Care Home: Oak Bank Residential Home

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What the care home does well It was evident from our observations that staff have established positive and supportive relationships with those living in the home. There is a real sense of staff knowing and understanding individuals from a personal perspective and the ability of staff to respond positively to demands from individuals. The new care plan format illustrated a person centered approach to the providing of care in the home. All of the individuals have lived in the home for a number of years and there is a stable staff group which has resulted in a consistency and continuity of care provision. In examining care records and talking with the manager and staff it is evident there has been a reduction in challenging behaviour and development of individuals with regard to their abilities and and emotional behaviour. This has led to improved quality of life and building of relationships for those living in the home. In talking with the manager and staff there was a real sense of commitment to improving the quality of lives for individuals and a strong ethos around promoting an enabling culture in the home. There is a real effort to provide stimulation in varying forms and methods and enable individuals to participate and use community resources. Activities are a strong feature of the home routine and are as far as possible arranged to meet the varying needs and choices of individuals. The home received a number of comments about the quality of their service from their Quality Assurance questionnaires including the following: "I was very impressed with the atmosphere of the home, the attitude, competence and confidence of staff and the generally positive feeling of the placement." (Social Worker) "I was impressed with this home and with the attitude of the manager and proprietor. The staff were friendly and approachable. I would place somebody in this home." (Social Worker) "Very welcoming and friendly environment felt like being in someones home rather then a care home." "Spacious feeling of the home gave a sense of freedom and well-being." What has improved since the last inspection? The last inspection identified a number of areas which we recommended needed addressing to improve the quality of care and systems in the home. These have been addressed resulting in an improved complaints procedure, record keeping and the introduction of a staff appraisal system to ensure staff performance and skill are reviewed and maintained. What the care home could do better: The focus of this inspection was to examine systems and procedures in place regarding the completion of care plans and importantly risk assessments. It is acknowledged that the manager is making progress in addressing these areas of practice to further ensure the safety and welfare of individuals living in the home. We have made a requirement in regard to risk assessments so that they accurately state the level of risk and the required measures so that staff are equipped to response to risk and challenging behaviour in a professional and competent manner. With reference to the incident which lead to the death of an individual there was an element of complacency relating to the management of the specific risk. This is illustrated by the failure of the manager to robustly review staffing practice (around the management of the risk) and involve other professionals in reaching decisions about the management of risks associated with this individual. We acknowledge the views of the manager with regard to the perceived level of risk and their desire to respect the individuals privacy and dignity however they did not share this view in the appropriate forum i.e. Best Interest professional meeting and reach practice decisions which were agreed within such a decision making process. There is clearly a balance between the management of risk and the respect for individual rights however paramount is the safety and wellbeing of individuals and the management of risk within a multi disciplinary approach. With reference to this specific individual and identified risk such an approach was not followed by the manager. We have identified a failure by the manager to have in place systems and arrangements for the recording and possible investigation of incidents in the home in relation to systems, procedures and staff practice. Such investigation and analysis would enable the manager to identify and manage emerging risks. We have noted the failure of the manager to ensure that a staff member was fully aware of the risks associated with the deceased individual. Whilst acknowledging the positive improvements in terms of individuals quality of life specifically around reduction in challenging behaviour with resulting improved opportunities for meaningful activities there remains a need to explore further this area of the homes practice. There are a core of what are certainly positive opportunities for individuals with regard to community based activities however there is a real lack of looking at and developing daily living skills and opportunity to further maximise independence. It is as a result of the efforts of the home that individuals are now able to build on their life skills. We have identified the need for the home to look at staffing levels. The creating of opportunities for individuals within the home and outside too improve their quality of life is largely dependent on the level of staff availability. It is evident that staffing whilst adequate does not enable the provision of support and assistance to the extent wherby the improvements in individuals lives can be achieved. The reduced level of staff early evenings limits the capacity of the home to offer activities and support to individuals during this period. We also note the use of staff in meeting the domestic and catering needs of