Care Home: New Oaks

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What the care home does well Information is available to help people decide if the home is right for them. People`s needs are thoroughly assessed, so that their care can be properly planned. People have detailed care plans, so that staff get the guidance they need to give support to each person in ways that suit each individual best. People are well looked after. Their care is well managed, so that they get the support they need to stay healthy and well. Proper arrangements are in place to make sure that people get their medicines at the right times and in the correct amounts. They get on well with the staff who care for them, as their rights to privacy and dignity are appropriately respected. Residents are able to do things that they value, and keep in touch with the people in their lives who are important to them. They get opportunities to do different activities so that their social, cultural, religious and leisure interests can be met. Staff support them to do as much for themselves as they can, to promote their continued independence. People have a balanced and varied diet so that they can eat healthily and enjoy their food. They can be confident that their concerns are listened to, taken seriously and acted upon. The home takes the necessary steps to ensure that people are protected from abuse, so they get the support they need to stay safe. The home is comfortable and generally well maintained. Action is taken to continue maintaining and improving the house, so that residents can enjoy the benefit of living in a home that is comfortable, clean and safe. The home is generally well run. The management team has an open and inclusive way of working. They take positive action to find out what people think about the service, so that they can continue to improve it. What has improved since the last inspection? Clear efforts have been made to meet the requirements made at the time of the last key inspection. Guidance to staff about people`s PRN ("as required") medication includes written protocols. This is to make sure that staff are clear about the circumstances in which such medication should be given. Care plans include appropriate risk assessments, so that people can get the support they need to stay safe. Packages of food stored in the fridge have been labelled with the date of opening. This is good practice to make sure that food gets used up or disposed of at the right times. Important policies and procedures covering safeguarding (adult protection) and the Mental Capacity Act have been reviewed. Additional information and training are being made available to staff, to ensure they keep their knowledge up to date. Maintenance and refurbishment of the house is continuing, to make sure that the residents can enjoy living in a homely and comfortable place.The service continues to take positive action to find out what people think about the support they get. This is so that future plans can be properly informed. What the care home could do better: Develop people`s care plans so that they include goals with outcomes that can be clearly measured. Check these regularly, to ensure that people are getting the support they need to achieve the things that are important to them. Improve the way that staff write about the activities that people do. Show clearly how their activity opportunities are linked to their agreed goals. Discuss these regularly with the residents as part of existing key worker meetings. Doing this effectively will help to ensure that people get the support they need to achieve their goals. Make sure that each resident`s weight is checked on a frequent and regular basis. Think about ways to further encourage residents to eat the recommended five portions of fruit and vegetables each day.This is to help ensure that they stay healthy and well. Develop the complaints record so that action taken and the resolution of the complaint can be clearly seen. The upstairs bathroom, floor coverings in the hall, stairs and landing, the kitchen and windows and blinds in the house all need attention. This is to ensure that the quality of the home environment is maintained, and that it continues to meet residents` assessed needs. A structured staff training and development plan is needed. This will help to ensure that training is kept up to date so that staff have the knowledge and skills they need to do their jobs well. Arrangements for making sure that all staff have regular formal supervision and an annual appraisal of their performance need to improve. This is to ensure that their training and development needs can be properly planned, and that they get the support they need to do their jobs well. Residents` files could do with a "tidy up". Removing old or superseded material from their personal files, could help manage information more effectively. Arrangements for regular testing of essential equipment needs to be reviewed. This is to ensure that jobs are done at the right times, so that health and safety in the home is promoted. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: New Oaks 277 Lordswood Road Harborne Birmingham West Midlands B17 8QL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gerard Hammond     Date: 1 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: New Oaks 277 Lordswood Road Harborne Birmingham West Midlands B17 8QL 01212502502 01212502503 michelle@newoaks277.fsn.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Clare Elizabeth Stevenson Type of registration: Number of places registered: New Outlook Housing care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability sensory impairment Additional conditions: Residents must be aged under 65 years Date of last inspection Brief description of the care home New Oaks is registered to provide care, support and accommodation for up to six people with visual impairment and learning disabilities. Most of the residents have lived together for several years, and there are currently no vacancies. The house is a large detached property, situated in a residential area of Harborne in Birmingham. The centres of Harborne and Bearwood are close by, so access to a wide range of local facilities is possible. The area is well served by public transport. On the ground floor of the home there is a lounge / dining area, kitchen, office, separate laundry room, and two residents bedrooms. Upstairs are a further four bedrooms, one of which has ensuite facilities. There are ample bathing and toilet facilities situated on both floors. There is no lift, so people with significant mobility support needs would not be able to Care Homes for Adults (18-65 years) Page 4 of 32 6 6 Over 65 0 0 Brief description of the care home access the first floor. However, there is disabled access to the front and rear of the property. At the back of the house is an enclosed, private garden with patio and lawn areas. Limited parking is available on the drive at the front of the house, or in the adjacent street. The service should be contacted directly for current information on fees and charges. