Care Home: Glenholme Oakdene Psychiatric Residential Care Home

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What the care home does well The training records examined, indicated that all staff (with the exception of those newly recruited) had been provided with the required mandatory training. The personnel records were well maintained and the necessary checks had been carried out prior to staff commencing work at the home. The registered provider and manager had co-operated fully with safeguarding investigations carried out by Social Services into allegations and complaints made. Lessons learnt from the findings of safeguarding investigations had been promptly incorporated into the management of the home and care of residents. What has improved since the last inspection? Improvements had been made in the area of health and safety. The risk assessment of the resident who sometimes smoked in her bedroom had been updated to include strategies for minimising any fire safety risk. This is to ensure the safety of residents. Window restrictors had been fitted to all bedrooms inspected. The temperature of the room where medication was stored had been monitored daily and maintained at no higher than 25 C. This is to ensure that medication is stored correctly. Improvements had been made in the care arrangements for residents. The manager had arranged for one to one support sessions for residents. This is to ensure that the care needs of residents are responded to. The resident`s bedroom, identified in the section on "personal and healthcare" in the last report had been kept clean and free of hazards and the care plan of this resident had been reviewed with professionals involved to ensure that it is appropriate. Following the last inspection in November 2007, the registered provider and social services had investigated complaints made by certain residents to ensure that residents are treated with respect and dignity. In interviews, these allegations were retracted by some residents. Curtains in bedrooms were hung properly and new armchairs had been ordered. CARE HOME ADULTS 18-65 Glenholme Oakdene Psychiatric Residential Care Home 30-32 Woodside Park Road North Finchley London N12 8RP Lead Inspector Daniel Lim Key Unannounced Inspection 28th April 2008 09:00 Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.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 Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glenholme Oakdene Psychiatric Residential Care Home 30-32 Woodside Park Road North Finchley London N12 8RP 020 8446 3401 020 8492 0530 glenholme.oakdene@zen.co.uk Address 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) Mr George Pirrie Macalister Mrs Elaine Alice Macalister Mr Andrew Kenneth Knight Care Home 18 Category(ies) of Learning disability (18), Mental disorder, registration, with number excluding learning disability or dementia (18) of places Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th November 2007 Brief Description of the Service: Glenholme/Oakdene is private care home that is part of the Woodbury Group. The company also runs other care homes and supported living homes. The home is registered to provide personal care for a maximum of eighteen younger adults of either gender, who have mental health problems. The home’s stated aim is to enable service users to gain sufficient life skills and confidence so that they are able to eventually move into semi-independent or independent living accommodation. To achieve the above, the home aims to support and empower residents to make their own decisions and take responsibility for their own actions within a homely environment. Part of the life skills development is centred on residents using local amenities, with support if required, in order to develop contact and equip residents to live within the wider community. The premises consist of two houses which have been converted and joined together, with interconnecting doors and halls. Each of the two houses have a lounge, dining room, communal bathrooms and kitchen. All residents have their own individual bedroom. Two residents are accommodated in bedsits. The home is located within a short walk of Woodside Park underground station, bus routes, North Finchley High Road and Tally Ho Corner. It is close to local facilities such as shops, restaurants and supermarkets. The weekly fees for residents living in the home range from £925 - £1,050. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.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 2 star. This means the people who use this service experience good quality outcomes. This inspection was carried out on 28 April 2008 and took a total of six and a half hours to complete. The inspectors, Daniel Lim and Tom McKervey were assisted by the registered manager, Mr Andrew Knight and one of the two registered providers, Mr George Macalister. The inspectors were able to interview a total of seven residents. The feedback received from them was mixed and indicated that some were satisfied with the care provided while others were not fully satisfied. Feedback was also received from questionnaires received from two staff and three healthcare and social services staff. These indicated that the respondents were generally satisfied with the care provided for residents in the home. Specific issues raised in these questionnaires and in interviews are reported on in the main body of this report. Statutory records were examined. These included four residents’ case records, the maintenance records, accident and incident records, financial records, complaints’ records and fire records of the home. These were on the whole well maintained. The premises including residents’ bedrooms, communal bathrooms, laundry, kitchen, gardens and communal areas were inspected. The home was comfortable and adequately equipped. Five staff on duty were interviewed on a range of topics associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. Staff records, including evidence of CRB disclosures, references, supervision and training records were examined. It was noted that essential training had been provided. In addition, the minutes of residents’ and staff meetings were examined. These indicated that residents and staff had been consulted and informed of changes affecting the running of the home. A recent Regulation 26 report was available for inspection. However, we were unable to use information from the Annual Quality Assurance Assessment forms (AQAA) which were sent to the home prior to the inspection as it was not returned by the due date. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 6 The manager and registered provider who were present stated that the home has achieved an “Investors in People award” following an assessment carried out on 11th April 2008. What the service does well: What has improved since the last inspection? Improvements had been made in the area of health and safety. The risk assessment of the resident who sometimes smoked in her bedroom had been updated to include strategies for minimising any fire safety risk. This is to ensure the safety of residents. Window restrictors had been fitted to all bedrooms inspected. The temperature of the room where medication was stored had been monitored daily and maintained at no higher than 25 C. This is to ensure that medication is stored correctly. Improvements had been made in the care arrangements for residents. The manager had arranged for one to one support sessions for residents. This is to ensure that the care needs of residents are responded to. The resident’s bedroom, identified in the section on “personal and healthcare” in the last report had been kept clean and free of hazards and the care plan of this resident had been reviewed with professionals involved to ensure that it is appropriate. Following the last inspection in November 2007, the registered provider and social services had investigated complaints made by certain residents to ensure that residents are treated with respect and dignity. In interviews, these allegations were retracted by some residents. Curtains in bedrooms were hung properly and new armchairs had been ordered. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 7 What they could do better: Improvements are required in the care of residents. The care plans of residents must be made comprehensive and address the cultural and spiritual needs of residents. This is to ensure that the holistic needs of residents are attended to. Complaints and concerns expressed by certain residents that some staff are insensitive and not responsive to their needs must be investigated and CSCI informed of the findings. Staff should be provided with training updates on customer relations and on “Equalities and Diversity”. This is to ensure that residents are treated with sensitivity and respect and staff are aware of their roles and responsibilities. The provision of food must be closely monitored and the registered persons must consult with residents and ensure that residents are provided with sufficient food. To ensure that residents live in a well maintained and pleasant environment there were areas of improvement needed in the premises. These were the replacement of light fittings, repairs to a wall and replacement or repair of an extractor fan. One resident’s bedroom had exposed pipework which needs to be boxed in to ensure he has a more pleasant room. Improvements must be made in Health and Safety and fire safety. Although risk assessments were carried out regarding residents who smoke in their bedrooms, advice must be sought from the fire authority (LFEPA) regarding this and whether residents are allowed to smoke in the conservatory. The registered persons must ensure that residents do not smoke in their bedrooms. Window restrictors must be engaged in all bedrooms unless a written risk assessment indicates that they are not needed. This is to ensure the security and safety of residents. Annual Quality Assurance Assessment forms (AQAA) from CSCI had not been returned until after the deadline had expired. The AQAA forms must be completed and returned to CSCI by the deadline set. This is to ensure that CSCI is kept informed of progress within the home and the quality of care provided is closely monitored. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 8 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. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 9 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 Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 10 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 People who use this service experience a good outcome. This judgement has been made from evidence gathered both during and before the visit to this service. The home has developed a comprehensive Statement of Purpose which is very specific to the resident group and considers the different styles of support, treatment and specialist services required to meet the needs of people who use the service. Admissions are not made to the home until a full needs assessment has been undertaken by the manager or a sufficiently skilled member of staff. EVIDENCE: No new residents have been admitted since the last inspection. The preadmission assessments which were previously examined were noted to be appropriate and comprehensive. The assessments included details of the personal, mental, cultural and spiritual needs of residents. Risk assessments had also been prepared for residents admitted to the home. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 11 The statement of purpose had been updated and contained the required information. It states that the home aims to develop residents’ independence by using a person-centred approach. Details of activities available for residents was included and there is an undertaking by the home to ensure that. residents are supported to keep in touch with their religion beliefs, or to attend their place of worship. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 12 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, 9 People who use this service experience a good outcome. This judgement has been made from evidence gathered both during and before the visit to this service. The service recognizes the right of individuals to take control of their lives, and effort had been made to ensure that this happens in practice. Appropriate risks assessments had been carried out. People who use the service are involved in planning their care. EVIDENCE: Individual care plans had been prepared for residents. A sample of four care plans were examined. These were on the whole well prepared and regular care reviews had been carried out. There was evidence in all four plans that residents had been consulted regarding their care and they had signed their plans. There was also evidence that residents had signed and agreed to be Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 13 involved in household chores such as