the home in that this practice reduces their capacity to be available to support and assist individuals. The arrangements for the support of individuals at night must be formalised and based on clear needs and level of risk in terms of making sure health and welfare is protected during this period of time. We have therefore made a requirement for the reviewing of staffing arrangements in the home with a view to addressing these areas of concern particularly to make sure that individuals are well supported to develop independent living skills to their fullest potential. A number of other requirements and recommendations have been made: improving training opportunities to consolidate and update staff skills and knowledge, assessment of possible need for environment support to address possible safety and risks associated with increasing frailty and physical health of those in the home, reviewing of medication storage arrangements and improving the auditing and quality assurance practice of the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Oak Bank Residential Home 31 South Road Weston Super Mare BS23 2HD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: John Clarke     Date: 1 9 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.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: Oak Bank Residential Home 31 South Road Weston Super Mare BS23 2HD 01934647670 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): oakbankresidential@tiscali.co.uk Oak Bank Residential Home Limited Name of registered manager (if applicable) Mrs Alison Davis Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 6. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Date of last inspection Brief description of the care home Oak Bank provides care for residents with learning disabilities and a range of complex needs. Oak Bank provides varying care packages with fees varying between #1400 and #1600 a week. The home is a very large Victorian detached house with a steep drive access. The Weston seafront and shopping centre are nearby. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 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: one star adequate 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 was an inspection prompted by a Safeguarding investigation following the death of an individual. The visit to the home took place over two days and there were two inspectors present on the first day one of whom has extensive experience of inspecting care homes for individuals who have a learning disability. As part of this inspection we looked at records relating to those living in the home and the deceased individual. These included care plans, risk assessments and daily care records. We also looked at the arrangements for the management and administering of medication, the facilities available to individuals living in the home, activities and daily living routines. We spoke with a number of staff and were able to observe staff interacting and supporting individuals living in the home throughout the two days of our visit. Because of the level of disability and communication skills of individuals we were not able to discuss directly their experience of living in the home. Care Homes for Adults (18-65 years) Page 5 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The focus of this inspection was to examine systems and procedures in place regarding the completion of care plans and importantly risk assessments. It is acknowledged that the manager is making progress in addressing these areas of practice to further ensure the safety and welfare of individuals living in the home. We have made a requirement in regard to risk assessments so that they accurately state the level of risk and the required measures so that staff are equipped to response to risk and challenging behaviour in a professional and competent manner. With reference to the incident which lead to the death of an individual there was an element of complacency relating to the management of the specific risk. This is Care Homes for Adults (18-65 years) Page 6 of 32 illustrated by the failure of the manager to robustly review staffing practice (around the management of the risk) and involve other professionals in reaching decisions about the management of risks associated with this individual. We acknowledge the views of the manager with regard to the perceived level of risk and their desire to respect the individuals privacy and dignity however they did not share this view in the appropriate forum i.e. Best Interest professional meeting and reach practice decisions which were agreed within such a decision making process. There is clearly a balance between the management of risk and the respect for individual rights however paramount is the safety and wellbeing of individuals and the management of risk within a multi disciplinary approach. With reference to this specific individual and identified risk such an approach was not followed by the manager. We have identified a failure by the manager to have in place systems and arrangements for the recording and possible investigation of incidents in the home in relation to systems, procedures and staff practice. Such investigation and analysis would enable the manager to identify and manage emerging risks. We have noted the failure of the manager to ensure that a staff member was fully aware of the risks associated with the deceased individual. Whilst acknowledging the positive improvements in terms of individuals quality of life specifically around reduction in challenging behaviour with resulting improved opportunities for meaningful activities there remains a need to explore further this area of the homes practice. There are a core of what are certainly positive opportunities for individuals with regard to community based activities however there is a real lack of looking at and developing daily living skills and opportunity