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is the homes key inspection for the current year 2008-9. We gathered information from a number of places to inform the judgements made in this report. The Manager completed an Annual Quality Assurance Assessment (AQAA) and sent it back to us.This is a self assessment that focuses on the outcomes for people who use the service and provides us with some numerical information about it. We visited the home and spoke with residents, the Assistant Manager and other members of the staff team. We also spoke with the Manager over the telephone, on the day following the fieldwork visit. Records including previous inspection reports, policies and procedures, personal files of people using the service, care plans, staff files and other documents were also looked at. Direct observation of care and support, and residents feedback to questionnaires about service quality provided further evidence for judgements made. Care Homes for Adults (18-65 years) Page 6 of 32 Thanks are due to the residents, the management team and staff for their co-operation and support throughout the inspection process. What the care home does well: What has improved since the last inspection? Clear efforts have been made to meet the requirements made at the time of the last key inspection. Guidance to staff about peoples PRN (as required) medication includes written protocols. This is to make sure that staff are clear about the circumstances in which such medication should be given. Care plans include appropriate risk assessments, so that people can get the support they need to stay safe. Packages of food stored in the fridge have been labelled with the date of opening. This is good practice to make sure that food gets used up or disposed of at the right times. Important policies and procedures covering safeguarding (adult protection) and the Mental Capacity Act have been reviewed. Additional information and training are being made available to staff, to ensure they keep their knowledge up to date. Maintenance and refurbishment of the house is continuing, to make sure that the residents can enjoy living in a homely and comfortable place. Care Homes for Adults (18-65 years) Page 8 of 32 The service continues to take positive action to find out what people think about the support they get. This is so that future plans can be properly informed. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Care Homes for Adults (18-65 years) Page 10 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs have been thoroughly assessed, so that their care and support can be properly planned. Evidence: There have been no admissions to the home since the last key inspection. This group of residents has lived together for several years. Most of them moved to New Oaks when it first opened, having previously lived at another home run by the same organisation. As reported at the last inspection, the home has an appropriate Statement of Purpose and Service Users Guide in place, as required. Sampling of peoples personal records showed that they all had detailed assessments of their needs, providing a sound basis for planning their care and support. These have been kept under review, as appropriate. Sampled files also contained copies of individuals license agreements, showing the terms and conditions of their residence at the home. Care Homes for Adults (18-65 years) Page 12 of 32 Care Homes for Adults (18-65 years) Page 13 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have detailed care plans and are regularly consulted. This means they get the care and support they need in ways that suit them best. They are encouraged to be as independent as they can be. Proper assessment helps to ensure that people get the support they need to stay safe. Evidence: Sampling of personal files showed that residents have detailed care plans in place. Clear efforts have been made to use person-centred approaches. This helps to make sure that the individual concerned always remains at the heart of the care planning process. Each person has an ELP (Essential Lifestyle Plan), a recognised personcentred planning tool. This includes information about peoples positive attributes (what others like or admire about them), the people and things that are really important to him or her, and the support needed to make sure that important things happen (e.g. especially things I need to help keep me healthy and safe). Care plans also include detailed guidance for staff, to ensure that people get the support they Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: need according to their preferences. Details include things like how I communicate, what I can do for myself and what I need help with, how to support me when Im out and about (e.g. what kind of transport I can use) and the things I like / dislike (particularly food and drinks). Records show that people are encouraged to do as much for themselves as they are able. They are directly involved in day-to-day tasks around the house according to their individual abilities, promoting their skills and personal independence. Records also showed that plans were kept under regular review. Individuals meet with their key workers on a regular basis to make sure that they are consulted about their care, and that information about their needs can be kept up to date and shared as necessary. Records also included information about local advocacy services so that people can access independent support, should they so wish. Care plans are appropriately supported with risk assessments. These