CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65
The Oaks Care Home 26-28 Corporation Oaks Woodborough Road Nottingham NG3 4JY Lead Inspector
Linda Hirst Unannounced Inspection 4th June 2008 10:00 The Oaks Care Home DS0000002237.V366038.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 The Oaks Care Home DS0000002237.V366038.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 Older People and 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. The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Oaks Care Home Address 26-28 Corporation Oaks Woodborough Road Nottingham NG3 4JY 0115 962 1075 0115 962 1075 theoaksrch@tiscali.co.uk 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) Dr Prem Tiwari Dr Shobhi Tiwari Mr Lee Stuart Hackett Care Home 22 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (22) of places The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd December 2007 Brief Description of the Service: The Oaks is a large converted Victorian house situated close to Nottingham city centre. The home is on a quiet road with no through traffic, it has a garden to the front of the property and a hard standing area to the side and rear. The home is within walking distance of local shops and places of worship and has good local transport links, especially into the City Of Nottingham. The home provides care for younger adults with mental health issues. The accommodation comprises of two lounges, a conservatory area and a dining room with a designated smoking area within the home. Smoking is not allowed in other areas of the home. The home is not fitted with a lift and has several flights of stairs, making it unsuitable for people with mobility problems. The current weekly fees for the service range from £294 - £356.11. These fees do not include hairdressing, holidays, cigarettes, newspapers, personal toiletries or clothing. The manager gives all of the people who want to live at the service a copy of the service user guide and the statement of purpose and a copy of the last inspection report are displayed on a notice board outside the manager’s office. The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes.
The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We received this back from the manager in good time but we found that quite a lot of information was the same as was provided to us last year. When we talked to the manager about this, it might have been caused by confusion about the way the form is worded, and he is now aware of what things we would expect to see in the Annual Quality Assurance Assessment. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. We sent out 6 surveys to people living at the home, 3 to relatives and 5 to professional people who visit the service to get their views on the service being provided. We received all six back from the people who live at the service, all of them were completed with help from a member of staff but we are not sure why this was the case as most of the people who live at the home could complete their own survey. There were no comments in the surveys from people who live at the service other than “I was shown around and liked it,” a comment made by two people. We received one back from a professional who visits the service, who commented, “the service user is happy living at The Oaks, the staff show genuine liking, respect and enthusiasm regarding working with service users.” They said the service could improve by the environment having “a major overhaul,” and by “ensuring staff get adequate training, at times they appear under pressure due to staffing levels and service demands.” The main method of inspection we use is called ‘case tracking’ which involves us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. English is the first language of all of the people who use the service living at the home at the moment, but there are people living there from a variety of
The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 6 minority ethnic groups. We case tracked someone with needs around their race and culture to make sure these are being properly catered for. The staff team come from a wide variety of backgrounds and experiences. We spoke with staff members and two people who live at the service to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. What the service does well: What has improved since the last inspection?
