Care Home: Oak Field

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What the care home does well The manager and staff team have worked well to prepare for people coming to live at Oakfield. Before starting a service, the staff team were given lots of training to enable them to meet people`s needs and understand the way the service should be run. Oakfield aims to accommodate people who present behaviours that may challenge the services they require. The service shows good ability to meet such specialist needs, which include autism. Admissions and settling in time are well managed and arranged in a planned way so that people`s needs are fully assessed, whilst ensuring that the service is suitable for them. Individuals are central to the planning of their care and staff have good information on how to meet their specific needs. Any changes in individual needs are acted upon and adjustments to their care and support are put in place. The premises are kept clean, safe and furnished to very good standard that provides homely and comfortable surroundings for the people who live there. One to one staff support is provided by a stable team who have worked at Oakfield since it opened. Good training and supervision systems support them to do their jobs well and reflect upon their performance and practice. The manager and staff have a very positive approach to developing this new service and show commitment and enthusiasm. Information from the AQAA also told us that the home has a good awareness of where it could improve and how it plans to develop its services over the next twelve months. What has improved since the last inspection? This was the home`s first key inspection since registration so it was not possible to judge where improvements have been made. What the care home could do better: The reader should note that newly registered services cannot achieve an excellent rating at their first inspection as they would need to demonstrate a consistent track record over time. This service has more strengths than weaknesses and we recognised that the manager is working hard towards excellent outcomes for people who use the service. As Oakfield was offering respite care arrangements, this needs to be reflected in the Statement of Purpose so that people wishing to use the service are fully informed about the services available to them. In addition, each person needs an up to date and completed contract so that they or their representative are given full information about the costs and what the service provides for the money. Recruitment practices need to be more thorough, to ensure that people are kept safe from unsuitable staff or poor practice. Full employment histories must be explored for all current and future employees and two references obtained that include the applicant`s most recent employer. Some improvements are needed in relation to the management of medication to ensure safer practice and minimise the risk of error. All stock medication must be checked regularly and recorded. Access to the medicine cabinet needs to be managed more securely. Finally, we need to be kept informed of any events that affect the well being of people staying at Oakfield. This is so we can track incidents and monitor whether the home has made the correct choices when dealing with events that could have put people at risk from harm. Management must therefore ensure that both they and all staff are familiar with the required guidance under regulation 37. Key inspection report Care homes for adults (18-65 years) Name: Address: Oak Field 21 Oakfield Road Croydon Surrey CR0 2UD     The quality rating for this care home is:   two star good 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: Claire Taylor     Date: 2 3 0 4 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 Field 21 Oakfield Road Croydon Surrey CR0 2UD 02086801948 02089161818 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care Expertise Limited Name of registered manager (if applicable) Larysa Teodor Khumurych Type of registration: Number of places registered: care home 7 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: 7 The registered person may provide the following catedory of service only: Care home only - Code PC to service users of the following gender: Either 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 Oakfield is owned, managed and staffed by Care Expertise Ltd. It is a seven bedded home registered to provide residential care for younger adults with learning disabilities. There were two people using the service at the time of our inspection. The home is a large detached property situated in a residential street close to the centre of Croydon and well placed for accessing local shops and public transport links.The home provides spacious en-suite accommodation over three floors for up to seven people. Shared space include a large lounge, open plan kitchen and dining area, office and paved rear Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 7 Brief description of the care home garden. There is also a separate laundry in the basement. Oakfield has additional onsite facilties comprising of two spacious rooms where people using the service can develop personal skills and participate in therapeutic activities such as music. Fees start at £1430 per week and were correct at the time of our inspection. More detailed information about the services provided can be found in the Statement of Purpose and Service User Guide; copies of these can be obtained directly from the home. 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 was the homes first key inspection since it first registered in April 2008. This is because the service was dormant until June 2009 when one person moved in. Prior to the visit, the manager returned the Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self-assessment that the service must complete every year. It is used to tell the Commission about the services provided, how the home makes sure of good outcomes for the people using it and any planned developments. The completed AQAA provided us with useful information about what the service does well and where it needs to improve. We also sent out have your say comment cards to obtain peoples views about the service and received three staff surveys back. This inspection report is based on findings from two visits made to Oakfield. One person was living in the home at the time of our visit and a second person was using the service for short term or respite care breaks. In order to make judgements about the care that individuals receive, we observed care practices; interactions with staff and tracked both peoples records of care. Case tracking means we looked in detail at the Care Homes for Adults (18-65 years) Page 6 of 32 care people receive. We also looked at various records in relation to the staff and the way the service was being run. Discussions were held with some of the staff, the manager and one of the directors from the owning company. During the inspection we observed daily life in the house and how staff assist people living there. We also looked around the building and viewed the bedrooms. All this information helps us to develop a picture of how the service is managed and understand what it is like to receive support and care at Oakfield. At the end of our inspection, we told the manager what we found. We would like to thank all those involved with this inspection for their time, assistance and hospitality. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The reader should note that newly registered services cannot achieve an excellent rating at their first inspection as they would need to demonstrate a consistent track record over time. This service has more strengths than weaknesses and we recognised that the manager is working hard towards excellent outcomes for people who use the service. As Oakfield was offering respite care arrangements, this needs to be reflected in the Statement of Purpose so that people wishing to use the service are fully informed about the services available to them. In addition, each person needs an up to date and completed contract so that they or their representative are given full information about the costs and what the service provides for the money. Recruitment practices need to be more thorough, to ensure that people are kept safe from unsuitable staff or poor practice. Full employment histories must be explored for all current and future employees and two references obtained that include the applicants most recent employer. Some improvements are needed in relation to the management of medication to ensure safer practice and minimise the risk of error. All stock medication must be checked regularly and recorded. Access to the medicine cabinet needs to be managed more securely. Finally, we need to be kept informed of any events that affect the well being of people staying at Oakfield. This is so we can track incidents and monitor whether the home has made the correct choices when dealing with events that could have put people at risk from harm. Management must therefore ensure that both they and all staff are familiar with the required guidance under regulation 37. Care Homes for Adults (18-65 years) Page 8 of 32 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. 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 9 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 10 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. People using the service and their representatives have the information they need to make an informed choice about the home. Admissions are arranged in a planned way and the needs of people who use the service are fully assessed prior to moving in. This ensures that a persons needs can be understood and met. Up to date contracts are needed so that people have accurate information about the facilities and services they can expect to receive. Evidence: There were two people using the service ; one person was staying on a regular short term basis. A third prospective person was due to move in a few days after our inspection. Overall, the Statement of Purpose and Service Users Guide both provide people with clear, illustrated information about the home and the services they can expect to receive. The documents need amendments however so that they accurately reflect the respite care facility that the home was offering. This will ensure that people who wish to use the service are fully informed. As part of the admission process, the home carries out its own needs assessment which focuses on achieving positive Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: outcomes for people. The assessment covers all aspects of a persons life, including their strengths, hobbies, social needs, dietary preferences, health and personal care needs and ability to take positive risks. In addition the manager had written a support plan for managing behaviours that may challenge services each person requires. Oak field also aims to provide a service to people who have specific needs such as autism and records told us that the home ensures that appropriate assessments are carried out prior to any move.The manager advised that people are offered a transition or introductory period of six weeks and admissions only take place if the service is confident that staff have the skills, ability and qualifications to meet a persons needs. Records showed that the home managed both peoples transitions in a well thought out and structured way. This ensures that any new person has the time they need to settle in and that staff get to know their support needs. The home ensures that families or representatives are also involved where appropriate. Both people also had an up to date needs assessment undertaken through their placing local authority. One improvement is that all people using the service must have an up to date and relevant contract or service agreement. It must specify what the person is expected to pay and include accurate information about the facilities and services that people can expect to receive. Any arrangements for charging additional costs that are not covered by the basic price of each persons placement must also be fully reflected in their terms and conditions.This will help them and/ or their representatives to have a better understanding of the care that is promised and likewise the homes duty of care to them. Care Homes for Adults (18-65 years) Page 12 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. Peoples needs are well met through good practices that are supported by informative care plan records. Risks are well managed and promote each persons independence whilst ensuring their safety from harm. Evidence: We looked at care records for both people using the service. The information recorded in them was current and clearly guides staff to effectively address each individuals personal, social and emotional care needs. There was good information about a persons likes and dislikes and plans were also illustrated with pictures and photographs to help individuals understand them. Guidelines were available on how best to support a person where their behaviour may challenge the services they require. The profile gave lots of detail about how a person expresses themselves. This helps staff to understand the persons unique behaviours, moods, signals and temperaments and what they might mean. One person using the service experienced some difficulties when they first moved to their new home. Records showed that guidelines and interventions were used by the staff to help lessen the persons anxiety Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: and help them settle in. Outcomes showed a positive effect on their well being. Person centered planning had begun for one person staying permanently in the home and included