clearly identify potential hazards, make judgements about the likelihood of occurrence and include control measures showing action to be taken to keep people safe from harm. It was recommended that these should be indexed and cross-referenced with individual care plans. The support needs of the people using this service are complex and high level. This means that the volume of information that is maintained for each person is significant, and managing this presents particular challenges. It should be acknowledged that the homes systems for care management and maintenance of personal records are generally very good. However, it was recommended that records should be reviewed so that old or superseded material can be archived or disposed of as appropriate. Doing this could help make sure that important information can be found quickly and more easily. It was also recommended that care plans be developed so that individuals personal goals have outcomes that can be clearly measured. This was discussed with the Manager. Goals should be evaluated regularly. Setting goals in this way means that it should be possible to see what is working and what might need to be changed. It was further suggested that this exercise could form part of the key worker meetings that already take place regularly. Doing this could help keep care plans live and ensure that people get the support they need to achieve the things they want. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to do things they value, go to places they like, and keep in touch with the people who are important to them. They can choose the food they like, so that they enjoy their meals. Evidence: People have opportunities to pursue valued activities and take part in the life of their local community. Each resident has an individual activity plan. Sampling of records showed that people attend local centres and colleges for some structured activities. Previous reports also show that residents get support from staff to access amenities in the neighbourhood including local shops, pubs and restaurants, cinemas and leisure centres, go out swimming and to local parks for walks. Activities are planned through the regular key worker meetings, taking account of what people say they want to do, and using staff knowledge of their individual preferences. One of the residents attends Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: a local church regularly, with support from members of the congregation. He also uses the ring and ride service to get to local facilities, for example to do his personal shopping. He goes to a local performing arts centre and out to visit friends each week. He said he enjoys living at New Oaks, does the things he wants and can come and go as I please. He said, Im in charge of what I do and that the staff support him well. Staff said that most residents had been away for a holiday in the past twelve months. Some chose not to go away, as they do not cope well in unfamiliar environments for any length of time. On the day of the fieldwork visit, another resident was being supported to go out to a Christmas lunch event. Also during the day, two of the residents had visits from family members. Records also show that people are supported to keep in touch with their friends and relatives, by visiting, telephone or post. Agreements are in place for handling mail and providing support to residents to do this. One persons plan showed that she likes her key worker to deal with her mail with her, and support her by putting postcards she receives on the pinboard in her bedroom. The Annual Quality Assurance Assessment (AQAA) shows that some improvement is needed to the way in which staff record peoples reactions / responses to the activities they do. It was noted that the documents for planning activities suggest categories for different activity types. These include teaching,leisure,social,and free time. Using this effectively should encourage staff to make activities purposeful. This was also discussed with the Manager. It was suggested that clearer links could be made between peoples activity opportunities and their agreed care plans and goals. Planned activities can clearly provide the opportunities people need to achieve their stated ambitions. As mentioned above (with regard to care planning in general) setting goals with measurable outcomes, and then evaluating them regularly, presents a simple way of finding out whether or not people are getting the support they need to do the things they want. One persons activity programme included a daily exercise routine, but it was not clear how this was being evaluated. Setting this as a measurable goal (e.g. I will do this exercise five times each morning) would provide a clear benchmark against which to measure its success. It would then be possible to see if the goal is working, or needs to be changed or developed. As suggested above, this could be incorporated into existing key worker meetings without too much difficulty. It may be that further training or discussion among the staff team is required in order to make this work more effectively. People were directly observed taking lunch. This was relaxed and unhurried, and people got the support they needed to enjoy their meal in comfort. Sampling of records showed that people have a balanced and varied diet. The home does not work to pre-arranged menus. The relatively small size of the group means that individual Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: choices can be easily facilitated. Meals are planned around peoples known preferences. It was noted that information from their care plans, detailing their specific food likes and dislikes, had recently been included in the folder kept in the kitchen. One of the residents said that he is able to do himself a microwave meal if he wants. However, he said I like the food I get and I can have what I want. The staff are good cooks. Food stocks were examined: these were ample and included fresh produce. It was suggested that the record of meals eaten might include a question along the lines of has (N) eaten 5 portions of fruit and vegetables today? in order to further prompt staff to support people to eat healthily. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally well looked after and get the support they need to stay healthy and well. Proper arrangements are in place to make sure that people get their medicines at the right time and in the correct amounts. Evidence: Direct observation of interactions between residents and members of staff showed people being treated with consideration and respect. Support was given with warmth and friendliness, and both were clearly at ease in each others company. Staff were sensitive to individuals needs, for example alerting people to obstacles because of their visual impairment. People were dressed in clean clothing of good quality: this was age and gender appropriate and suitable for the time of year. It was clear that people had been supported as required with their personal care and hygiene. Visiting relatives of two of the residents both said that they thought their family member was generally well cared for. One of the residents said that staff are excellent, hard-working and very supportive and that they provide high standards of care. Sampling of peoples personal records showed that advice and support are sought from Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: health and other professionals, to ensure that residents get the care they need to stay healthy and well. People have Health Action Plans, and these are kept under regular review. One person has complex support needs because he suffers from epilepsy. Staff said that they had received excellent support from the Epilepsy Nurse Specialist. A detailed management strategy is in place, supported with guidelines for the use of rescue medication when required. There were serious concerns about another residents low weight. The Dietician and Speech and Language Therapist were consulted and appropriate guidance obtained. Following this has improved the situation, allowing him to be discharged from their care. It was noted that weight monitoring for some of the other residents had not been done as systematically as for this person. It was recommended that action be taken to ensure that this gets done on a regular basis. Another person has a history of depression, and receives regular support from the Community Psychiatric Nurse. Peoples files contain records of their appointments, and care plans are updated appropriately. Other professionals involved included GP, Consultant Psychiatrist, Dentist, Optician and Audiologist. The home uses the Boots Monitored Dosage System (MDS) for managing peoples medication. The blister packs and Medication Administration Record (MAR) were examined. The record was complete and medication had been given as required. Records are supported with copy prescriptions,general information about each medicine, residents photographs and written protocols for PRN (as required) medication. The Buccal Midazolam (epilepsy rescue medication) is managed as a controlled drug, with separate secure storage and recording. Audits of medication stocks are completed each day, and verified with two signatures. The Pharmacist also independently audits medication stocks and management. The most recent audit showed no problems identified. Arrangements in place help to ensure that people have the support they need to get their medicines safely. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns are taken seriously and acted upon. Residents are protected from abuse, neglect or self-harm. Evidence: Previous inspection reports show that the home has appropriate policies and procedures in place for dealing with complaints and also the protection of vulnerable adults (safeguarding). Sampling of records showed that a copy of the complaints procedure was held on individuals personal files. There are also large print, braille and audio versions available. The complaints file was examined. This showed that complaints received had been logged and investigated, as appropriate. One complaint remained unresolved at the time of the fieldwork visit. Records seen show that complaints are taken seriously and investigated. It was recommended that the complaints file should provide a clear audit trail so that the complainant is identified (where appropriate), action taken in response to the complaint is shown, and the resolution is recorded when complete. The Annual Quality Assurance Assessment (AQAA) shows that the organisations safeguarding policy and procedure has recently been updated and the staff training pack rewritten. Good use is made of read and sign sheets to ensure that staff have all seen these. Staff on duty were interviewed about this. They were able to demonstrate appropriate knowledge and understanding of the different types of abuse. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: They were also able to identify potential indicators, and say what action they would take in the event of suspecting or witnessing abuse. The last inspection report shows that appropriate action has been taken in the past to safeguard individuals from abuse, by following agreed procedures correctly. One of the residents told us I feel safe living here. Residents are further protected by the services recruitment practices. Sampling of staff files showed that checks had been carried out with the Criminal Records Bureau (CRB) before people started work at the home. Sampling of peoples personal records also showed that appropriate systems are in place to account for their finances. Written records of transactions, backed with receipts, are kept and audited regularly. Sampling of these showed that cash held tallied with the accounts. It has to be acknowledged that the support needs of this particular group of residents mean that formal processes have limited significance. People rely on the vigilance of the staff team, and their knowledge of the individuals particular ways. They have to be sensitive to changes in behaviour, demeanour and body language as indicators that something may be of concern to the individuals who have limited verbal communication. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy the benefit of living in a house that is comfortable, safe and homely. Some renewal and refurbishment is required to ensure that good standards continue to be maintained. The house is clean and tidy, with good standards of hygiene throughout. Evidence: A tour of the premises was completed. The house is a large detached property, converted to provide residential care accommodation for the people who live there. Each person has a single bedroom. Peoples rooms are spacious, and individual in style. They have their own personal possessions and effects, including pictures, ornaments, TV and music players, and sensory lights. Bedrooms are comfortably furnished. Some have been redecorated recently, and there is a rolling programme to bring / keep the others up to standard. It was noted that windows and blinds around the house are generally in need of attention. Staff advised that quotations had been obtained to replace the blinds. The Registered Provider should pursue the matter of replacing the windows with the Landlord. One person has en-suite facilities in his bedroom. There are sufficient bathing and toilet facilities (situated on both floors of the house) to meet the needs of the Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: residents. The upstairs bathroom is in need of refurbishment. Staff advised that the possibility of installing an assisted bath in this room is currently being investigated. The hall, stairs and landing have recently been redecorated. The floor covering in these areas is in need of replacement: being a heavy traffic area the carpet has become worn and stained and should be renewed. It was also noted that units and work surfaces in the kitchen are looking tired and would benefit from replacement. The lounge and dining area has been completely redecorated and refurbished, with new floor coverings, curtains and settee provided. Staff advised that delivery of new chairs is awaited. The laundry room has also been redecorated, and a new washing machine with sluice cycle installed. The homes maintenance record was examined. This showed that identified jobs were generally attended to promptly. As redecoration and refurbishment continues around the home, further consideration should be given to contrasting colour schemes, variations in texture and the provision of other sensory cues, recognising the residents specific needs in relation to their visual impairments. Specialist advice on this should be sought where appropriate. It should be acknowledged that these issues have already been identified as a result of quality assurance monitoring within the service. There is an enclosed private garden to the rear of the property. The patio area has recently been relaid and work done to prune shrubs and hedges. The garden provides residents with an attractive outdoor space,when the weather permits. The house has disabled access both at the front and the back. However, there is no lift, so the upstairs rooms are not acessible to people with significant mobility support needs. Having identified a number of issues requiring attention, it should be recognised that New Oaks provides a comfortable and homely environment for the six people who live there. Staff work hard to keep the place clean and tidy and to make it a welcoming place to be. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Important checks are carried out on staff before they start work at the home, to make sure they are fit for the job. Staff are well qualified, but action is required to make sure that all of their training is kept up to date. Arrangements for formal supervision and appraisal also need to improve. This is to ensure that staff have the knowledge and skills, and get the support they need, to do their jobs well. Evidence: Sampling of staff records provided evidence that practices for recruitment and selection of staff to work at the home are appropriately robust. Files contained complete applications, two written references and checks with the Criminal Records Bureau (CRB), as required. The Annual Quality Assurance Assessment (AQAA) and the last inspection report show that new staff undergo a comprehensive induction programme, to make sure they have the necessary knowledge and skills to do their jobs. The Managers absence on the day of the fieldwork visit meant that the staff training and development plan was not available for inspection. Individual staff files and conversations with staff on duty provided some evidence that training opportunities are provided. The Annual Quality Assurance Assessment shows that nine out of eleven Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: permanent members of staff (82 ) are qualified to NVQ level 2 or above. The other two members of staff are said to be working towards this. Sampling of staff records did not produce any evidence of annual appraisal of staff performance. This should be an integral part of individuals training and development programme. In the absence of the staff training and development plan, it is difficult to assess fully whether or not statutory training is properly up to date. It is recommended that the plan be produced in spreadsheet / chart format. The plan should show, for each member of staff, training completed and qualifications gained, with dates. Dates when refreshers are due should be included in the plan, which should also show when outstanding training is to be delivered. Doing it in this way should provide the Manager with an up to date overview, and an effective tool for planning and managing staff training and development needs for the future. Some concerns were expressed about continued dependency on staff from external agencies working in the home. The high level and complex needs of some of the residents mean that continuity of care is of particular significance. The Manager advised that use of agency staff had decreased in recent weeks and that vacant posts had now been filled. It was anticipated that new staff would commence work shortly, when necessary clearance had been obtained. As reported above, one of the residents has particularly complex care needs due to his epilepsy. Staff reported that he requires two people to attend to him when he has a seizure. This could mean that situations might arise where other residents are left unattended. The Registered Provider should ensure that the staffing complement of the home fully reflects the assessed needs of all the residents. The Manager advised that this situation is recognised, and that the Commissioning Authority responsible for this residents placement has already been contacted, with a view to reviewing his care package. The staff team meets regularly, and copies of the minutes of these meetings were seen. Sampling of staff files suggests that arrangements for formal staff supervision are variable. The National Minimum Standard for formal supervision is six times in any twelve-month period (pro-rata for part-time staff). It was suggested that the Manager review current practice and make arrangements to schedule supervision on a regular basis. It should be acknowledged that staff interviewed said that they were supervised regularly, and felt generally well supported. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well run. Clear efforts are made so that the quality of the service is monitored regularly. This helps to ensure that it is run in the best interests of the residents. Some improvements are required to make sure that checks on essential equipment are carried out regularly. This will help to ensure the health and safety of people living and working in the home. Evidence: The homes current manager has been appointed since the time of the last key inspection. She is qualified to NVQ level 4 and is currently working towards gaining the Registered Managers Award (RMA). She said that this should be completed in the near future. Staff said that they got good support from the Manager and Assistant Manager, and felt able to approach her with any matters of concern. As previously reported, the organisation has an established system for monitoring and quality assurance of the service. The Manager also advised that the process of renewing the Investors in People Award for the organisation is currently in train. The Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: Operations Manager for the organisation visits the home regularly and produces written action plans for the staff team to follow. A copy of the organisations Quality Assessment Report for its residential service was also seen. The Manager advised that this years round of questionnaires had been distributed, and are due for analysis on their return. It was noted that the Quality Assessment Report related to the whole of the organisations residential service. This was discussed with the Manager. The desired outcome for National Minimum Standard 39 is service users are confident their views underpin all self-monitoring, review and development by the home. It was recommended that the report should show specifically how residents views have been taken into account in developments at New Oaks, as opposed to informing the overall picture for the residential service. It was suggested that this also presents an opportunity in the future to include an analysis of how well the service has done in supporting people to meet their personal goals. These recommendations are made merely as suggestions of developing existing good practice. It has to be acknowledged that the home, and the wider organisation, are very proactive in their efforts to keep service quality under review, and to develop it for the benefit of the residents. Safety records were examined. The fire alarm and emergency lighting systems have been tested regularly, but it was noted that there were significant gaps in the record. These jobs must be done systematically, to make sure that equipment is working properly. The arrangements for getting this done should be reviewed, to ensure that tests are not missed. Fire-fighting equipment had been serviced, the fire risk assessment has been reviewed, and evacuation drills have been carried out. Certificates for water treatment, gas safety and portable appliance testing of electrical equipment are in date. Regular tests of temperatures of the fridge and freezer, and of cooked food have been done, and a full written record maintained. Packages of food stored in the fridge were labelled with the date of opening. The COSHH store was secure. It is recommended that the COSHH information file be indexed, and new read and sign sheets put in place, to ensure that staff are fully up to date with products currently used in the home. Sampling of records provided evidence that practices regarding Health and Safety in the home are generally satisfactory. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Develop care plans so that they include goals with outcomes that can be clearly measured. Evaluate these as part of existing key worker meetings, to ensure that people get the support they need to achieve the things that are important to them. Index and cross-reference risk assessments and care plans, to ensure that important information can be found quickly and more easily. Develop activity recording so that there are clear links between peoples activity opportunities and their agreed goals: evaluate these regularly as part of existing key worker meetings. Doing this effectively will help to ensure that people get the support they need to achieve their goals. Include a prompt for staff on meal record sheets to further encourage residents to eat the recommended five portions of fruit and vegetables each day. Monitor and record each residents weight on a frequent and regular basis, to help ensure that they stay healthy and well. Develop complaints record to provide a complete audit trail, so that action taken and the resolution of the complaint can be clearly seen. Page 30 of 32 2 9 3 12 4 17 5 19 6 22 Care Homes for Adults (18-65 years) 7 28 Take action required to refurbish shared spaces in the house (upstairs bathroom, floor coverings in the hall, stairs and landing, and kitchen) and windows and blinds. This is to ensure that good environmental standards are maintained, and the home continues to meet residents assessed needs. Produce staff training and development plan, to ensure that training is kept up to date and staff have the knowledge and skills they need to do their jobs well. Ensure that staff receive formal supervision at least every two months, and have an annual appraisal of their performance. This is to ensure that their training and development needs can be properly planned, and that they get the support they need to do their jobs well. Remove old or superseded material from residents personal files, to help manage information more effectively. Review arrangements for regular testing of essential equipment, to ensure jobs are done at the right times and promote health and safety in the home. 8 35 9 36 10 11 41 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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