There is a record of the personal belongings of each person who lives at the service so the staff know what they own and can return it to them if anything were to go missing. The care plans are clearer now and they have information about each person’s mental health need, what staff should look for if they are not well and how their symptoms affect them. This offers clear information to staff about how to support people with their needs. The risk assessments are now clearer and are up to date, and these balance the decisions of people with the risks to themselves and other people. The care plans offer better information and clearer guidance to staff so they can help people with their needs. People from minority ethnic groups now have care plans which reflect the care and support they need, and we found that appropriate hair and skin care products are being provided to keep people healthy and to make them feel good about themselves. We also found that people are being encouraged to
The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 7 visit local centres for minority ethnic groups so they can meet new people, feel part of the community by keeping their cultural identity and make new friends outside of the service. “I have been to the African Caribbean National Artistic Centre and have enjoyed the West Indian and Caribbean food.” The in house activities have been looked at and changed after the people who live at the service were asked what things they like doing and would enjoy doing. Some people are being supported to look into work placements and college courses. We saw evidence that there are disco nights at the service, barbeques and games evenings, but people told us, “there are still not enough people on shift in the evening so that we can go out, they tell me I can go out for a walk when I want, but I don’t want to walk by myself. I feel I stand out, it’s bad enough being a mental health patient but I don’t like attention being brought to it, it’s important for me to blend in.” We found the staff are better at recording when people have taken their medication so the people who live at the service can be assured they will get their medicines as their Doctor prescribed. We also found there is more flexibility about how medication is given out which is a positive change, one person said, “I mostly go to the office to collect my tablets but the staff will take medication round to people in their rooms, and if I am in my room they will bring my tablets up to me.” This shows the routines of the service are more flexible now around the needs and wishes of people who live there. All staff have had some training on safeguarding and whistleblowing and the people we spoke to were clear about the kinds of behaviour that are abusive and what they would do in response to any concerns. We also found that staff have had training on supporting people whose behaviour may be challenging so they can help them in a consistent way. Overall we found that the staff are now more aware of what they should do to make sure the people who live at the service are properly supported and protected from those who may harm or abuse them. There have been many improvements to the physical environment that people live in. Rotten windows have been replaced and some have been repaired, radiators have been fixed, the flooring in the conservatory has been replaced, a more effective smoke extractor has been installed and this is preventing smoke travelling through the building, new curtains and privacy screening has been provided in a double bedroom, a new mattress is available to replace a worn one, some carpets have been replaced, the sealant around sinks has been replaced, Portable Appliance Testing of electrical items has been completed and the broken and boarded windows have been replaced. We found this has resulted in a safer and more pleasant environment for the people who are living at the home, and although there remain some areas which need attention this is a significant improvement. We found that there have been changes to the way in which the service is being delivered to the people living there, there is more flexibility and responsiveness to what the people who live at the service want and need,
The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 8 rather than routines revolving around staff. Some people now have support from independent advocates to help them express their views more clearly and service user meetings have restarted and menus and menu planning has changed. As a result, the food is more varied and looks more appealing now. The people who live at the service were positive about the changes and said, “things have improved since your last visit.” 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 summary of this inspection report can be made available in other formats on request. The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who want to live at the service have their needs assessed properly so they can be assured these can be met there. EVIDENCE: There have been no new admissions to the service since we last visited but we looked again at the care plan for the last person who was admitted to the service. We found that the plan has much more information about their mental health needs, symptoms and how these affect the person. We also found that there are new and better risk assessments in place for this person which will help staff minimise risk to themselves and to other people living at the home.
The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 11 There is more information about the interests and personal preferences of the person which helps staff to support the person and meet their holistic needs. The Annual Quality Assurance Assessment the manager completed indicated that the service has done some training for staff on the admissions process and procedure and staff we spoke with are clear about the criteria for people who want to live at the service and the procedure in place before they are admitted. They also told us that they are happy with the systems in place for telling them about the needs of prospective residents and that they have all of the information they need to support people properly. As no one has been admitted since our last inspection, there were no comments from the people living at the service about initial assessment and admission procedures. The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices
The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives, but need to be encouraged to play a more active role in planning the care and support they receive. EVIDENCE: We looked at three care plans during our visit and found that these have improved significantly; they now cover not only the mental health needs of the people who live at the service but also their cultural and religious needs and