to further maximise independence. It is as a result of the efforts of the home that individuals are now able to build on their life skills. We have identified the need for the home to look at staffing levels. The creating of opportunities for individuals within the home and outside too improve their quality of life is largely dependent on the level of staff availability. It is evident that staffing whilst adequate does not enable the provision of support and assistance to the extent wherby the improvements in individuals lives can be achieved. The reduced level of staff early evenings limits the capacity of the home to offer activities and support to individuals during this period. We also note the use of staff in meeting the domestic and catering needs of the home in that this practice reduces their capacity to be available to support and assist individuals. The arrangements for the support of individuals at night must be formalised and based on clear needs and level of risk in terms of making sure health and welfare is protected during this period of time. We have therefore made a requirement for the reviewing of staffing arrangements in the home with a view to addressing these areas of concern particularly to make sure that individuals are well supported to develop independent living skills to their fullest potential. A number of other requirements and recommendations have been made: improving training opportunities to consolidate and update staff skills and knowledge, assessment of possible need for environment support to address possible safety and risks associated with increasing frailty and physical health of those in the home, reviewing of medication storage arrangements and improving the auditing and quality assurance practice of the home. 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 on page 4. Care Homes for Adults (18-65 years) Page 7 of 32 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 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 9 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. The home has pre-admission systems and procedures in place so that they can make an informed decision about the suitability of any individual wishing to live in the home. Evidence: There has been no new permanent admissions to the home since our last inspection. Records showed that there are assessment formats in place. Individuals are normally referred through social services and they provide information and assessments regarding the care needs of the individual. The home manager will undertake their own assessment and gather further information importantly considering the needs of existing individuals living in the home. Care Homes for Adults (18-65 years) Page 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has introduced a Care Plan format which is through and provides the necessary information so that individuals health and social care needs can be met in a competent and efficient manner. The risk management arrangements are adequate however they need to be more explicit in the detail of actions required by staff and circumstances which may result in identified risk occurring. This will ensure that the health and welfare of individuals is as far as possible protected. The home has an ethos which is enabling and supportive of individuals in making choices in their daily lives. Evidence: In the past month the manager has introduced a new care plan format at the time of our inspection only one had been completed using this format. There are a number of elements to the care plan: Dependency Profile, Physical Assessment, Skills Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: Assessment, Risk Assessment and Behaviour Support Plan. Included in the Dependency Profile is information about Speech/Communication, Sociability, Personal Safety, Daily Activities, Personal care needs, Challenging Behaviour, medication, diet. For the one individual for whom this had been completed there was detailed information recorded which was person centered providing clear instructions and guidance to staff particularly around behaviours and safety. Included were routines around managing challenging behaviour. There was no information about spiritual, cultural or sexual needs and behaviours. There was no evidence of involvement and consultation in the completion of care plans of the individual or other interested parties such as social worker, family, significant others in the individuals life. The physical assessment covered areas such as personal cleansing, physical health, eating and drinking, skin integrity, sleeping routines. The skills assessment had not been completed. An Individual Behaviour Support Plan for one individual was looked at and it provided areas of risk associated with Things I do that worry people identifying slap my ears throw doors open self-harm i.e. knee walls, bite my fist. Also included were behaviours associated with being upset, happy and relaxed, when anxious and how to address anxiety including give me cup of tea, check Ive had my cigarettes offer reassurance, support and physical contact, only if I want it. We looked at care plans for the 3 other individuals in the home which were of the old format. They included behaviour management plans,Sensory Integration plan, personal care needs, daily routines. Also included were health checks (completed with GP) weight record, health intervention records. Care plans had been regularly reviewed and local authority annual reviews of the placesments had taken place. A key worker system is in place and the new care plan includes recording of keyworker input. We looked at the records in relation to the Safeguarding incident and found that a risk assessment had identified significant risk of harm through the individuals challenging behaviour. There was conflicting information about the management of the risk and the care plan did not record risk associated