CARE HOME ADULTS 18-65
The Oaks Firs Road Kenley Surrey CR8 5LH Lead Inspector
James OHara Unannounced 15 August 2005 08:20 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. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Oaks Address Firs Road Kenley Surrey CR8 5LH 020 8763 1719 020 8763 1719 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) Surrey Oaklands NHS Trust Mrs Nimah Virah-Sawmy Care Home 14 Category(ies) of Learning disability (14) registration, with number of places The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: A variation has been granted to allow four specified service users aged 65 or over to be accommodated until such times that the home is no longer able to provide the care they require. Date of last inspection 07/02/05 Brief Description of the Service: The Oaks is owned by Surrey and Borders NHS Trust and is registered with the Commission for Social Care Inspection to provide residential care for up to 14 adults with learning disabilities. The home currently has 12 service users and two vacancies. The home currently has a wide age range of service users, the youngest being 35 the eldest being 75; however most of the service users are of the older age range. The home offers accommodation to people who have a moderate to severe learning disability. The home is beautifully situated in a wooded area of Kenley. The home is not easily accessible by public transport being a 20 minute walk up a very steep hill from both bus and rail routes. The home has 2 vehicles one of which is adapted for wheelchair users. The property is a large, converted building with accommodation sited across 3 floors with access being provided by a lift. The home has day-service facilities on site. All bedrooms were noted to be of good size, communal accommodation is a large lounge and a smaller quiet lounge, a large dining room, 3 bathrooms and 5 toilets. The home has a large garden, which is frequented by squirrels and other wildlife. The home has a heated, in-door swimming pool. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The home was inspected under the National Minimum Standards. This unannounced inspection took place at 8.20 and finished at 10.20 on a Monday morning. Service users were up and dressed and preparing to attend daytime activities. Methods of inspection included, previous inspection experience of the home, a tour of the premises observation of contact between staff and service users and discussion with three of the four members of staff on shift, the home manager was not present at the time of the inspection. Records examined included staffing rotas, care plans, Person Centred Plans, Risk Assessments, fire records, water temperature checks, medication records and complaints. Requirements and recommendations from the previous inspection were discussed with the senior member of staff on shift Sandra McKenzie. Sandra provided evidence were she could however she could not access all the relevant information. As the home manager was not present some of these requirements and recommendations will be discussed with her at the next inspection. What the service does well: What has improved since the last inspection? The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 6 The Surrey and Borders NHS Trust has now appointed a new manager to run the home, this will benefit to both the service users and staff working at the home. The homes administration systems have been discussed at the staff team meeting held on the 7th March 2005 as recommended at the last inspection. The homes policy and procedures were also discussed. During the last inspection it was identified that some service users holidays were not arranged due to lack of staffing and staff long-term sickness at the home. A new member of staff has been recruited and the new home manager is due to start work at the home shortly. Six service users have had an annual holiday this year and there may be plans for other service users to go on holiday and daytrips. The home has purchased a new cooker and the hallway, dining room and utility room have recently been redecorated. 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. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 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 The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 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) 1, 2 and 5. Information available to prospective service users is good. No new service user has moved to the home since the last inspection however all the procedures are in place should they be needed. EVIDENCE: The home has a Statement of Purpose and Service User Guide that includes all details as listed in Schedule 1 and Regulation 5 of the National Minimum Standards. The homes administration systems have been discussed at the staff team meeting held on the 7th March 2005 as recommended at the last inspection. The homes policy and procedures were also discussed. Although the home is registered to support fourteen service users there are currently only twelve service users living at the home. The Surrey and Borders NHS Trust has its own assessment for admission to residential care, which is completed by the home. No new service user has moved to the home since the last inspection. All service users have contracts drawn up by the Surrey and Borders NHS Trust using Standard 5 of the National Minimum Standards as guidance. These contracts are located in the service users personal files. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 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 and 9. Person Centred Plans and assessments of risk are comprehensive and sufficiently detailed to enable staff to meet the service users personal, social and health care needs. However some of the service users still need to have their needs assessed by their care manager thus ensuring that the home is suitable for the purpose of meeting their needs. EVIDENCE: It was recommended at the last inspection that the service users plan is written in conjunction with the service user and his/her representative and is duly signed. The senior member of staff on shift said that recent reviews had been completed and were in the process of being typed; when this task is completed the plan will be sent to the service users representative for comments and to sign if they agree with the minutes. A requirement was set at the last inspection that all service users have a care manager assessment carried out. The senior member of staff showed evidence that a care manager had visited the home to arrange needs assessments for four of the service users. One service user file was examined and there was evidence of regular six monthly reviews of Person Centred Plans and risk assessments.