The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 13 their personal preferences. One person was able to tell us that they have the hair and skin care products they need now and the person said they feel their skin and hair is in much better condition as a result. We saw evidence that care plans are being reviewed regularly and the people we spoke with know what is written in them, although it is not certain whether they are actively involved in their development and review. Staff could not say whether care plans are developed with the people living at the home, but they commented, “I read care plans all the time and make sure junior staff also read them. I think they are easy to read and give me good guidance. You can find out all you need to know.” One professional commented in a survey that, “the management and staff have always been willing to work in collaboration with people who use the service to develop plans which meet health and safety requirements whilst also respecting service user’s views where possible.” The plans of care now record the personal preferences of people who live at the service and those we spoke with said, “I decide what I do with my day, I get up at 6.00 and I go to bed when I want, I do what I want.” We found that the routines of the home have relaxed more and that they revolve more around the needs and wishes of the people living there. “People can get up when they want, breakfast is served later now, up to 11 o’clock they can have baths or shave when they like.” People who live at the service told us that they don’t have to go to the office for their tablets any more, and people can make their own drinks in the independence kitchen. Staff told us, “I talk to service users to determine their preferences, I can tell if people are worried about something, I will always make time to chat to them and to help them.” Some of the people we spoke with now have independent advocates who work with them to make sure their views are heard, and we saw evidence that the service user meetings have started again and that people are being consulted about menus, activities and about new furniture for communal areas. One person told us, “I feel that staff respond and listen to suggestions.” These are all positive improvements. We found the risk assessments about people living at the service have improved and they offer guidance to staff about how to minimise risks. Staff we spoke with said, “I have done courses on risk assessments and I think the care plans give us good guidance. I am very much aware of those who may harm themselves or others we have regular reviews with Community Psychiatric Nurses to feedback.” There is no evidence that people are restricted unnecessarily, which shows a balance between risk and decision making. A professional commented in a survey, “staff, to my knowledge have always explained the reasons for their actions to service users and where possible work in collaboration (with them.)” The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 14 Lifestyle
The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 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 Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 15 People who use services are able to make choices about their life style, but are not motivated and supported enough to fully develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. EVIDENCE: We saw evidence that the staff and Community Psychiatric Nurses are trying to find people appropriate college courses and they are promoting links with culturally appropriate centres for people who live at the service. This is a significant improvement. People told us, “I have been to the African Caribbean National Artistic centre and have enjoyed the West Indian and Caribbean food,” and another said they are excited about attending a college course their Community Psychiatric Nurse has found for them, “I’m looking forward to getting some fresh air and meeting new people.” People have been consulted about activities, attending day services and getting work, and the in house activities have been reviewed, “the night staff have been trying to improve activities in the evening, and we have skittles games and dancing and music nights which I love.” Staff told us, “We have a disco every Friday, we are having a barbeque this week, we do things like Bingo, cards, bowling, etc. I am trying to get a Karaoke machine. We are working hard at getting them motivated, at first only four came to the disco but now they all come.” Some people have plans in place about developing independent living skills now, using the small kitchen. One person told us they have their own coffee and they enjoy using the small kitchen. “I have been doing some cooking and washing my own clothes.” Staff told us, “Most people use the training kitchen now but I think we should have a rota day to day to keep it clean. I would like to see its use developed further.” We saw evidence around the home to indicate that people who smoke are expected to hand in their cigarettes before they go to bed. Our conversations with staff, the manager and people who live at the service indicates that staff search people’s bedrooms for cigarettes before they retire, we also saw written evidence of this in staff meeting minutes. This is an infringement of their human rights and their rights to privacy, there is no evidence that people lack capacity or have agreed to or consent to having their belongings searched. This arrangement must be reviewed, as most of the people living at the service would have the capacity to refuse consent as defined by the Mental Capacity Act. We saw evidence that the people living at the service have been asked for their food preferences and for new ideas for the menu and this has been changed to take account of their views. We observed lunch, two choices were
The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 16 prepared and served and the food was nicely presented. We were given conflicting evidence about the quality of food, one person said, “it’s not very good,” another said, “it’s ok, I get plenty to eat.” Staff told us, “The food is not bad, she does a nice dinner, we had a pudding tonight but no one liked it so we won’t do it again. Service users were asked for preferences and the menus were changed. The food looks appetising when it is served up.” The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support
The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) 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 good This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. EVIDENCE: Most of the people whose care plans we looked at only need prompting or reminding to undertake personal care tasks, and no one needs help at the moment because of reduced mobility. The people we spoke with said the staff prompt them to have a bath or to change their clothes or bedding, but people said they are independent.