information about their preferred routines, activities, likes and dislikes, social links,how to stay healthy, safe and well and what support they need to achieve this. We suggest that person centered planning is extended to the person who stays for respite care so that their plan is more accessible and meaningful to them. A key worker system is in place that works effectively and gives consistency to each person. Records told us that the home makes sure peoples care plans are regularly checked and updated where necessary. Key workers do this on a monthly basis with people who live at the home, to make sure they are still meeting their needs properly. Individual diaries are used daily and records seen were thorough, relevant, and also gave a sense of that persons experience of their day. There are good systems in place that will ensure that the placement and the care plans are reviewed regularly. These also involve peoples care managers, family and other representatives as necessary. Observation and records showed that where an individuals behaviour could potentially present risks this is well managed with staff continuing to promote the persons independence at home and in the community.We saw a general risk assessment for each person that reflected a wide range of potential risks. Individual plans covered areas such as accessing the local community, road safety awareness and using the kitchen. These assessments aim to support each person to take acceptable risks in order to maximise their independence wherever possible. Information about a persons vulnerability could cover several different areas of risk however. Separate risk assessments should therefore be recorded for each person to show how each identified risk is managed. Care Homes for Adults (18-65 years) Page 14 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 lead fulfilling lives as they are supported in the lifestyle they choose and have good links with the local community. Relationships with family and friends are well supported and daily routines ensure that peoples 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. Evidence: This service provides people with lots of varied activities and social experiences both within the home and beyond. The property has the benefit of two additional rooms within the rear garden for therapeutic activities such as music. As a new service, the manager has plans to provide a wider range of social and leisure activities once more people have moved in. Preferred interests, hobbies and likes are identified as part of the personal care planning process. We looked at records for the two people using the service. Each person had a full activity programme which takes account of their Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: preferences, interests, experiences, age and capabilities. Activities are flexible but act as a structure to each persons week since they benefit from routine and consistency in their lives. One person has a range of pictures and photographs to help them to make choices and understand their routines. Individual risk plans had been carried out to help make activities as safe as possible for people. The two people staying at Oakfield regularly access their local community with appropriate one to one staff support. Activities include shopping, pub visits, fitness gym and cinema. We spoke with one staff who clearly described the needs of the person they supported and their preferred leisure interests. Within the house, individuals are supported and encouraged to maintain their independence and life skills such as personal care, preparing meals and domestic tasks. Again, one person had photo cards to help them understand their daily routines. During both visits, the two people we met appeared relaxed and comfortable in their surroundings. Staff spoke respectfully with individuals and supported them with their planned activities. Records showed that relatives, friends and guests are welcome and that the manager maintains good communication links with peoples respective families. Care plans included details about each persons social network and who is important in their lives. The staff support people to visit and to keep contact with those that are close to them. Future plans on the AQAA included swimming sessions and to develop a sensory room. The manager advised that holiday plans were underway for the two people at Oakfield. We saw records to show that people are asked what they want to eat and that their food choices were included on the weekly menus. The menus reflected a healthy and varied diet. Dietician support is used where needed and one person had a specific plan for eating and drinking so that staff can support them safely when eating. 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. Health care needs are well met and closely monitored. This ensures that people receive health services efficiently when required and promotes their quality of life. Medication practices are generally well organised although some improvements will ensure better safety and consistent treatment for each person. Evidence: As stated within other parts of the report, records told us that each persons individuality is recognised and this extends to how they have their personal and healthcare needs met. Peoples preferences about how they receive personal care were recorded in their care plans. Healthcare records were well maintained, kept upto-date and linked to each care plan. Routine checks such as optician, dental, general practitioner and consultant psychiatrist appointments were also recorded clearly. This shows that the staff team monitors healthcare needs closely and works positively with local health care professionals to offer a responsive and supportive approach in assisting people to maintain good health. Records told us that any health or behaviour changes are clearly documented and necessary action is taken to gain specialist advice. For example, one person had involvement with physiotherapy and psychology services. We checked the way the service manages its medication practices and Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: discussed the process with the manager. Medicines were stored correctly in a locked cabinet and administration charts were all signed and accounted for. Information about the prescribed medication was available to staff and all have completed training on safe administration. We found some improvements are needed however to further ensure safe practice. There were no up to date records for the receipt and disposal of medication and the medicine key was not stored securely. In addition, all stock medication must be checked on a regular basis and not just when it is administered. This is to provide an audit trail and minimise the risk of error. We acknowledge that this is a new service and that only one person was prescribed regular medication. Systems need to be put in place however to ensure the safe and effective management of medication. 