behaviour or practice relating to the supervising of the individual. There was no information regarding the level and probability of identified risk occurring or specific actions defining the level of supervision required to alleviate the risk. Records showed a Best Interest meeting had been held, however no review had taken place following further incidents of the behaviour occurring to look at the decisions made at the original meeting and to agree the management of risks and supervision required. A new risk assessment format is in place and we looked at a completed one for an individual. There were risk management plans in place for personal care specify having a bath, mealtimes, using the homes mini bus, out walking and risks around routines. Identified were the foreseeable risk may become agitated, self injurious behaviour and information Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: about the situations risk occurs, likelihood, who is at risk and likely injuries/harm. Regarding routine there were specific instructions to staff regarding prevention this spoke of early indicators but did not identify indicators. It referred to baseline rather than day to day behaviour patterns. Spoke of structured routine and gave detail of what this was for that individual to alleviate risk. Under What to do if risk occurs stated provide safe environment remove potential hazards but did not illustrate what these maybe for this specific individual. For an individual who has epilepsy a risk assessment had been completed with guidance about how to respond in the event of a seizure. We spoke with a staff member who was able to tell us accurately the actions he would take to safeguard the individual in the event they had a seizure. A record of seizures was looked at and showed information as to duration and effect. This individual uses a high low bed with rails, there was no risk assessment completed for their use. We looked at a risk assessment about an individual having a bath. It identified actions to be taken by staff including removal of bath plug and tap heads to prevent individual running bath with no staff present. We went to individuals room and this action had been taken. We also discussed the risks with a staff member who was able to state the actions they needed to take to make sure this area of care was undertaken in as safe a manner as possible to reduce risk. In looking at care records and care plans it was evident that staff have an approach which recognises the right of individuals to make choices. Care plans stated ...... able to choose what he wishes to do give ..... choices so he understands what you are asking. In discussion with staff they illustrated an approach of being supportive and enabling. Care Homes for Adults (18-65 years) Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good arrangements for the providing of activities, leisure opportunities and the inclusion of individuals in the local community. However these could be improved by looking at providing a greater range of activities particularly in the evenings. The home provides a welcoming environment for relatives so that individuals can maintain contact with those important in their lives. This could be improved by enabling greater social contact with peers, and where individuals are able, the forming of personal relationships. There are very limited opportunities for individuals to participate in the daily life of the home enabling and supporting in the undertaking of daily living tasks. Meals provided in the home are varied, nutritious and take place in a safe environment meeting the needs and preferences of individuals in the home. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: Records showed that individuals in the home have access to local facilities with support of staff. Individuals attend hydrotherapy, local day centre, local cafe. Other activities included one staff taking an individual to the local pub and out to the park for lunch. It is noted that most if not all of these activities take place during the day, there was no evidence of activities in the evenings. We looked at the care records for one individual for period of 6 days and this showed they had been out on five occasions during this time. They had had lunch out, bought clothes, been to Macdonalds, visited the park and cafe. One individual attends a local church. The home has an activities room which is used on a daily basis for varying activities including crafts, painting, drawing, sensory relaxation. Activity Charts are completed for individuals for one this recorded remember to offer sensory/tactile activities at different times during the day. Examples drawing in the sand, drawing on carpet tiles. The home has in the past arranged holidays for individuals. The home has a mini bus which is used regularly for going out. On one of days we visited some individuals had been taken to Bristol airport. All of the individuals living in the home, other than one, have family with varying degrees of contact. We spoke with a relative who was visiting the home. They told us that staff always make us feel welcome, always let us know if he is unwell, keep me informed. We asked if they had ever been invited to social events at the home and they told us no. The manager later told us that they had not arranged any social events for relatives and friends to attend. There was no evidence from care records or care plans of the homes efforts to enable individuals in the home to meet and socialise with peers or have (where able) personal relationships. Records such as care plans and daily records showed limited occasions where individuals are encouraged and supported to undertake tasks associated with the life of the home such as doing personal laundry, cooking, cleaning of person accommodation. For one individual records stated that they had undertaken vacuuming. Care plans do not