The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 18 We looked at the arrangements for the administration and recording of medication and found these to be safe. We saw the staff administer medication which is prescribed as required appropriately and safely. The medication trolley was not secured to the wall of the office initially but this was rectified straight away and the storage of medication other than this was safe. The staff we spoke with told us they have had training on the safety of medicines and they said that more is planned. They are able to talk through safe practice in terms of administrating medication and making records and we saw them follow this through in practice. People we spoke with told us, “the staff look after my tablets and bring them to me in my room, they bring a drink and make sure I take them.” The care plans we saw show that if people have health care needs, these are assessed properly, we saw evidence of people having blood tests, being referred to Hospital for tests on their physical health, of well man and woman checks, and of regular reviews by the staff and their Community Psychiatric Nurses on their mental health. People we spoke with told us they are well and healthy and see their Doctor if they need to. Staff told us, “the staff are on top of health needs.” The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection
The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) 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. People who use the service are able to express their concerns, but as these are not always recorded appropriately the effectiveness of the complaints procedure is reduced. People who live at the service are safeguarded from abuse by staff but failure to follow the correct procedures places them at risk of harm. EVIDENCE: We saw the complaints procedure displayed on the notice board outside the manager’s office, this is a clear procedure and easy to understand. We looked at the record of complaints and found there have been two complaints, one about care staff having to do domestic and catering chores, which was partially upheld and is still being resolved through recruitment (see YA33). The second was allegedly from staff members concerning a named person who lives at the service. This has not been upheld as the alleged complainants deny raising a complaint. This issue would have been more appropriately recorded in other ways (E.g. through the care planning and review process.)
The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 20 There was a record on a staff file of issues being raised by a person living at the service about staff sleeping on night duty but there was no corresponding record in the complaints book as there should have been. People who use the service told us they know how to complain and they said they would have confidence that the manager would respond appropriately. The staff told us the manager, “would respond properly I am sure.” The manager told us in his Annual Quality Assurance Assessment that there have been no safeguarding issues since our last visit but the Commissioning team have identified an incident between two people who use the service which resulted in physical assault. This incident was not reported under safeguarding procedures, although the Police and the Community Psychiatric Nurse were notified. There is a copy of the local safeguarding procedures at the service for staff to use if need be and the manager must make sure that the proper procedures are followed in all cases. We saw evidence that all staff have been given in house safeguarding training and they are also booked to attend training being delivered by Nottingham City Council on various dates. The staff we spoke with showed a good understanding of what is abusive behaviour and the actions they should take to protect people from harm. “I would report any abusive behaviour, I have done it before, and the person does not work here anymore. I watch new staff a lot to make sure the job is being done right anyway.” The people we spoke to who live at the service told us they feel safe and get on with the others who live there most of the time, they both said, “the home is very quiet and I like that, there are some arguments but these do not develop into fights.” There is a financial agreement in place for each person who needs support to manage their finances and this states much they would like each day. The records indicate when money is received in and goes out, and a staff member and the person concerned sign each transaction. We checked the balances and these tally with the records, receipts are held for any expenditure made by staff on behalf of people living at the service. At the moment there are no regular independent checks on records other than by signatories and it is suggested that the provider do this as part of the monthly visit to the service. One of the people we spoke with is concerned about their financial situation and it is recommended that advice and guidance be sought from the Citizen’s Advice Bureau. The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, 30 Quality in this outcome are is adequate This judgement has been made using available evidence including a visit to this service. The accommodation has improved but more work is needed before it can be said to provide a comfortable and homely environment for people who live there. EVIDENCE: The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 22 We did a partial tour of the accommodation and found that there have been significant improvements to many parts of the home, including new carpets and windows, replacement of the flooring in the conservatory and the provision of new curtains and screening in double bedrooms. There is a new extractor fan in the smokers’ room and