The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 and 15. Provision is made so that all service users attend appropriate social activities and day centres. Arrangements are made so that all service users have regular contact with their friends and families. EVIDENCE: Service users attend the Driscoll Centre one full day per week with additional sessions for art therapy. The home has a well-resourced day care room where a number of service users were observed to be engaged in a variety of activities, including painting, puzzles and ball games. The home has a heated indoor swimming pool, which was converted, from an outdoor pool when the property was purchased from the previous owner. A requirement was set at the last inspection that all service users are offered an opportunity to go on holiday this year. Six service users have had an annual holiday this year, the senior member of staff said that there may be plans for other service users to go on holiday this year but she was unsure if and when these are to take place. Some service users have not gone on holiday because of illness and one service user does not wish to go on holiday. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 11 During the last inspection it was identified that some service users holidays were not arranged due to lack of staffing and staff long-term sickness at the home. A new member of staff has started work at the home since the last inspection and a new home manager is due to start work at the home shortly. The home is supportive of family and friends’ visiting the home. The home has no visiting restrictions although it does ask that visitors telephone before a visit in case the service users are out. The home has a second, quiet lounge, which can be used, as a private visitor’s space. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19. Suitable arrangements are in place to ensure that service users physical and emotional health care needs are identified and met. The homes policies and procedures for handling medicines in the home ensure the service users are so far as reasonably practicable protected from harm and/or abuse. EVIDENCE: All of the service users are registered with a local General Practitioner. The Surrey and Borders NHS Trust supplies most of the Community Health Facilities that the service users require, this system offers the service users ready access to health facilities. Input from physiotherapists, dieticians and such professionals were regularly noted on service user’s files. All service users have annual health checks and flu vaccinations. It is recommended that the service users health care appointments be recorded in the service users file. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 13 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 and 23. The home has appropriate complaints procedure in place. The home has suitable vulnerable adult protection and abuse prevention measures in place to ensure the service users are so far as reasonable practicable protected from abuse, neglect and/or harm. EVIDENCE: The homes has an appropriate complaints procedure included in the service user guide, this includes details of the Commission for Social Care Inspection. Members of staff on shift said that they have attended Vulnerable Adults training facilitated by the Surrey and Borders NHS Trust. As the home manager was not present staff training records were not accessible on the day of the inspection. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 14 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, 29 and 30. The overall impression when visiting this home is that it is homely, comfortable clean and hygienic however many of the service users bedrooms require redecoration. All service users who have hearing impairments should have Audiologist assessments in order to assess if a loop system would be of benefit to them. EVIDENCE: The home is well laid out and meets the needs of the service users. The home is situated in substantial grounds that are well used during the summer months by the service users. The senior member of staff said the home has purchased a new cooker and showed evidence that the hallway, dining room and utility room have recently been redecorated however the internal decoration of the home was far from ideal, the porch area still needs to be refurbished, a new toilet seat is required in the down stairs toilet and many of the service users bedrooms require redecoration. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 15 A requirement was set at the last inspection that the home manager arrange Audiologist assessments for the service users who have hearing impairments in order to assess if a loop system would be of benefit to them. There was evidence that one service user has attended an appointment with the audiologist however the senior member of staff was unsure if the home manager had arranged for other service users with hearing impairments to be assessed. This requirement will be examined at the next inspection. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 34. Staffing records were not available for inspection. However the senior member of staff on shift said that a number of staff is still awaiting their Criminal Records Bureau Checks being returned to the home. EVIDENCE: The home manager was not present on the day of the inspection so staffing records were not available for inspection. The senior member of staff on shift said that a number of staff are still awaiting their Criminal Records Bureau Checks being returned to the home in fact a some staff have had to reapply for these checks on three separate occasions. The home manager must inform the Commission for Social Care Inspection when all staff Criminal Records Bureau Checks have been received at the home and arrange a date for these to be inspected. A list containing the staff members names, Criminal Records Bureau reference numbers and the date of the check should be set up for the home. The inspector will sign the list when the Criminal Records Bureau Checks have been seen. The list would be kept in the home as evidence. Theoretically once seen and signed for these Criminal Records Bureau Checks could then be destroyed and new Criminal Records Bureau disclosures would then be kept with this list until seen and signed for by the inspector.
