with staff in the community. Since the last inspection residents’ meets have not taken place and from the last meeting, residents appeared to give good information about their wishes in relation to care and recreation. The acting manager stated residents are consulted on a one to one basis as communication is difficult, however, residents appeared quite vocal of their wishes in the previous minutes recorded. Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 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 the following standard(s): 11,12,13,14,15,16. Residents have good access to the community and leisure activities with appropriate social contact with family and friends. Residents are able to develop personal skills and interest in the home and have their needs respected in relation to daily life skills. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this home. EVIDENCE: Staff arrange various activities for residents and one resident who has an interest in buses was to go on a day trip to London with staff to visit places of interest on a bus and train. Records confirmed residents had been on various annual holidays and days out whilst living in the home. During inspection one resident was in the garden colouring, two residents were swimming and one resident was having a lay in. Residents go out at least twice a day and lead active and fulfilling lives, enjoying annual holidays with staff to various locations including abroad and in the UK depending on preference.
Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 12 Residents at The Oaks are physically active and enjoy going out. Residents have use of a large garden trampoline and paddling pool with sufficient recreational facilities including jigsaws, paintings, DVDs and CDs. Residents participate in daily living skills within their capabilities. Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 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 the following standard(s): 18,19.20. Residents receive personal support and appropriate health care and administration procedures for medication have improved. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this home. EVIDENCE: At inspection all residents looked happy and healthy. Care plans confirmed residents receive appropriate health care from medical professionals and files examined confirmed appropriate medical professionals including the optician, doctor, dentist, behavioural team, psychiatrist and occupational therapist see residents. Residents receive personal support from staff and at inspection communication beween staff and residents were mutually respectful and caring. The home operates a key working system but no evidence was seen in one file of any one to one key working sessions with staff. Details of relatives and professionals survey evidence placing social workers and relatives are happy with the care at the home. Relatives stated “ Thank you for all the care given, The Oakes have been a blessing in so many ways, staff work over the top of what’s expected – he’s really happy” Another comments stated “My son get agitated with some staff”.
Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 14 Comments from professionals included “ Always provides a quality service and high level of support, staff and proprietor are flexible and accommodating”. “Very impressed with care and dramatic improvement in my client would not hesitate to use again.” At inspection another resident was having a review which relatives were invited to give feedback in. Medication was inspected and found to be in very good order. The acting manager had updated the medication and administration policies and procedure and produced an easy step guide for staff regarding the dispensing of medication. Examined files found MARS sheets were complete and medication stocks stores appropriately, with correct stock amounts, in date with appropriate records for disposal. Files contained residents photos and signatures of staff that are trained to give medication. The home does not regularly audit medication but stocks are checked ad recorded daily. Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Residents are consulted but this could be improved residents are protected from abuse and neglect. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this home. EVIDENCE: Staff have training in protection of vulnerable adults (POVA). However, one agency staff member was unaware of the whistle blowing policy but conversant with the signs of abuse and procedures for reporting abuse. All staff receive appropriate POVA training but not all staff have attended training for restraint and challenging behaviour. The home currently accommodates residents with challenging behaviour. The home does not have a log for recording restraints but does record incidents and accidents. All examined records had been recorded appropriately and follow up action recorded and signed of by the homes acting manager to help prevent future occurrences. The home has received no complaints since the last inspection. Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,28,30. Residents live in a clean homely environment, which is safe and decorated to a good standard. Quality in this outcome is good. This judgement has been made using available evidence including a visit to this home. EVIDENCE: The home was clean, welcoming, bright and comfortable. Mostly decorated to a good standard but some parts of the home inspected needed some redecoration and refurbishment. These included the hallway, bathroom, and lounge. The hallway paint was chipped and marked and the upstairs bathroom was in need of new flooring as it was torn, a new bath panel and the ceiling above the shower was peeling. The homes stair banister was in need of repair or replacement as they were unstable. The lounge suite was in need of repair or replacement as it was worn. One resident had just had his room decorated in the colour of his choice, which he was very happy with. Since the last inspection the home has been personalised more for residents with photos displayed. The home has a resident’s notice board and non-verbal board to help them communicate their needs.
Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35. Staff are competent and appropriately trained but staff numbers need to be increased to meet registration conditions. Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this home. EVIDENCE: Staff appeared to meet the needs of residents accommodated but at inspection there were agency staff on duty as the home has currently 5.5 full time vacancies. The home is registered to have a high staff number to meet the challenging needs of residents accommodated and the acting manager stated staff are being recruited currently by the company for all Kingswood Care homes following new staff needs assessment completed by the senior manager. The number of staff on duty appeared sufficient to meet residents’ needs and the staff rota matched the numbers of staff on duty but it was noted agency staff names were not recorded on the rota in full and staff hours were not defined for early and late shifts. The acting manager was to make appropriate changes. It was noted residents were quite relaxed with the core staff team on duty who had a good knowledge of residents’ needs but the home has experienced some recent staffing problems which were being investigated during inspection by the registered provider.
Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 18 It was also noted the home employs some staff to work set hours which do not meet the needs of the residents daily lives. Minutes of staff meetings evidenced staff are able to voice their view and opinions but the recent changes in management have caused them some anxiety. Meetings examined included staff views are sought regarding care in the home. Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,42,43 A new acting manager who runs the home ensures residents’ needs are met and has progressed the home since the last inspection. The acting manager has the appropriate experience and qualifications to manage the home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this home. EVIDENCE: The new acting manager has had to make many changes to improve outcomes for residents which has affected the smooth running of the home. However, residents needs are met and the home is now run more efficiently. The acting manager has just completed a Registered Managers Award qualification and has the experience to run the home. Staff stated at inspection that the new acting manager is approachable and that they were happy with the improvements made since his employment. Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 20 One member of staff stated, “The new acting manager has had to deal with a lot of issues inherited from previous management and is doing very well”. Examined files confirmed the registered manager had called a meeting with staff to address poor attitudes from staff to residents regarding negative approaches specifically “talking about residents in front of them, carrying negative attitudes about residents from one shift to the next, staff being too domineering and controlling”. The registered manager gave staff a handout regarding psychological abuse and stated staff would be expected to complete SCAPE training and conflict management to help staff confidence when dealing with residents. The home has completed a survey to seek the views and opinions of residents placing social workers and family but this does not include the views of residents. The inspector found a very good template to obtain residents views in the homes files and requested the acting manager use this for the next survey. Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 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 Standard No Score 1 2 2 3 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 3 X 3 3 Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 22 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. 2. Standard YA1 Regulation 5 Requirement The home must produce a service users guide suitable for residents with a learning disability. Timescale not met 01/11/05 01/04/06 The home should ensure residents have a suitable service users guide before admission to the home. Timescale not met 01/11/05 01/04/06 Care plans and risk assessments should be regularly reviewed and updated to meet the changing needs of residents. Timescale for action 01/08/06 3. YA3 5 01/08/06 4 YA6 15 2 (b) 01/08/06 Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 23 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. 3. 4 5 6 7 8 8 9 Refer to Standard YA33 YA29 YA20 YA18 YA22 YA28 YA32 YA33 YA39 YA6 Good Practice Recommendations The homes staff rota should include full names of all agency staff employed in the home and codes of hours staff work. It is recommended the home install internet access to maximise residents’ independence and improve planning and communication for staff. An appropriate designated senior member of staff should regularly monitor mediation. Key working sessions should be evidenced in care plans. Regular residents meetings should take place to enable residents to voice their views, opinions and any concerns they may have. The home should ensure the home is decorated and furnished to a good standard. This refers to the suite in the lounge, hallways, staircase and first floor bathroom. Staff should have training in challenging behaviour, whistle blowing policy, restraint and learning disabilities. Staff numbers and hours should be increased to meet the homes registration requirements. Residents views should be sought when developing a quality assurance and monitoring survey. The home should keep a record of all restraints. Oakes (The) DS0000018125.V300206.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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