Inspection on 27/09/07 for The Oaks

This inspection was carried out on 27th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Oaks 01/09/08

The Oaks 02/02/07

The Oaks 07/02/06

The Oaks 22/08/05

The Oaks 23/11/04

The Oaks 02/06/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Oaks, The 165 Worcester Road Malvern Worcestershire WR14 1ET Lead Inspector Jean Littler Unannounced Inspection 27th September 2007 11:00 Oaks, The DS0000035110.V346589.R02.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 Oaks, The DS0000035110.V346589.R02.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. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oaks, The Address 165 Worcester Road Malvern Worcestershire WR14 1ET 01684 572079 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) doreen@exalon.net www.exalon.net Exalon Care Homes Ltd Mrs Doreen White Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is primarily for people with a learning disability, but may also accommodate people who have associated physical disabilities. 2nd February 2007 Date of last inspection Brief Description of the Service: The Oaks is a care home providing a service to a maximum of ten younger adults of either gender who have a learning disability. This is one of two homes owned by the registered provider, Exalon Care Homes Ltd. The Oaks has been a home for adults with learning disabilities since November 2002. The home is situated between Malvern Link and Great Malvern, opposite the common. It is ideally situated for access to local facilities and on a bus route to Worcester. The detached house extends over three floors with communal rooms and ten single bedrooms. Information about the service is available from the Home on request, from the providers web site or from the head office at Albion House, Market Place, Westbury, Wiltshire, BA13 3DE. The fees range between £1170 and £1390 per week. On top of the fees the residents have to pay for personal items such as clothes and toiletries, and personal services such as haircuts and chiropody. The cost of group outings and meals out are included in the overall fees, individual outings and meals are extra. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over eight hours on September 27th and October 2nd. The inspector was helped by a pharmacy inspector who looked at how residents are being supported with their medicines. An Expert also helped with the inspection. She spoke to residents and spent three hours in the Home. She uses services for people with learning disabilities and was supported by Sandwell People First. Her views have been included in this report. The manager was on duty both days and helped with the inspection. We looked around the house and spoke with two of the staff. Some records were seen such as care plans. The manager sent information about the service to us before the visit. Most of the residents, and several relatives, professionals and visitors gave their views of the service in questionnaires. What the service does well: New residents can visit and move into the Home on a trial basis to see if they want to live there. The residents have their own bedrooms with their own things and some have en-suite toilets. They are supported to stay in touch with their families. The residents enjoy the meals and they are offered a menu choice. The residents said they liked the staff and can tell the manager if they have a problem. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 6 They are supported to have a meeting each month so they can give their views about meals and activities. The residents are involved in choosing new staff. What has improved since the last inspection? What they could do better: The residents should each have a care plan that clearly shows how their special needs are being met. The residents should be better supported to plan their goals and ambitions with their family and friends. All the staff should have the skills to support the residents in line with their care plan. Each resident should be supported to take part in meaningful activities that meet their needs and help them develop. The residents should be given information in a form that helps them make choices and communicate. Repairs to the house should be carried out more quickly. The residents should be supported to choose who their share their communal space with and asked about how the layout of the house could be changed. The residents should be supported by staff who are well trained and stay in their jobs for longer. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents cannot be confident they will be provided with the information they need to make an informed choice about where they live and have their aspirations and needs fully assessed and met. The mix of people sharing living communal accommodation has led to poor outcomes for some residents. EVIDENCE: The Statement of Purpose has been reviewed since the last inspection. This states the service is for people with a learning disability with associated mental health needs. Some of the residents also have additional physical disabilities, Autism, and behaviours that can challenge the service. The document does not clearly explain how these four specialist areas of need will be met. There is a marketing brochure and a Service User’s Guide that is available in Widget format. The last resident to be admitted, in December 2006, had not been given a copy of the Guide. Only one resident understands the Widget symbols. The manager plans to develop the Guide into other formats such as an audio tape and DVD but this work has not been started yet. The records and assessment process for the newest resident were assessed at the last inspection in February 07. The person had come to visit the home on four occasions prior to moving in to try out the service and his agreement was Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 10 sought before he moved in. Information was obtained from external professionals. These assessments showed that the resident had some specific needs that had not been addressed in the manager’s assessment. This person’s care plan still did not clearly show how these needs were being met both within the Home or by external health professionals should crisis intervention be needed. The staff have not been provided with any specific training that relates to these additional needs. There was a lack of clear evidence of how the four hours a day one-to-one staff funding was being used for this resident’s benefit on days when he had not been to carry out his paid work on the Home’s allotment. The placement had been made permanent after a three month trial, however there was no evidence that a six monthly review had taken place in August 07 in line with the arrangements outlined in the Statement of Purpose. One of the funding authorities gave feedback that there was poor matching of the client group on assessment for admission to the Home. The care records seen showed that one resident’s behaviours affected another and staff had observed him being agitated and staying in his room more as a direct result. Some of the residents told the Expert that they did not like one of the people they live with and so they often stay in their rooms. Four of the residents’ relatives felt the mix of needs within the Home had negative consequences for their children. The Expert reported: I was also told that a few people do not get on with someone they live with as this person gets quite loud when upset. I feel quite strongly people should not be living with people they do not get on with and have not chosen to live with. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents cannot be confident that their assessed and changing needs will be reflected in their care plans and kept under review. The residents are not always being viewed as individuals and some are having unnecessary restrictions put on them. They are being consulted about some decisions that affect their lives but the level of their involvement in planning their support and futures could be greatly increased. EVIDENCE: All the residents have a care plan and a sample of two were viewed. The design of the plans makes the information clear for staff and the headings cover many areas. The plans have not been presented in a format that would enable the residents to understand what is written about them and there is no evidence that they or their representatives have been consulted about the content. One contained the resident’s personal aspirations but these had not been reflected into specific goals or a ‘pathway to independence’. The manager reported that this was because the man had not been in the home for a year yet and it was too early. Person centred planning meetings have not been introduced. Neither resident has had a review held in the last six months and Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 12 one resident’s had been seventeen months previous. The manager reported that one had been booked for May 07, however his social worker carried out an assessment in view of finding him another placement instead. She reported that all other residents had had an annual review. No risk assessment was found for one resident who has started going out alone. Some risk assessments still refer to ‘adequate staffing’ being a safeguard. Residents do not appear to be being assessed as individuals e.g. none are allowed to access the kitchen without staff supervision. One resident used to live alone and there was no evidence he would be at risk. Keyworkers have been writing monthly summaries since the last inspection. Those seen were brief and did not report in a meaningful way on whether the care plan had been implemented or if there had been any personal development. Comments included, ‘spending more time in his room, any ideas?’ and ‘I think we should be doing more with this person in the evenings rather than him standing on the stairs, such as art or give him a job around the house’. The manager seemed surprised by the content, even though she reported in the AQAA that they are read out at each staff meeting. The Expert reported the following: I asked one person what plans they might like in the future. I was told this person was really happy living here and does not want to move. I couldn’t help thinking this young woman would benefit more living in a smaller home where she could develop her skills. As living in a big home like this can be limiting for people and I would encourage people to have real choices for the future. I also asked if people had any Person Centred Plans but people had not heard of it. If this type of plan is needed in a person’s life they should be entitled to one. Overall people did seem happy in the home but living in a big home people do not get the same opportunities to develop independence skills, have choices and they don’t realise they have the opportunity to move on. One of the placing authorities reported that the care plans for their clients did not demonstrate how their existing bench mark skills had been assessed or how these were to be promoted. The risk assessments were poorly refined and promoted a culture of risk aversion. The minutes from the residents’ meetings showed that the residents are being supported to make decisions by suggesting menu, activity and holiday ideas. The minutes did not show if ideas given at the last meeting had been actioned. The residents were consulted about the new kitchen and have been given the opportunity to take part in recent staff interviews. The last report suggested the level of understanding and involvement of less able residents could be greatly increased if information was provided in alternative ways. An easy read/pictorial agenda is being considered but this has not implemented yet. For the first time a resident was supported to chair the meeting the week of the inspection. A consultant currently involved in the Home has suggested an external facilitator supports these meetings instead of staff. One resident Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 13 attends a self-advocacy group. The manager reported that others have been encouraged to attend and some have accessed advocates in the past. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents do attend some activities they enjoy but their opportunities to develop a truly personal lifestyle are limited. Some of their rights and responsibilities are not being recognised. They are being supported to stay in touch with their families but socialising and the development of friendships are not well promoted. They do have choice over the meals provides and a balanced diet is being provided. EVIDENCE: As detailed above the care plans did not provide clear evidence of how people are being supported to develop and reach personal goals. One resident’s review meeting in February 07 highlighted that he needed to get to know the area and increase his road crossing skills to promote his independence. It is positive that he is now going to the local shop alone, which is a trip that does not involve crossing roads. The care plan did not show how he was being enabled to develop these skills despite him being funded for four hours one-toone support each day. A senior worker could only think of one example of a resident developing since the last inspection. She reported that a resident with Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 15 Autism was now speaking more but put this down to her attending college rather than input from the Home. The Expert reported: On arrival we were welcomed by the manager and asked to sign in and wear visitor badges. This made me feel uncomfortable as I don’t make my visitors to my home wear badges and I don’t see why others should. It doesn’t make the home feel very homely. This feeling was mirrored when I saw staff wearing t-shirts with the name of the service provider on them. I felt the staff wearing uniforms was very old fashioned. One lady said she would show us around her home, this was really positive and it came across this woman was very comfortable in her home. A few people said they had busy weeks with college, and working at an allotment but people did not do anything in the evenings. This is due to staff finishing work at 8pm, I know this is currently being looked at and I hope these changes are very soon. I feel shocked people are being denied a social life in the evenings due to staff shifts. At weekends people said they sometimes go out in the people carrier, have a lie in and listen to music. I felt that people seemed to have a lack of things to do on the weekends, people should be encouraged to do individual activities and develop friendships. One gentleman said he had a friend who he would like to see more regularly but depends on staff to arrange it. I met another person who said he goes to a day centre on a Monday where he plays with play dough. I felt this activity is extremely inappropriate for this gentleman. Another lady said she enjoyed cooking and shopping. This lady did not say very much to me but during my visit and I was concern of the lack of interaction this lady had from staff. Another person I met enjoys his time at the allotment where he gets paid for the work he does and really enjoys it. This man said he use to have a job where he used to live and really misses it. Staff said they are looking to develop this man’s skills and look for alternative jobs closer to home. I hope this plan is put into place. In the AQAA the manager reported that all residents undertake a Recreational Therapy Treatment plan. The care plans seen both had an outlined activity plan although this made no reference to how each activity was benefiting or ‘treating’ the person. The residents have not been provided with information, in a suitable format, to help them understand their week ahead. Some residents attend community day centres and college sessions. Other activities in the plans included lunch out, hydrotherapy, the sensory room, drawing, belly dancing, walking rescue dogs and doing recycling. One resident’s weekly plan included personal shopping, bowling, the pub, two sensory room sessions, grocery shopping, a trip to a café, hydrotherapy, music at the Social Education Centre, free leisure time on the Saturday and football club or TV sport on a Sunday. His records however, showed in September he had been offered eight walks, three drives, one lunch out, one sensory session and three days at the company day centre. The records did not give explanations about why the plan was not followed. The manager reported that using a local hall once a week as a company day centre had been a success. The records did not give clear information about what was being provided and how residents are benefiting. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 16 One worker said snakes and ladders are played, music and puzzles. The shortfalls above have been identified during previous inspections and in a management audit conducted in May 07 but improvements have not been made. There are two vehicles to enable residents to access outings. An activities budget of £60 a week is provided. The manager said that the residents decide how this is spent and gave having a takeaway as an example. The current rota means staff go off duty at eight pm. One resident attends a monthly evening meeting but it is someone from the club who brings him home. The manager said others have been offered evening activities but have not wanted to go. One family said transport and staffing limit opportunities and the vehicle seems to have to be full before a trip takes place. Another reported to be very upset that a worker was not provided to enable their son to continue a one day a week college course he was benefiting from. She and a senior both said the range of activities offered needs to be expanded and they are considering adding another day to the company day centre and setting up an art room in the Home. It is positive that residents make suggestions about activities but person centred planning should form the basis of each person’s lifestyle and activities. Agreed plans then need to be consistently followed. There does seem to be a flexible approach about the daily routines e.g. no set bed times, and residents seemed relaxed in their home. Two residents regularly attend religious buildings or services. The residents’ sexual preferences are respected and some of the staff and one resident have attended an equality and diversity course. It is positive that an annual holiday is provided within the fees. Small groups had gone away in the summer and were reported to be a great success. One worker described positive changes in some residents’ behaviours once they were in a different environment. The majority of residents have regular visits with their relatives and use the phone to stay in touch. Most relatives confirmed that contact was promoted and they were told of important issues. One relative said her son had been enabled to call her while living at other care homes but this did not happen at The Oaks. Another said staff do call but this is usually for advice when the manager is away. The manager reported that all residents are encouraged to use the telephone. One funding authority reported that there was little evidence of additional value and the Home relies heavily on traditional day settings. Staff motivation to prepare these relatively young adults for any sort of life outside of the home is non-existent. Overall we have found that when our clients are at home, staff are drawn into caring for the most vulnerable clients. Education or therapeutic intervention by staff appears random and superficial. The residents reported that they liked the food a lot. Some of the residents help shop and prepare food if they want to. The menu is discussed at residents’ meetings and now two choices are being offered. One resident has benefited from food photographs to help choice making. A worker assisted one resident at lunchtime and encouraged him to feed himself and bring items back to the kitchen. An example was given of another resident choosing lunch by looking in the kitchen cupboards. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are not always having their personal care needs met in a way they require or prefer. The residents’ physical health needs are taken seriously but their emotional and psychological needs are not being fully addressed. Medication is generally well managed but some areas for further improvement have been highlighted. EVIDENCE: The care plans contain details of how staff should best support each resident with their personal care. The two residents’ risk assessments both said they should not be left alone in the bath as there are at risk of drowning. There was no information to indicate why this was and one man used to live alone. The care plan guidance did not mention if they should be offered some private time to relax and soak even if a worker needs to remain outside the door for safety. The guidance did say what the residents need assistance with, however it was not clear if there were particular goals that were being worked towards and how progress was being monitored. There was no evidence that the residents or their representatives have been consulted in the development of the guidance. The manager has reported that those able to express their preferences had been asked about same gender care and that the three female residents are only supported by female staff which is very positive. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 18 Records confirmed that daily care was being given and baths taken regularly. The residents looked quite well presented and those who returned questionnaires said they were happy with how they are supported in this area. The residents go out with staff to purchase their own clothes and staff gave examples of how people are enabled to choose what to wear. Two of the families reported persistent shortfalls in personal care standards despite these being drawn to the manager’s attention. One resident has a particular interest in her appearance however discussions revealed that she does not have a fulllength mirror of her own and there are none in the Home. All residents have a Health Action Plan in place. Arrangements are in place for regular medication reviews, dental and chiropody checks etc. It is positive that the manager has arranged annual well-man/woman checks since the last inspection. One health record showed a resident’s first annual health check had highlighted an earwax problem. Although treated this had not been noted in the plan to ensure staff are aware for the future. Positive feedback questionnaires were received from two GPs. One confirmed that residents attend the surgery in the normal way rather than home visits being requested. The manager reported in the AQAA that new residents have been given the option to retain their own GP, which is positive. At least three residents have Autism Spectrum Disorder. The care plan for one of these people made no reference to this other than stating the diagnosis. It did not demonstrate that there was an understanding of the triad of impairment and that the support was planned accordingly e.g. the difficulties in anticipating family visits were not identified as transition anxiety and the action was only to not tell him when they were coming. There was