cleaning their bedrooms and communal areas as part of their rehabilitation. Residents’ forums had been organised and there was documented evidence that they had been consulted regarding the management of the home. This was also confirmed by residents interviewed. Appropriate risks assessments had been prepared for residents. These were of a good standard. Following a requirement made in the last inspection report the risk assessment of a resident who sometimes smoked in her bedroom and was a potential fire risk had been updated to ensure that any potential risk is minimised A staff questionnaire received indicated that the cultural needs of residents had not been adequately met. In addition, we noted that the four care plans examined did not include plans which addressed the cultural and spiritual needs of residents. This was brought to the attention of the manager. He explained that the cultural and spiritual needs of residents had initially been assessed and documented although plans addressing these areas were not always prepared. He agreed that plans of care addressing these areas would be provided. In order to support residents, separate forums had been organised for male and female residents. Documented evidence of this was provided. The manager stated that residents had attended these sessions and topics of interests had been discussed. He further indicated that as part of their rehabilitative care, residents had also been encouraged to cook and take responsibility for their own finances. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.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): 12, 13, 14, 16, 17 People who use this service experience an adequate outcome. This judgement has been made from evidence gathered both during and before the visit to this service. The manager and his staff are aware of the need to support residents in coping with their problems and enable them to develop skills of independent living such as shopping and cooking. People using the service are given the opportunity to take part in a variety of activities both within the home and in the community. However, this process could be further improved and monitored to ensure that it happens in practice as complaints were made regarding the provision of food and lack of staff support. EVIDENCE: Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 15 The home had a programme of organised daily activities for residents. Details of daily activities for individual residents were displayed in bedrooms visited. The manager stated that effort had been made to introduce a wider variety of activities for residents. These included meals in the pub, art sessions, cookery, film nights, snooker, separate groups for male and female residents. Documented evidence was provided. The case records examined, contained social care plans and indicated that residents had access to activities provided by local day centres, sheltered workshops and employment schemes. Residents interviewed indicated that a wider range of activities had been organised for them since the last inspection. They further confirmed that a trip to the museum had been organised for them the next day. Some residents interviewed stated that they were well cared for and staff were respectful towards them. Comments made included, ”well treated by staff” “I am satisfied” and “yes, staff are helpful and caring” However, some residents (4) who were interviewed during the inspection stated that some staff were not always responsive or sensitive towards them. This issue had been addressed by the home and is also reported in detail in the section on Complaints. The kitchen inspected was found to be clean. A record of fridge and freezer temperatures had been kept. The menu examined appeared varied. Three of the residents interviewed were satisfied with the meals provided. However, four stated that they were not satisfied and there were times when they did not have sufficient food. They further indicated that they did not have access to snacks during the day or after the evening meal. This was confirmed when one of the inspectors found very little food in the cupboards and fridges. In addition, there was insufficient cutlery for residents in a part of the home (Glenholme section). The manager explained that there was ample food in the outhouse store in the garden. However, it was locked and was not accessible to residents. A healthcare professional who was interviewed was also of the opinion that there were occasions when residents did not appear to have access to sufficient food, especially during the weekends when managers are not around. The allegations made were discussed with the manager and registered provider. The registered provider stated that he spends significant sums of money on food for the home. He agreed that they would consult with residents, closely monitor the food provided and ensure that residents are provided with adequate food and cutlery. (An action plan addressing this deficiency was received from the provider in the same week). Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 16 The provision of food for residents from ethnic minorities was discussed. The manager stated that such residents could purchase and cook food they liked and two of them had done so. One of them had cooked food she liked and shared it with other residents. He also provided reassurance that further effort would be made to meet the cultural needs of residents (The inspector was informed after the inspection that meetings had taken place with staff and residents to obtain suggestions on how the cultural and diverse needs of residents can be met). Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.