outline ability of individuals in relation to daily living tasks though an element of the new format includes this information. Records of meals provided in the home were looked at and showed a good variety of meals available to individuals. Staff were very informed about individual likes and dislikes and clearly make real effort to provide an appropriate choice of meal. One staff member told us of the dislikes of an individual and how they are able to tell by their behaviour what they will and will not eat. Specialist needs are catered for specifically where food needs to be prepared in a way which reduces the risk of Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: choking. None of individuals living in the home help in the preparation of meals or snacks. We were present during mealtimes there was a relaxed and unhurried atmosphere with staff available to assist and support individuals. One staff member was observed feeding an individual, this was achieved in a sensitive and appropriate way. Care Homes for Adults (18-65 years) Page 16 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. The routines and arrangements for the care of individuals in the home are flexible and respect choice however opportunities could be made to encourage and provide stimulation and activities so that individuals are enabled to remain up longer in the evening period. Arrangements for the provision of health care and use of specialist community health care resources are good recognising the specific needs of individuals in the home. The medication arrangements are good so that the health and welfare of individuals is protected however storage of medication would benefit from improvement so that risks to individuals are further reduced and facilities are as required by those living in the home. Evidence: During our visits we were able to observe staff and noted their approach was supportive and sensitive. They illustrated a good understanding of individual needs and whilst assisting individuals in one instance with their meal and in another trying to direct an individual to an activity, was done with respect and enabling the person to Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: make a choice. Staff we spoke with about personal care routine showed a good knowledge of the specific needs and preferences of individuals around maintaining personal hygiene, bathing and personal care. Records and talking with staff evidenced the majority of individuals getting up when they choose and going to bed when they choose. It was noted that all but one of the individuals are generally in bed by 7pm. Records showed the involvement of specialists in the care of individuals; community nursing, Community Assessment and Development team. Speech therapist, Occupational therapist (Sensory Integration report), Psychiatrist. There was no evidence of specialist assessment around individuals environment in terms of need for equipment such as rails. This maybe of increasing relevance as individuals health and physical needs change. Records evidenced regular health care checks including dentist and individuals are supported to access community health support including doctor, community nurse. We looked at the arrangements for the management, storage and administering of medication. Records were examined and found to accurately record the administering of prescribed medication with no gaps in recording. For one individual who had medication, as required, this was recorded separately in daily records and there was a protocol around its use. Stocks were recorded and found to be accurate. Staff who administer or have any responsibility regarding medication have received the necessary training and records confirmed this training had taken place. Medication reviews take place to make sure that all medication remains appropriate and necessary for that individual. It is noted that all medication is stored in locked walk in cupboard in kitchen area and there was no separate controlled drugs cupboard in the event these are required by individuals. Care Homes for Adults (18-65 years) Page 18 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. There are procedures in place to enable individuals who may wish to register a complaint and the home has the required Safeguarding policies in place. Evidence: The complaints policy, process and timescales meet the standard required with a pictorial version available. However because of the level of individuals disability complaints would need to be made by others acting on their behalf. The home has a Safeguarding policy and procedure in place and staff undertake Safeguarding training with updates planned for all staff in March. As a result of a death of an individual in the home a Safeguarding investigation was initiated. At the time of writing this report the investigation was ongoing with no conclusions being reached. The matter is the subject of a coroners inquest to be held at a date yet to be determined. We have commented on matters relating to the death of this individual and practices of the home and manager in Outcome area 2 Individual Needs and Choices and 8 Conduct & Management of the home Care Homes for Adults (18-65 years) Page 19 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. The home provides a suitable and homely environment with the necessary facilities to meet the health and social care needs of individuals living in the home. However the communal lounge area could be improved to make it more homely and welcoming. Evidence: We were able to view all parts of the home including an individuals personal accommodation. There is a large lounge which whilst furnished with pictures and items of furniture was lacking warmth and homeliness. The activities room was well equipped with sensory materials and lighting and there is an additional activities room in the garden of the home. Individual accommodation was