little in terms of planning to compensate for difficulties with understanding socialisation and comments included, ‘he does not like it and gets vocal if he is not the centre of attention’. Assessment information from speech and language therapists on both care plans seen were not being fully implemented. Both men had been assessed as needing verbal communication reinforced with signing, gestures and pictures, as their understanding abilities are limited. Only some staff sign and information is not routinely provided in easy read and pictorial formats. One resident continues to present behaviour that challenges the service and impacts on the lives of the other residents. Following input from the Worcester Behavioural Team charts for monitoring have been set up. As the service is meant to be a specialist one it is concerning that clear information was not already available for the health professionals to analyse. Staff only received training from within the organisation to enable a physical intervention strategy to be implemented in July even though senior staff in the company were trained to teach these techniques in February 07. The incident forms do not ask staff to report full information e.g. what happened prior to and after the incident, to aid analysis. One report described a member of staff going behind a resident to prevent another resident reaching her when he was being aggressive. The other resident told his peer to leave the worker alone. In one Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 19 report a night worker described going into the office to leave a distressed resident to bang on the office door in an incident that lasted half and hour. There was no evidence that senior staff were reviewing these reports. The pharmacist inspector looked at medication procedures, storage and records. The Shift Leader said that the home has a good relationship with a local pharmacy who provide advice to the home. Updated medication procedures could not be found at the time of the inspection, however there was an out of date medication administration procedure available dated 7/6/04. Medication storage and administration procedures dated June 2007 were sent to CSCI following the key inspection. There were little or no procedures to follow for the receipt or return of medication. Medication was seen to be stored neatly within a locked medicine trolley. External preparations such as liquid bath emollients were seen stored next to internal medication, which is not good practice. The Shift Leader removed all of the external preparations and locked them in a separate cupboard. All the medication seen was within the correct expiry date, which the home monitors and records. All medication records were seen. The majority of the medicine records were pre-printed by the pharmacy. Sometimes staff had to handwrite new medication records, however there was no double check system to ensure that the records were accurate. The administration of medication was recorded with a staff signature onto a printed medicine chart although there were a few omissions seen with no signature or appropriate code to explain why the medication had not been given. On two separate occasions the use of white correction fluid had been used to delete an error on the medicine records. This was highlighted to the Shift Leader as poor practice and it was agreed that all staff would be informed that this should not continue. The allergy status of the residents was not documented onto the medicine charts, which was of particular importance for penicillin allergy sufferers. The receipt of medication from the pharmacy was available and recorded. Medication no longer needed was recorded and returned to the pharmacy. The majority of the medication was available in blister packs. A medication check showed that the records were correct and matched the amount of medication available. Some medication was stored in separate containers, however this could not be checked as there was no date of opening recorded. None of the people who lived in the home looked after their own medication. Consent for staff to administer medication was available. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents and their relatives cannot be fully confident that their views will be listened to and acted upon. The residents are not being fully protected from abuse. EVIDENCE: The home has a complaints procedure and a version is available in Widget form. An easy read version with pictures has not been developed. The residents meeting minutes showed the policy had been read out recently. Two of the three complaints recorded since the last inspection had been made by residents and the notes showed action had been taken to address their concerns. One was about clothes not being ironed. The other was about a workers attitude and the resident concerned now chooses which worker accompanies him to his one-to-one work sessions. All residents who returned questionnaires indicated that they would inform staff or the manager if they had a problem. Records showed that one resident who cannot speak becomes vocal and agitated when another resident displays certain behaviours. They also showed that two residents had complained that this resident disturbs them at night and tries to get into their bedrooms. No action was recorded and these issues did not appear to have been dealt with as complaints. Some of the residents’ relatives reported that action is usually taken when issues are raised. Two families said the Home had consistently failed to respond to concerns about poor personal care. One of these families wrote to the manager about recent shortfalls and sent a copy to us. The manager investigated the complaint and replied promptly giving details of some action taken as a result. The family are not satisfied and are taking the