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 People who use this service experience a good outcome. This judgement has been made from evidence gathered both during and before the visit to this service. On the whole the healthcare needs of residents had been met. Personal and healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each resident’s plan and they give a clear view of the healthcare needs of residents. People who use the service are helped to remain as independent as possible. Staff have access to healthcare training and remedial services and the arrangements for the administration of medication was on the whole, well managed. EVIDENCE: Residents were noted to be able to go out and return freely. The case records examined indicated that residents were able to purchase things they liked and some were able to do their own shopping and prepare their own meals. They were also involved in daily household chores. The aim of the home is to enable Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 18 residents to be as independent as possible and eventually be able to live on their own in the wider community. A psychiatrist visiting the home indicated that the healthcare needs of his patients had been met and their care had been regularly reviewed. He was pleased that staff had maintained close liaison with him. However, he said that his involvement with the home was for only a limited period. Some residents interviewed were of the opinion that staff were caring, supportive and respectful towards them and their healthcare needs had been fully met. However, four residents interviewed stated that some staff were not always supportive towards them. This matter has already been addressed by the home and is reported in detail in the section on Complaints. Residents who were interviewed stated that they had access to medical and nursing professionals such as the psychiatrist and community psychiatric nurse. This was confirmed in the case records examined. There was documented evidence that the care of residents had been reviewed regularly. The minutes of these reviews, including reviews done by healthcare and social services professionals were kept in the case records and available for inspection. The inspectors noted that following a requirement made in the last inspection report regarding the healthcare of a resident, the bedroom of this resident which had been dirty had been kept clean and items of clothing were properly stored in the wardrobe. In addition, the care plan had been reviewed with professionals involved. The medication charts were examined. These indicated that medication had been administered properly and the charts were appropriately signed. The temperature records of the room where medication was stored had been recorded daily. These were satisfactory and no higher than 25C. One resident stated that he was unhappy living in the home. He stated that he wanted to move into another home. Following a requirement made in the last inspection report, the resident’s placement had been reviewed with the responsible social worker and an alternative placement had been found. The social worker concerned indicated that he was expected to move soon. An incident had been reported to CSCI by a healthcare professional regarding the inadequate management of a resident’s insulin administration. This was investigated by Social Services and an action plan was agreed. There was evidence that this plan had been followed and the resident’s insulin had been administered as prescribed. This was confirmed by the responsible social worker. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 19 A healthcare professional indicated that medication was not always obtained on time for some residents. This was discussed with the manager who explained that difficulties had previously been experienced with the home’s pharmacist. He provided reassurance that the matter is no longer an issue.. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.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 Some people who use this service experience a good outcome. This judgement has been made from evidence gathered both during and before the visit to this service. The arrangements for responding to complaints and for adult protection was on the whole, satisfactory. The required polices and procedures for safeguarding residents were in place and give clear and specific guidance to staff. Staff training in adult protection had been provided. The home had demonstrated that they will co-operate with external agencies and always attend safeguarding meetings. The outcomes of these meetings are managed well and recommendations acted upon. EVIDENCE: The home had a complaints procedure and this was included in the service users’ guide. The complaints book was examined. Several complaints had been recorded since the last inspection on 20 November 2007. These had been promptly and appropriately responded to. The home had an adult protection procedure. It included information on examples of abuse and guidance to staff on reporting allegations of abuse to Social Services and The CSCI. Following the last inspection in November 2007, certain allegations regarding the behaviour of staff were brought to the attention of the manager and registered provider. The inspectors noted that Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 21 the registered provider and manager had co-operated fully with Social Services and CSCI in ensuring that these allegations and subsequent allegation received were fully investigated. Lessons learned from the investigations and decisions agreed in safeguarding meetings (4 since the last key inspection) have been incorporated into the management of the home and care of residents. Action plans prepared had been implemented. Subsequent improvements made included better training for staff, closer liaison with social and healthcare professionals and closer monitoring of healthcare provided. Three residents interviewed stated that they were well treated and staff were respectful towards them. However, four other residents interviewed continued to express unhappiness at the way they were treated by some staff. The perception of these residents was that some staff did not really care about them and were at times insensitive to their feelings. These allegations were discussed with the manager and registered provider. The manager explained that there may be occasions when staff were busy and may not be able to respond promptly. The registered provider nevertheless agreed to investigate the concerns expressed and provide CSCI with an action plan to address any deficiencies identified (This was received the same week). There was evidence that all staff (with the exception of three who were recently recruited) had been provided with adult protection training. When interviewed, they were aware of the procedure to follow when responding to allegations or incidents of abuse. Four residents complained that no residents’ consultation meetings had been held recently. This complaint was brought to the attention of the manager. The manager indicated that this was untrue and provided documented evidence that a recent meeting had been held. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.