suitable and it was evident that where possible and safe, rooms are personalised. It is noted that rooms are well decorated and furnished and spacious with some having full en suite (i.e. bathroom & toilet) providing personal facilities. Care Homes for Adults (18-65 years) Page 20 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. Staff receive the required mandatory training so that they can perform their duties in a competent and professional manner. However there are areas of training which would benefit staff and improve their knowledge and skills. The staffing arrangements are generally satisfactory however the home must review the night-time staffing so that they are satisfied there are the required levels of staff to meet care needs and individuals health and welfare is as far as possible protected. Evidence: We looked at the training records for four members of staff. We found all of the staff had completed mandatory training: moving and handling, first aid, food hygiene, fire safety. Three of the four had undertaken COSHH and Medication. It is noted that the fourth staff member confirmed to us they did not have any responsibilities around medication. Staff have also completed specialist training around Autism, Communication skills and Epilepsy. All staff are to undertake Safeguarding training in March. There has been no training around Equal Opportunities & Disability Awareness, Mental Capacity Act & Deprivation of Liberty. There were no individual training and development profiles. We looked at the staffing rota for the month of February. We found that there are generally three staff on duty during the day (8-7) with manager working Mon-Fri 9-3 Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: & 9-6. The owner is also present most days (Mon-Fri) though is not part of the staff rota. Night staff are on duty 7pm-8am with one waking and one sleep-in. The manager also advised that at times both of the night staff sleep in and therefore there are no waking night (from 10pm). There are no domestic or kitchen staff, these duties being undertake by care staff. We discussed the staffing arrangements with the manager and owner specifically the early evening and sleep-in arrangements. On occasions additionally staff will be on duty particularly when an individuals needs support when going out of the home. At the present time there are no individuals in the home who need one to one staff support. We looked at the recruitment records for a recently appointed member of staff. A full and detailed application form had been completed giving employment history, Criminal Record Bureau checks and POVA1st had been obtained. They had completed the Skills For Care Induction programe. Care Homes for Adults (18-65 years) Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the necessary qualification and experience to manage the home however there has been a failure to make sure that records are completed as required and staff are made aware of individuals needs and importantly risks so that the health and welfare of individuals in the home are as far as possible protected. Quality Assurance systems are in place however there are no arrangements to seek the views of individuals in the home through methods which maybe available and suit their communication ability. The Health & Safety arrangements specifically relating to the environment and safety of individuals and staff are generally satisfactory. There is no system to review policies and practices in the home following incidents. Evidence: The manager of the home has extensive experience of working in a care setting and with individuals who have a learning disability. Since 1986 she has worked in care homes and was appointed manager of Oakbank in 2006. She has the Registered Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: Managers Award. Other training completed include Safeguarding, Mental Capacity Act and disability. There were no records of Risk Management training. In talking with staff they described her as approachable and open and communication is good. The home has quality assurance, environment and food audit arrangements in place however there was no records of audits being undertaken since 2008. Quality Assurance questionnaires are sent to professionals and the responses were very positive. Quality assurance questionnaires were sent to family and visitors to the home in September 2009. Recognising the very limited communication and lack of verbal skills of individuals living in the home reflecting the level of their dependency and disability there is no system in place to try and seek the views of individuals living in the home. When looking at Health & Safety records we noted there was no procedure or formal records of accidents and incidents in the home. We discussed the completion of Regulation 37 notifications specifically with reference to the individual who is the subject of a Safeguarding investigation. The manager confirmed that staff members present had not completed the Reg 37 and no statements by staff had been recorded about the incident. The manager has not taken any actions or investigation as to the incident and staff practice surrounding the death of the individual. However she has co-operated fully with the Safeguarding investigation. Health & Safety records confirmed that staff undertake regular fire drills, fire alarm tests and emergency lighting tests are completed as required. The fire alarm system was last serviced 16/12/09 and the home has completed a Fire Risk Assessment. Equipment such as lift are regularly serviced. Health & Safety policies and procedures are in place relating to working practices in the home such as moving and handling, fire safety, infection control, health emergencies. Care Homes for Adults (18-65 years) Page 24 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 25 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 1 6 15 The registered manager to 16/04/2010 make sure after consultation with the individual or a representative, revise the individuals service plan. This relates to reviewing and completion of new care plan formats for all individuals in the home. To do so with consultation with other professionals and family members where this is possible and appropriate. 