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. Arrangements for protection from abuse are well managed and help ensure that people using the service are safe. Evidence: Good policies and practices help ensure that people are safeguarded from harm and their views and concerns are listened to, and acted upon. Information about how to raise a concern or complaint is made available to the people living at Oakfield. Staff have developed this by using pictures to help people understand how they can be supported in making their views and concerns known. Since the home registered in 2008, no complaints or safeguarding concerns about the service have been raised with us or to the home. Records confirmed that staff are properly inducted on abuse awareness and they have all attended training. There are policies and procedures for safeguarding adults that give clear specific guidance to those using them. This includes appropriate local authority procedures so that staff know who to alert in the event of a concern. Other training around dealing with physical and verbal aggression has also been provided to all staff. The manager is qualified to deliver such training known as PROACT-SCIPr (Positive Range of Options to Avoid Crisis and use Therapy Strategies for Crisis Intervention and Prevention). The home defines this as a methodology of dealing with behaviours that challenge that places emphasis on nonaversive techniques. The Mental Capacity Act and Deprivation of Liberty Safeguards(DOLS) came into force in April 2009. This relates to new legislation which concerns the protection of peoples rights when using care services. Although the Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: manager had recently completed relevant training, we suggest that other staff also attend similar training so that they are familiar with current legislation and practice. Care Homes for Adults (18-65 years) Page 20 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. People using this service are provided with a safe, clean and comfortable living environment that meets their needs, preferences and lifestyles. Evidence: We were shown around the building and viewed both peoples bedrooms with their permission. The accommodation is arranged over three floors and decorated to a very good standard. Shared space includes an open plan kitchen with dining area, comfortable lounge and an enclosed rear garden that is mainly paved. At the back of the garden, people using the service can also make use of two activity rooms in a separate building. One room contained lots of music equipment. All seven bedrooms have modern en suite facilities. In order to meet one persons needs and preferences, their bathroom has been converted into a shower wet room. A second vacant bedroom also has the same facility. Individuals are encouraged to see the home as their own. People have begun to personalise their rooms how they like and been involved with choosing their room colour and furnishings. For the prospective third person, the home had bought new shelving and furniture in preparation for their move. It was clear that the service supports people to see the home as their own and encourage individuals to personalise their rooms. For example, one person enjoys using the internet and has access to a laptop computer in their room. Once the service is fully operational and more people have moved in, there are plans to add more Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: furnishings such as pictures and games/ activities according to their interests and choices. A smoking shelter has been built in the rear garden since our last inspection. All areas were very clean, well maintained and in a good state of repair. The local fire authority (LFEPA) carried out an inspection of the premises before it opened. The fire safety report identified some areas that needed attention and records confirmed that the manager had taken action to address them. Care Homes for Adults (18-65 years) Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefit from a competent and knowledgeable staff team, who are provided with the necessary training and guidance to support their specific needs.There are good recruitment practices which safeguard people from unsuitable staff although some additional checks are needed to ensure that people are fully protected. Evidence: Before anyone moved in, the staff team were given lots of training to enable them to meet peoples needs and understand the way the service should run. At the time of our inspection, there was one to one staff support for each of the two people using the service. Staffing levels had been adjusted in preparation for a third person due to move in. All three staff we spoke to had a good understanding of each persons specific needs and their unique ways of communicating. Interactions we saw showed that people were comfortable and relaxed around the staff on duty. People benefit from a stable team, most of who have worked at Oakfield since it opened. The zero turn over of staff means that people benefit from the consistency of a well-established staff team. We looked at records for four staff and each file contained most of the required legal checks and documentation. For two staff however, there were some gaps in their employment histories (no explanation) and insufficient references for one staff member.The correct recruitment checks must be carried out on all employees to Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: ensure that people are fully protected.It would also be better if authenticity on references was checked more carefully. Also, that any verbal references should be recorded before written confirmation is received.Aside from these issues, all other recruitment checks had been completed appropriately including CRB and POVA checks; proof of identity and a health declaration. Staff meetings are held regularly. We looked at some minutes of these meetings which showed clear discussions for keeping everyone up to date and sharing information about developments and practices in the home. The manager had completed a training record to show what training courses staff have done and when they did them. Most of the training is provided by Care Expertise and covers a variety of topics that are relevant to the aims of the service. Certificates showed that staff have attended various courses such as epilepsy, dementia awareness and managing challenging behaviours. As discussed in other parts of the report, staff have also completed manadatory training on key health and safety topics. Records showed us that staff receive a thorough induction to the post and are supported in their jobs through regular supervision and an annual appraisal of their work. These systems therefore support staff to do their jobs well and reflect upon their performance and