this has considerably reduced smoke travel in the building, resulting in a more pleasant and safer environment for non smokers. We noticed that the carpet in the large lounge looks stained and needs cleaning or replacing and furniture is needed in the conservatory to make it a useable space for the people who live at the service. One person needs their mattress replacing but due to a misunderstanding from the previous report this was not achieved. The manager has given assurances that this will be replaced immediately. There is an outstanding issue about providing appropriate flooring to meet the needs of one named person, we have agreed to relax our timescale to allow for work to be completed on this. The service has had a food safety inspection since our last visit and various requirements and recommendations have been set which must be addressed within the timescales specified by them. The home looks clean and tidy. People who live at the service commented, “the home is shabby but comfortable and there are still items that need replacing, I like living here though. The conservatory looks better and the manager has written and asked us what furniture we would like in there.” Staff told us, “we are getting there with the physical standards of the home. It is better than it was, definitely. We have got the independence kitchen now, which most people use. Repairs could be quicker, but this is improving.” A visiting professional commented, “the environment while appearing homely is very well worn and lived in..it needs a major overhaul.” The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome are is adequate This judgement has been made using available evidence including a visit to this service. Staff who work at the home are trained and are supportive of the people living at the service, but there are not enough staff on duty at appropriate times to make sure their holistic needs are met. EVIDENCE: We found that all staff are undergoing the Skills for Care induction and that three people have completed their National Vocational Qualification level 2, twelve other staff are doing this. Once this training has been completed, the
The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 24 service will have met its target of 50 of care staff trained to National Vocational Qualification level 2. Staff we spoke with confirmed they are doing this training. We looked at the staff rota, this does not reflect what catering and domestic hours are being provided and by whom. It is therefore not an accurate record of hours worked. The rota indicates that the service is usually staffed by three staff in the morning, and two in the afternoon with two waking night staff. The service employs a “recreational therapist,” but he only works twice a week between 10am and 3pm. People living at the service told us that that although the activities are more appropriate now, it would be nice to have more staff on at a weekend and at night so people could go out more. “There are still not enough people on shift in the evening so that we can go out, they tell me I can go out for a walk when I want, but I don’t want to walk by myself. I feel I stand out, it’s bad enough being a mental health patient but I don’t like attention being brought to it, it’s important for me to blend in.” Another commented, “the staff leave me alone to do my own thing, I am happy with this, I listen to music and watch TV, though I do get bored.” Staff we spoke with said, “there are not really enough staff on duty, we need at least three or four staff to do different things with people who use the service and to meet their individual needs.” A visiting professional echoed this view and commented to us, “ I have always found the staff very respectful and helpful. At times they have appeared under pressure due to staffing levels and service demands.” Reviewing the holistic needs of the people living at the service and ensuring that the staffing levels are sufficient to meet these is an outstanding requirement, however, we saw evidence that they have recruited and selected three extra care staff, a full time cleaner and a part time cook so we have agreed to extend the original timescale for a final time to enable the service to complete their recruitment checks. The deployment of staff will also remain an outstanding recommendation and we will review the situation during our next visit to the service. We looked at the staff files and found that all of the information and documentation is in place to make sure that staff who are employed are suitable to work with vulnerable people. The manager has developed a training matrix to assist him in planning for the training needs of his staff. This provides evidence that training has been provided or is booked on Skills for Care induction, Basic Food Hygiene, Basic First Aid, Infection Control, the management of violence, safeguarding adults, Mental Health Awareness, Loss and Bereavement, medication safety, National Vocational Qualification Level 2, risk assessment, and Dementia awareness. The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 25 The staff we spoke with told us, “I have been on a lot of courses, I have asked for training on death and bereavement too.” People who live at the service commented that the staff are ok, “but they don’t have time to do anything with you really.” Another said they are, “really kind, lovely, they support me and it feels comfortable being with them.” People said the staff are supportive and know what they are doing. “When they have time they spend time with you and chat.” The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome are is adequate This judgement has been made using available evidence including a visit to this service. The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 27 The