complaint Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 21 further. We have not received any other complaints since the last inspection. Another family reported that if they write a letter when verbal concerns are not acted on this seems to cause upset. So they are now unsure of the best way to raise issues. The Expert reported that the people she spoke with knew how to tell someone if they had a complaint or were upset. She was pleased they feel confident in talking about any issues, although she felt they should be aware of the CSCI inspector’s details, in easy to read format, in case they did want to discuss any concerns outside of this service. The Home has a procedure for dealing with allegations of abuse. The Whistle Blowing procedure, that guides staff about what to do if they have concerns about poor practice or abuse has been revised since the last inspection to inform staff about how they will be protected if they make a disclosure. No adult protection issues have been reported since the last inspection. Existing staff received training in protecting vulnerable adults in 2005. Refresher training had been arranged but cancelled due to recent extreme weather. It has not been rearranged yet. It is positive that the long shift system is being reviewed as these could potentially put residents at risk because of staff tiredness. The changes have not yet been implemented. The majority of staff have now attended additional training in relation to behaviour that is challenging and physical intervention techniques but an agreed strategy is still being developed. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents live in a home that is safe and reasonably comfortable. The communal space could be more homely and better used. The residents are enabled to personalise their bedrooms but rooms are not always allocated that suit the individuals needs. The house is being kept clean but infection control and building improvements can be better managed. EVIDENCE: The Home was purchased by the company in 2002, having previously been a Care Home for older people. It is situated in a residential area of Malvern opposite the common on a bus route. The location means the residents are within walking distance of local shops. The building is a detached, extended Edwardian house on three floors. Suitable fire prevention and detection systems are in place. There is an enclosed garden to the front and rear with seating. The communal rooms include a kitchen, main lounge and dining room that are on the ground floor with one bedroom. Three bedrooms are located in a ground floor annexe off a long corridor, along with a small lounge/diner that has a door to the garden. There is also a small lounge situated on the second floor used primarily by one resident whose bedroom is on that floor. There are Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 23 ten single bedrooms, of which seven have en suite toilet facilities. Suitable bedroom door locks are fitted and a few residents hold their own keys. The sample seen were of a reasonable size and had been personalised. One resident’s mattress was checked and found to need replacing. No system for checking these or routinely replacing them is in place. The newest resident now has a longer bed and his en-suite toilet light has been changed to help him be able to stand up straight while using this facility. The residents have access to four bathrooms and two separate toilets that are plain and functional. The hot taps are fitted with temperature controls to reduce the risk of scalding. One bath is adapted with a chair hoist that is used by two of the residents. There is no call bell system but there is usually two waking night staff on duty that check on the more vulnerable residents. One resident has now been provided with a specialist piece of equipment to alert staff when he has a seizure at night. One resident’s family reported that when their son moved into a 2nd floor bedroom they were told he would be moved to a ground floor room when possible as he is not secure and confident on the stairs. He has not been moved and they feel this has been overlooked. The manager reported that this was because no vacancies had occurred. One resident who displays behaviours that are challenging has one of the smaller narrow bedrooms. This cannot easily be used by her as a private space to spend time with or without staff. The manager reported that it was the only room available and was approved by her representatives before her admission. The Home is for ten people who have very mixed needs and abilities. There is evidence elsewhere in the report that some of the residents are sharing their home with people they do not want to live with. The recommendation to review how the accommodation is used has only resulted in a plan to turn the staff room into an art room. This will have benefits for some residents, however it does not enable the residents to choose who they wish to share their communal space with, which would be possible if two or three separate units were created. The kitchen has been refitted since the last inspection and is much improved. This is kept locked to ensure residents only access it with staff supervision. New dining tables, chairs and art have made the dining room brighter and more modern. A new heating system has been fitted, although the Home was cold on the first day of the inspection. Some of the communal décor and furnishings remaining are dark and old fashioned. The lounge carpet had been professionally cleaned the day before the first visit but it had an unpleasant odour. This had lessened on the second visit but was still noticeable. The garage at the end of the garden has been fitted out to be a sensory room and a wall fan heater has recently been fitted to hopefully enable this to be used during the winter. This facility has not been available for the residents to use on two occasions recently as it was being used for storage. It had been emptied after three weeks just prior to the inspection. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 24 The Expert reported that she felt some rooms needed to be re-decorated but others seemed well decorated. The main lounge was cold and smelt like urine. It was quite un-homely with individual chairs and no sofas, it reminded me of a waiting room. I was pleased the home has different communal areas for people to be in, I really liked the idea of the arts and crafts room and hope this is put into practice soon. I also noticed the drawing on the wall of the stairs of people that live here and that was really nice to see, very personal. I was uncomfortable to see a staff toilet in a person’s home and I don’t understand why this is needed. Repairs and redecoration work continue to be outstanding. The maintenance worker is now working full time so this situation should improve if resources are made available. One resident was using another room as a temporary bedroom while he waited for a roof leak to be repaired. The most recent monthly report for the providers stated that there is some confusion in the company about who is responsible for commissioning contractors. The home has a separate laundry that is suitably fitted out. Since the last inspection this has been made larger by the removal of the adjoining toilet that was rarely used. Protective clothing is available for staff and systems are in place to manage infection control. The washing machine has a sluicing facility and the manager reported that the practice of staff sluicing soiled items by hand has now stopped. Staff are provided with infection control and food hygiene training although not all have attended this. A cleaners post was created during 2006, however the post has been vacant for several months. The residents and families who returned questionnaires all said the home was kept clean. A recent inspection from the Environmental Health department resulted in two requirements and three recommendations, which had been actioned. One was to implement the food hygiene management system Safer Food Better Business. The manager should also consider using the Department of Health’s guide to infection control management ‘Essential Steps’. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents like the staff but they are not benefiting from support from a fully effective and well-trained staff team. The residents are being protected by the staff recruitment procedures. EVIDENCE: There are five staff on duty during the day. This was increased from four following the admission of the tenth resident. The manager also works during the day Monday to Friday so is available if additional support is needed. Two waking night staff are considered appropriate because of the size and layout of the Home. These staffing levels are maintained but agency staff are used frequently e.g. on thirty-four days over three months. The day staff are split into two teams, led by a team leader who all work twelve hour days. The rota is fixed so the teams do not work often with each other. The staff have been made aware that this shift system is due to change. The evening shifts will end later enabling evening activities to be regularly planned for. This is a positive step and the manager should ensure a new culture of flexible staffing is developed where work patterns respond to the residents’ needs and requests. As mentioned some residents have specific arrangements for one-to-one hours but how these are used is not shown on the rota or recorded clearly in the Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 26 residents’ records. The home has a maintenance person and a vacant cleaners post. Care staff clean, cook, shop, keep records and give medication, as well as provide personal care to nine of the residents. One resident needs the support of two staff with care tasks. There are currently fifteen permanent staff in post and one vacancy. The high staff turnover levels continue. The manager reported that in the last year seven full time staff and four part time staff have left. The manager did report after the inspection that four of these workers returned to work in the Home regularly or on the bank to cover gaps. Several relatives reported being worried about the frequent staff changes, having to liaise with people they do not know and having concerns about the consistency of care. The residents who returned questionnaires all said they liked the staff and they listened to them. One family felt the senior staff know their son’s needs but they do not do much to develop him and often seem under pressure. Another said the senior staff try hard to look after the welfare of ten residents but seem quite hassled. Other families had no concerns in this area. In light of the overall findings of this inspection staffing arrangements should be fully reviewed. The manager reported that all new staff complete the common induction standards and then going on to the Learning Disability Award Framework foundation units (LDAF). Just under 50 of the permanent staff hold a relevant qualification such as an NVQ in Care. This has risen from 33 since the last inspection, which is positive, and three others are working towards one. Some gaps in basic training have been mentioned previously e.g. food hygiene, adult protection. It is positive that more local specialist training is being accessed such as Autism, Challenging Behaviour and Total Communication courses, however as mentioned this knowledge does not seem to be being used consistently to the benefit of the residents. No training has been provided on the Mental Capacity Act. The manager had not arranged this as the company has a training manager, but she was not aware what this person was planning. This Act is now law so training is essential. Staff have not been provided with mental health related training although some residents have these needs. The manager has a training matrix to show where gaps exist but no clear training plan is in place for 07/08. One worker’s recruitment record was sampled. This showed that appropriate checks had been obtained prior to the worker taking up post. The manager reported that recruitment procedures are now more robust. Three references are now obtained and the most recent employer is also telephoned. The reasons an applicant left previous work with vulnerable adults or children is established and any employment gaps are explored. It is positive that some of the residents have been involved in the recruitment process. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents’ are not benefiting from a well run home that meets their individual needs. EVIDENCE: The manager is appropriately qualified for her position and she has managed the Home since it was opened in 2003. She is also an NVQ assessor. The manager seems very committed to the Home but does not have a clear vision and aims that will substantially improve the outcomes for residents. She has not visited other services to benchmark the service at The Oaks and is not fully informed about all areas that fall under her responsibility e.g. the mental capacity act, person centred planning, specialist techniques to support people with Autism. Quality assurance systems are in place such as the residents’ meetings and periodic questionnaires and these systems have influenced some changes. It is positive that management support has been commissioned from external consultants, however this involvement started in May 07 and an Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 28 action plan has not yet been developed. The organisations policies have all been reviewed in 2007. Information relating to the health, safety and wellbeing of residents has been reported on throughout this report. Systems are in place but some shortfalls have been identified. Monthly monitoring checks by the providers highlighted that although routine health and safety systems are in place the checks are not always carried out e.g. weekly fire alarm tests. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 1 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 x LIFESTYLES Standard No Score 11 2 12 2 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 2 2 x x 2 x Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES 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 YA6 YA19 Regulation 12, 15. Timescale for action The care plans must contain 02/10/07 clear information about how each resident’s assessed specialist needs will be met. Previous requirement not met the timeframe was 31/03/07. Requirement 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 YA1 Good Practice Recommendations The Statement of Purpose should be expanded to demonstrate how residents special needs will be met. The Service User Guide should be updated and provided to residents in formats they understand. Person centred planning should be introduced and review meetings held at least six monthly to support residents to develop and achieve their personal goals. Care plans should be developed into a format that enables the residents to understand and contribute to what is written about them. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 31 2 YA6 3 YA11 YA16 The residents should be better supported to make lifestyle choices and develop their independent living skills. The residents restrictions. should not subject to unnecessary The residents should be better supported to communicate with aids to assist their understanding and meet their needs. 4 YA12 Each resident should be provided with meaningful activities that are designed to meet their assessed needs and have been agreed through person centred planning. All staff should be provided with training on Adult Protection and the specialist needs of the residents. All residents should be consistently provided with the support they need to maintain high personal care standards. The shift-monitoring systems should pick up if the medication charts have not been signed for the doses given. The stock control systems should include a bring-forward system for supplies that are not used up during the month. Two staff should sign hand written entries on the charts to check the doctor’s instructions have been correctly entered. Brought forward. All residents’ allergy status should be documented on their medicine record charts in order to ensure their safety. The medicine policy should always be available. This should be specific to the needs of the service and includes receipt and disposal of medication to ensure that the health and welfare of residents taking medication are safeguarded. 8 YA22 Reword the residents’ complaints procedure into Plain English. Consider if a more simple version with pictures would assist some of the residents to better understand DS0000035110.V346589.R02.S.doc Version 5.2 Page 32 5 6 YA35 YA23 YA18 YA33 7 YA20 Oaks, The 9 YA24 YA11 their rights. The environmental should be more homely improvements and repairs carried out more quickly. and How the home is used should be reviewed and consideration given to providing smaller living groups to enable residents to choose who their share their space with and to provide a more specialised service. 10 11 YA33 YA39 YA40 Provide a staff team that are more stable and are trained to a higher level to meet the residents’ assessed needs. Have a clear development plan to improve outcomes for the residents. Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oaks, The DS0000035110.V346589.R02.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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