2 9 13 The registered manager shall make sure that unnecessary risks to the health and safety of individuals is identified and so far as possible eliminated. This relates to completion of risk assessments and management plans. To include full detail and guidance around the 26/04/2010 Care Homes for Adults (18-65 years) Page 26 of 32 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 individuals behaviour or triggers leading to risk occurring, explicit information about actions i.e making environment safe, removing hazards. 3 9 13 The registered manager to make sure that unnecessary risks to the health and welfare of individuals are identified and so far as possible eliminated. This relates to the use of bed rails and the need to have a risk assessment in place and evidence of the need for their use in terms of identifying the level of risk. Their use must be with the agreement of the individual, their representative or other interested parties. 4 15 12 The registered manager to 31/05/2010 make sure that the care home is conducted so as to promote and make proper provision for the health and welfare of individuals and for the care of individuals. This relates to providing varied activities (at all times of day) too enable and improve individuals opportunities of having 26/04/2010 Care Homes for Adults (18-65 years) Page 27 of 32 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 relationships with their peers and others. 5 16 12 The registered manager shall make sure that the care home is conducted so as to promote and make proper provision for the health, welfare and care of individuals in the home. This relates to creating opportunities and enabling individuals to undertake daily living tasks within their ability and in a safe manner. 6 33 18 The registered manager 23/04/2010 having regard to the size of the care home, the number and needs of individuals living in the home shall make sure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of individuals in the home. This relates to the reviewing of staffing levels particularly during the night-time period. 7 35 18 The registered manager shall having regard to the size of the care home and the number and needs of 30/06/2010 30/06/2010 Care Homes for Adults (18-65 years) Page 28 of 32 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 individuals shall make sure that the persons employed to work at the care home receive training appropriate to the work they are to perform. This relates to staff receiving further training to improve their skills and knowledge. Specifically Disability Awareness, Equal Opportunities and Mental Capacity Act. 8 37 17 The registered manager shall maintain records specified in Schedule 4 Care Homes Regulation 2001. This relates to the manager putting in place a procedure for the recording of incidents and accidents in the home. To have in place arrangements to review procedures, risk assessments and staff practice in light of incidents. 9 37 12 The registered manager shall make sure that the care is conducted so as to promote and make proper provision for the health and welfare of individuals in the home. This relates to the practice 02/04/2010 16/04/2010 Care Homes for Adults (18-65 years) Page 29 of 32 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 of the manager namely to make sure that all staff have full access to care records and are fully aware of the care needs and risks associated with the individuals living in the home. 10 39 24 The Registered Manager 30/06/2010 shall establish and maintain a system for reviewing at appropriate intervals the quality of care provided at the care home. The system shall provide for consultation with individuals living in the home and their representatives. This relates to the need to explore and look at methods of involving individuals in the home in quality assurance and providing opportunity for their comments and views to be expressed. 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 Care Plans to provide information about the spiritual, cultural and sexual needs and behaviour of the individual so this is clearly identified and addressed to support the right of the individual in this regard. Care Homes for Adults (18-65 years) Page 30 of 32 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 2 15 Look at providing greater opportunities for the involvement of family and other significant individuals in the life of the home through social events and other such occasions. Consider the needs of older individuals in the home for specialist equipments to assist and support them in their own accommodation i.e. rails in bathroom To review the arrangement where medication is stored in kitchen in that this is area which is accessible to individuals whilst staff are present. To consider re siting of medication in separate secure area and in addition the provision of control drug cupboard which meets standards required under the Medicines Act Look at ways of improving the environment of the communal lounge so that it is more welcoming and not as cold and sparse in appearance. Training audit and individual staff development profiles are completed so that there is a structured approach to the training of staff. The manager to look at Risk Management and Assessment training so that they have the opportunity to improve and consolidate their skills and knowledge to undertake this aspect of their responsibilities. 3 18 4 20 5 24 6 35 7 37 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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