The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 17 A requirement was set at the last inspection that the home manager write to the Agency manager asking the agency to ensure that all agency staff sent to the home has clear Criminal Records Bureau Checks. The senior member of staff said that this had been done however she could not access this information on the day of the inspection. It was recommended at the last inspection that the home manager assess the staff teams mandatory training needs and ensures that staff attends training in these areas. The senior member of staff said that she and other staff had attended training on moving and handling and other staff had attended other training however staff’s training records were not available on the day for inspection. These will be examined at the next inspection. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 18 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. The deputy manager is currently running the home and has maintained good care practices and activities for the service users. The Surrey and Borders NHS Trust has appointed a new manager to run the home, this will benefit to both the service users and staff working at the home. EVIDENCE: The senior member of staff said that a new home manager has recently been recruited to run the home but was unsure when she will start work. The deputy manager is currently running the home and has maintained good care practices and activities for the service users. Fire records, weekly water temperature checks and weekly first aid box checks were observed on the day of the inspection. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 19 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 3 3 x x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 x 3 x 3 3 Standard No 11 12 13 14 15 16 17 x 3 x 3 3 x x Standard No 31 32 33 34 35 36 Score 3 x x 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Oaks Score x 3 x x Standard No 37 38 39 40 41 42 43 Score 3 x x x x x x G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 20 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. Standard 6. Regulation 14(1)a Requirement Timescale for action 30/11/05 2. 34. 19(1) 3. 34. 19(1) 4. 24. 23 (2) b The home manager must ensure that all of the service users have a care manager needs assessment carried out. The home manager must inform 30/11/05 the Commission for Social Care Inspection when all staff Criminal Records Bureau Checks have been received at the home so that the inspector can arrange a visit to the home to inspect them. The home manager must write 30/11/05 to the Agency manager asking the agency to ensure that all agency staff sent to the home has clear Criminal Records Bureau Checks. The porch area must be 30/11/05 refurbished, a new toilet seat must be installed in the down stairs toilet the service users bedrooms must be redecorated. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 21 No. 1. Refer to Standard 6. Good Practice Recommendations The inspector recommends that the home manager send copies of the minutes to service users relatives who are not able to attend and ask the service users relatives for comments and sign if they agree with the minutes. Care managers should be invited to the reviews as they could sign on behalf of the service user. The inspector further recommends that the home manager contact Croydon Advocacy for support in this matter. The inspector recommends that the home manager arrange Audiologist assessments for the service users who have hearing impairments in order to assess if a loop system would be of benefit to them. The inspector recommends that the home manager assess the staff teams mandatory training needs and ensures that staff attends training in these areas. It is recommended that the service users health care appointments be recorded in the service users file. 2. 29. 3. 4. 35. 20. The Oaks G53-G53 S25852 TheOaks unann V225538 150805 Stage 0.doc Version 1.40 Page 22 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor, Grosvenor House 125 High Street, Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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