practice. Three staff who completed comment cards said that the training was relevant to their role. All staff said that they had appropriate recruitment checks carried out prior to them starting work and ticked that their induction covered everything they needed to know very well. Care Homes for Adults (18-65 years) Page 24 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. There is an experienced manager who has a good leadership approach to run the service in the best interests of the people who use it.Record keeping is well managed to ensure that peoples rights and best interests are safeguarded. The environment is safe for people and staff because health and safety practices are carried out. Evidence: The manager Larysa Khmurych has been running the home since it opened. Previous experience was working as a deputy manager in another learning disability service owned by Care Expertise. The manager said that she has recently completed her NVQ level 4 management qualification and was awaiting the certificate. Discussions and observation confirmed that the manager understands the importance of person centered care and improving outcomes for people using the service. She has an open and positive management approach, also regularly working as part of the team. We received three staff surveys that each gave positive feedback about the manager. The returned AQAA was well written and fully supported by appropriate evidence from this inspection. The self assessment also gave clear information about where further developments are either planned or would benefit the people who use the service. As Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: the service is still in its first year of operation, the overall effectiveness of the quality assurance systems could not be fully assessed. The manager has plans to ensure that the quality of the service is monitored however. For example, satisfaction questionnaires were due to be sent to relatives and other professionals. We saw that monthly unannounced visits were being undertaken by a representative from the owning company. Reports were mostly task related however and could include more information about the experiences and views of people. We suggest that more attention is given to looking at outcomes for people who use the service. The home has good systems in place that aim to promote the health, safety and welfare of the people using the service, staff and visitors. There is a health and safety coordinator within the staff team. A regular check of the environment is carried out monthly to ensure that it remains safe. Records and certificates showed that regular checks are carried out on the building and equipment. This includes checking electrical appliances, the gas supply and regular fire checks. These systems help to make sure that the home is well managed and is a safe place to live and work in. The owning company has an ongoing programme of mandatory training to ensure that staff update their skills and knowledge in key health and safety issues. Staff had completed training on moving and handling, infection control, food hygiene and first aid. Appropriate records are kept for accident and incident reporting although we must be kept informed of all significant events that affect a persons well being. This is so we can track incidents and monitor whether the home has made the correct choices when dealing with events that could have put people at risk from harm. Care Homes for Adults (18-65 years) Page 26 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 27 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 1 4 The Statement of Purpose must be updated to reflect the respite care service and explain how the needs of those who use the service will be met. This is so that people who may wish to use the service can understand exactly how they will be cared for and supported. A copy of the revised Statement of Purpose must be sent to the Commission on completion. 23/07/2010 2 5 5A All people using the service 23/07/2010 must have an up to date and completed contract So that they or their representatives are given full information about the services that are being arranged and what the 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 home provides for the money. 3 9 12 Specific risks concerning each persons vulnerability need to be recorded separately. This is so that staff have clear information on how each risk should be managed whilst promoting safety and independence for the person. 4 20 13 All stock medication must be 23/07/2010 checked on a regular basis. To maintain an audit trail that further ensures safe practice and reduces the risk of error. 5 20 13 The key for the medicine cabinet must be stored securely. To ensure safe practice and that access to the cabinet is protected. 6 34 19 When recruiting new staff appropriate references must be relevant to work and include the applicants most recent employer. This makes sure that all people who work at the home are safe to do so. 23/07/2010 23/06/2010 23/07/2010 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 7 34 19 All of the required 23/07/2010 information and vetting checks must be obtained prior to staff beginning work. Full employment histories with an explanation of any gaps must be explored and recorded. This makes sure that all people who work at the home are safe to do so. 8 42 37 The Commission must be notified of all significant events that are reportable under the remit of safeguarding vulnerable adults. This is so we can track that appropriate action has been taken and people are safe. 23/07/2010 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 Person centered care planning is extended to the person who stays for respite care so that their plan is more accessible and meaningful to them. All staff should complete training in person centered care. This will enhance peoples involvement and contribution to their plan of care and ensure staff are familiar with current good practice and developments. Weekly checks on all medication should be recorded for audit purposes. 2 6 3 20 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 4 23 That training on the Mental Capacity Act and new legislation on Deprivation of Liberty Safeguards is rolled out to all staff working in the home so that they are familiar with the guidance and can apply it in their practice. Authenticity on employment references should be checked more carefully and any verbal references recorded before written confirmation is received. All staff attend training on autism to keep their knowledge and skills up to date and in line with current good practice. Reports of the monthly unannounced visits by the registered provider should include more detail about the experiences and outcomes for people using the service. 5 34 6 7 35 39 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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