service is improving but further action is needed to ensure that the home is well managed and is operating in the best interests of the people living there. EVIDENCE: The manager returned the Annual Quality Assurance Assessment to us when we asked for it. All sections were completed, but more evidence is needed to indicate the service is improving, as there appeared to be repetition of wording from last years document. There have been many improvements in the service since our last visit, and the owner and manager have addressed many of our concerns. There are still some matters which must be addressed (YA16, YA22, YA23, YA33) to evidence that the home is being managed effectively and in the best interests of the people living there. The manager was praised by staff, people living at the service and in comments from visiting professionals. “He (the manager) looks after me well,” “the service runs ok, the manager is ok,” “the home is run well, the manager does a good job. He is a good manager, you can talk to him about anything,” and, “the manager has always been approachable. He has also contacted me for support and advice as required.” There is evidence to show that people who live at the service are being consulted about the quality of service they are receiving and those we spoke to confirm they have completed questionnaires and attend service user meetings. The information the manager provided in his Annual Quality Assurance Assessment indicates that Health and Safety tests and servicing have been conducted as needed. Staff we spoke to told us, “my health and safety are looked after well.” The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 28 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. Where there is no score against a standard it has not been looked at during this inspection. 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 X 2 3 3 X 4 X 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 X 26 X 27 X 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 3 40 X 41 X 42 3 43 X 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Oaks Care Home Score 3 3 3 X DS0000002237.V366038.R01.S.doc Version 5.2 Page 29 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 YA16 Regulation 16(2)(h) Requirement The use of the independence kitchen must be developed more to encourage people to prepare their own meals and snacks and further develop their independent living skills. People’s rooms must not be searched for cigarettes or for any other purpose without their consent as this breaches their rights. There must be a record of every complaint made by people who live at the service to ensure these are fully investigated and formally responded to. All safeguarding incidents and allegations must be reported to the safeguarding team and to the Commission for Social Care Inspection without delay to ensure people are properly protected. Appropriate furniture must be provided in the conservatory to enable people living at the service to use it as a communal area.
DS0000002237.V366038.R01.S.doc Timescale for action 02/09/08 2. YA16 12(2 & 3) 10/07/08 3. YA22 22 10/07/08 4. YA23 13(6) 10/07/08 5. YA28 16(2)(c) 31/07/08 The Oaks Care Home Version 5.2 Page 30 6. YA30 16(2)(j) 7. YA33 17(2), Sch 4(7) 8. YA33 18(1)(a) The requirements and recommendations made by the Environmental Health Officer must be complied with within the timescales they have set to ensure the health and safety of people at the service. The rota must reflect the hours worked by staff and in what capacity to make sure the staffing hours are sufficient to meet the needs of the service and those living there. The dependency levels and holistic needs of people who use the service must be reviewed to ensure that your staffing levels are appropriate to meet these needs. This requirement is outstanding. Timescale of 28/02/08 not met. We have extended this timescale for a final time; failure to comply may result in further enforcement action. 31/07/08 10/07/08 31/07/08 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. Refer to Standard YA6 YA22 Good Practice Recommendations People who live at the service should be actively involved in the development and review of their care plan. Concerns raised by staff about individuals living at the service would be more appropriately recorded and addressed by the care planning process rather than compromising their right to confidentiality by raising this in the complaints records. Financial advice should be sought for the named individual
DS0000002237.V366038.R01.S.doc Version 5.2 Page 31 3. YA23 The Oaks Care Home 4. YA23 5. 6. YA28 YA30 7. YA33 8. YA37 concerning their finances to see if any changes would result in better outcomes for them. The provider should check the financial records and balances on his monthly visit to the home to ensure the financial interests of people living at the service are being protected. The carpet in the large lounge should be cleaned or replaced to provide a comfortable home for people. Flooring which is appropriate to the needs of the named person must be provided as soon as possible. We must be informed as soon as this has been completed. Outstanding. Consideration should be given to how staff are deployed to ensure they are available to support people who use the service to pursue leisure activities in the evening or at weekends if they choose. Outstanding The Annual Quality Assurance Assessment must provide clear evidence of the improvements to be made to the service and those that have been achieved to provide evidence that the service is continuing to work towards improvement. The Oaks Care Home DS0000002237.V366038.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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
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