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, 30 People who use this service experience a good outcome. This judgement has been made from evidence gathered both during and before the visit to this service. The home provides a physical environment that is generally clean and appropriate to the specific needs of the people who live there. Residents are allowed to personalise their bedrooms. It is comfortable and adequately furnished. However, further improvements are required to ensure that there is ongoing maintenance. EVIDENCE: Residents interviewed stated that they were satisfied with the accommodation provided. The home was clean and tidy. A cleaner was on duty during the inspection. Bedrooms inspected had been personalised by residents with their Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 23 own souvenirs and memorabilia. Furniture provided in the lounges were comfortable. There were two lounges and a sheltered area in the garden where residents can sit in. The laundry on the ground floor was inspected and found to be satisfactory. The garden which is located at the back of the home was well maintained and seating had been provided. No specialist equipment were provided as all residents were mobile and none of them required specialist equipment. Following a requirement made in the last inspection report, curtains in bedrooms inspected now hung properly. The manager stated that new armchairs had been ordered. This was confirmed by the registered provider who was present. The inspectors noted that the ceiling light outside bedrooms 6 and 7 was not working. This was in an area where there was no natural light. There was a small hole in the wall behind the door in bedroom 5. This would need to be repaired. The extractor fan next to bedroom 2 was not working. There was exposed pipework in a resident’s bedroom. This appeared unsightly and should be boxed in. These deficiencies were brought to the attention of the manager who agreed to rectify them. He explained that the home had a handyman and some maintenance issues had already been reported in the maintenance request book. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 24 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, 34, 35 People who use this service experience a good outcome. This judgement has been made from evidence gathered both during and before the visit to this service. The service has a good recruitment procedure that is followed in practice. The service recognizes the importance of training and tries to deliver a programme that meets statutory requirements. Residents have expressed concerns about current staffing levels which are now being reviewed. The home has responded to these and new staffing arrangements are in the process of being implemented. Additional training to assist staff in their roles and responsibilities is being organised. EVIDENCE: Five staff on duty were interviewed on a range of topics associated with their work. They were on the whole, noted to be knowledgeable regarding these topics. The staff composition was ethnically mixed. Some had worked at the home for several years. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 25 The duty rota was examined. Staffing levels consisted of 2 carers during the morning shift, 3 carers during the evening shift and 2 carers during the night shift. The manager (full time), assistant manager (full time) and deputy manager (full time) were all supernumerary. Ancillary staff working at the home comprise one full time cleaner who works Monday to Friday. Some residents (3) interviewed indicated that the staffing levels were not always adequate as staff appear unable to respond to their needs or spend adequate time with them. This was also reiterated by one staff interviewed and in one completed staff questionnaire received. The manager and registered provider indicated that the staffing levels had recently been reviewed and the staffing arrangements were in the process of being reorganised. In addition, a new manager and new staff (including team leaders) had been recruited and were due to start soon. The training records examined, indicated that all staff (with the exception of those newly recruited) had been provided with the required mandatory training and additional training. Documented evidence was provided. Recruitment records examined indicated that the required recruitment procedures (including obtaining of satisfactory CRB disclosures and two references) had been followed. Three care staff had left the home since the last inspection in November 2007. The manager, deputy manager and assistant manager are also due to leave the home soon for new appointments. Concern had been expressed by some residents regarding the attitude of some staff. The registered provider had responded promptly and provided the inspector with an action plan which included training updates on customer relations and “Equalities and Diversity”. This is to ensure that staff are fully aware of their roles and responsibilities. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 26 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, 39, 42 People who use this service experience a good outcome. This judgement has been made from evidence gathered both during and before the visit to this service. People living in the home can be assured that the home is generally well run. Residents are able to give their views about the service they receive which is generally acted upon by staff. Residents are generally protected by the home’s health and safety policies. EVIDENCE: Five of the seven residents indicated that significant improvements had been made in the management of the home. This was also confirmed in responses received from three social and healthcare professionals who were consulted. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 27 They were generally of the opinion that improvements had been made in the management of the home. The improvements noted included documented evidence of formal consultation with residents, improved response to concerns expressed by residents, a wider variety of activities, better medication monitoring of a resident with diabetes, more comprehensive risk assessments and improved health and safety. The fire records examined contained details of fire drills, fire training and fire alarm checks carried out. The fire alarm checks had been carried out weekly. Inspectors noted that some residents smoked in their bedrooms. This was discussed with the manager and registered provider. To ensure the safety of residents and staff, risk assessments must be carried out. These must include strategies for minimising potential fire risks (such as residents agreeing to handing in lighters and matches at bedtime and involving night staff in ensuring that the rules are being followed). A staff member stated that as a result of residents smoking in the conservatory of the home, there was a smell of smoking on her /his clothes when she/he went home. This staff member was unhappy that residents were allowed to smoke in the conservatory. This was discussed with the manager and registered provider who stated that an environmental health officer who visited the home recently stated that it was alright to smoke in the conservatory. As this appears to be at variance with current fire legislation, the registered persons must consult with the fire authorities (LFEPA) and obtain clarification from them regarding the legality of this matter. Window restrictors were provided in all bedrooms inspected. However, not all window restrictors in these bedrooms were engaged. For safety and security reasons, window restrictors provided must be engaged unless a written risk assessment indicates otherwise. This was brought to the attention of the registered provider and manager who agreed to attend to this deficiency. The manager explained that some window restrictors had been disengaged by residents of the bedrooms concerned. The home had a valid certificate of insurance. The financial records of four residents were examined. These were noted to be well maintained. The residents concerned had signed their accounts and the manager stated that they were capable of doing their own shopping. In addition, the home had a comprehensive policy and procedure for the management of residents’ finances. The home had a development plan and there was evidence that systems were in place to review the quality of care provided. A service user audit had been carried out the previous year and the report had been published. Lessons learnt from safeguarding strategy meetings held had been incorporated into the management of the home and care of residents. However, the Annual Quality Assurance Assessment forms (AQAA) from CSCI had not been returned Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 28 although the deadline had expired. It is a legal requirement for homes to send this document to the Commission when asked for. This is to ensure that CSCI is kept informed of progress within the home and the quality of care provided is closely monitored. This was discussed with the manager who stated that he was about to complete them. (The AQAA forms were eventually returned to CSCI after the inspection). The manager, deputy manager and assistant manager are due to leave the home soon to take up new posts elsewhere. The registered provider stated that a new manager had been recruited and he is due to take up his post when all the necessary recruitment checks had been made. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.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 CONCERNS AND COMPLAINTS ‘’’’CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score Standard No 22 23 Score 2 3 2 3 X 3 X ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 x 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000010445.V361111.R01.S.doc LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 x 16 3 17 2 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 2 X X 2 X Version 5.2 Page 30 Glenholme Oakdene Psychiatric Residential Care Home 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 Regulation 12(1) 15(1) Requirement The care plans of residents must be comprehensive and address the cultural and spiritual needs of residents. This is to ensure that the holistic needs of residents are attended to. 2 YA17 12(1)(a) 16(2)(i) Residents must be consulted regarding the provision of food and have access to sufficient supplies of food at all times. This is to ensure the well being of residents. 3 YA22 18(1)(c) 22(3) Staff must be provided with training on customer relations and “Equalities and Diversity”. This is to ensure that residents are treated with sensitivity and respect. 4 YA24 23(2)(p) Glenholme Oakdene Psychiatric Residential Care Home Timescale for action 20/06/08 01/06/08 06/06/08 23/05/08 The ceiling light which was not working (outside bedrooms 6 and 7) DS0000010445.V361111.R01.S.doc Version 5.2 Page 31 must be replaced or repaired. This is for health and safety reasons. 5 YA24 23(2)(b) The hole in the wall behind the door in bedroom 5 must be repaired. This is to ensure that residents live in a pleasant and well maintained environment. 6 YA24 23(2)(c)(p) The extractor fan in the bathroom next to bedroom 2 must be repaired or replaced. This is to ensure that there is adequate ventilation. 7 YA39 24 Annual Quality Assurance Assessment forms (AQAA) must be completed and returned to CSCI by the deadline set. This is to ensure that CSCI is kept informed of progress within the home and the quality of care provided is closely monitored. 8 YA42 13(4) 23(4) 13/06/08 The fire authorities (LFEPA) must be consulted as to whether residents are allowed to smoke in the conservatory. This is to ensure the health and safety of residents and staff in the home. 9 YA42 13(4) 23(4) 13/06/08 Risk assessments must be carried out regarding residents smoking in their bedrooms. These must include strategies for minimising potential fire risks This is to ensure the health and Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 32 13/06/08 30/05/08 30/05/08 safety of residents and staff in the home. 10 YA42 13(4) Window restrictors must be engaged in all bedrooms unless a written risk assessment indicates that they are not needed. This is to ensure the security and safety of residents This requirement was partially met. It is restated and reworded. The previous timescale was 17/12/08 13/06/08 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 Refer to Standard YA24 Good Practice Recommendations The exposed pipework in a resident’s bedroom (identified to the deputy manager) should be boxed in. This is to ensure that residents live in a pleasant and well maintained environment. Glenholme Oakdene Psychiatric Residential Care Home DS0000010445.V361111.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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. 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