Care Home: Oak House Short Term Breaks

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What the care home does well There is a stable staff team at the home and there have been minimal changes to this staff team since our last visit to the home, providing continuity and a consistent approach for the people who live at the home. Care plans and the associated records are well written, these are person centred and are kept under review, these documents are amended and updated as required. Staff spoken with were able to demonstrate a sound understanding of the diverse needs of the people who stay at Oak House. Staff are recruited appropriately in line with the organisations policies and procedures, staff are well trained and undertake training in key areas as well as specialist training. What has improved since the last inspection? When we visited the service in November 2008 a requirement was made by us that arrangements must be made for the safe handling and recording of medication received into the home. This meant ensuring that the service`s procedures for dealing with medication are adhered to, and appropriate records are maintained. This was to ensure that medication is safely managed and the people who use the service are not at risk because the appropriate procedures are not being followed. At this visit following our checks of medication, administration practices and recording we found no errors or areas of concern, this requirement had been met. Monthly, unannounced visits to the home are now undertaken in accordance with Regulation 26 of the Care Homes Regulations 2001. This can ensure that the Oxfordshire Learning Disability NHS Trust meets its statutory responsibilities, and the people who use the service can be confident that the standard of care and the conduct of the home are being appropriately monitored and reported on. A system for evaluating the quality of services provided at the service has been established, however, the system has provided consultation with the only with the representatives people who use the service, not the service users themselves. This requirement remains, this is to ensure that the Oxfordshire Learning Disability NHS Trust are making the improvements that are needed, and that the views of the people who use the service, are being taken into account and acted on. What the care home could do better: Risk assessments must be completed to show how people are supported with their personal care, this is to evidence that all issues in respect of the risks associated with bathing and showering have been evaluated, this assessment should include information about any assistance/aids required. A system for evaluating the quality of services provided at the service has been established, however, the system does not provide for consultation with the people who use the service, only with their representatives. This requirement remains, this is to ensure that the Oxfordshire Learning Disability NHS Trust are making the improvements that are needed, and that the views of the people who use the service, are being taken into account and acted on.The Registered Person must act upon the recorded areas of deficit recorded within the organisation fire risk assessment dated 20th October 2009. This is to ensure that people who stay at and who work at Oak House are not put at risk from avoidable issues and to further ensure that identified required actions are undertaken. The Registered Person must act upon the recorded areas of deficit recorded within the risk assessment dated 2nd September 2009 for the working environment at Oak House. This is to ensure that those who stay and work at Oak House are not put at any unnecessary risk and that appropriate action is taken as identified. Monies held on behalf of those staying at the service must be accounted for and correspond with records in place at the service. This will ensure that people`s money is audited and clearly accounted for. The Registered Person shall, having regard for the number and needs of service users ensure that the physical design and layout of the premises to be used as a care home meets the needs of service users. It is required that the Registered Person acts upon the recommendations of the completed disability access report in order to ensure that people who stay at Oak House are not restricted within the home due to to building not being `fit for purpose`. Improvements must be made to the lighting in the main corridor of the home, this is to provide a brighter, safer environment for those staying at Oak House. The Registered Person must act upon the recommendations of the disability access report completed in respect of making the building more accessible for those who have a disability. Key inspection report Care homes for adults (18-65 years) Name: Address: Oak House Short Term Breaks Brimble Hill Wroughton Swindon Wiltshire SN4 0RA     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: Odette Coveney     Date: 0 2 1 1 2 0 0 9 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 34 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) 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Oak House Short Term Breaks Brimble Hill Wroughton Swindon Wiltshire SN4 0RA 01793814827 01793845782 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Oxfordshire Learning Disability NHS Trust 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 category of service only: Care home only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: Learning Disability (Code LD) Date of last inspection Brief description of the care home Oak House Short Term Breaks is run by the Oxfordshire Learning Disability NHS Trust (O.L.D.T.). O.L.D.T. were registered in May 2008 to run the service, which was previously being provided by the Swindon Primary Care Trust. The service is designed to give people with learning disabilities and their families a break from their usual living arrangements. The service is predominately for people living in the Swindon area. The number of breaks available is agreed at the referral stage, being based on the needs of individuals, and their family situations. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 7 1 3 1 1 2 0 0 8 Brief description of the care home The service is provided at a property on the outskirts of Wroughton. This property has had a number of institutional type uses over the years, and there are plans for the service to move into new, purpose built accommodation during 2009. Our visit in November found that this had not happended, with no iminent plans to move premises. The people who stay at Oak House receive support from a management and staff team, which consists of registered manager, team leader and support workers. Information about the service is provided in a Statement of Purpose and a Service Users guide. A report of this inspection will be available from the service. Inspection reports are also available on the Commissions website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 34 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 unannounced key inspection took place over 8 hours and was completed in one day. The Registered Manager was present during the inspection and participated in the process. Evidence was gained from a whole range of different sources, including: Information provided by the registered provider with the completed Annual Quality Assurance of the service, information taken from comment cards, directly speaking with people who work at the home, a review of individuals care records, a tour of the home, an examination of some of the homes records and observation of staff practices and interaction with the people who live at the home. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act and to review the quality of the care provision for the individuals who stay at Oak House and to also review the seven requirements and five recommendations made during our last key visit to the Care Homes for Adults (18-65 years) Page 6 of 34 service which was undertaken in November 2008. Ten comment cards were received prior to the inspection, four were from people who have stayed at Oak House and it was clear that they had been supported to complete the form by their relatives, four completed surveys were also received from staff who work at the home, one was from a relative of an individual who has stayed at Oak House, one was from a health/social care professional who has supported a person who stayed at the service. Comments made were reviewed during the inspection visit and comments, maintaining individuals confidentiality, were shared with the manager and some of these have been incorporated within this inspection report. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Risk assessments must be completed to show how people are supported with their personal care, this is to evidence that all issues in respect of the risks associated with bathing and showering have been evaluated, this assessment should include information about any assistance/aids required. A system for evaluating the quality of services provided at the service has been established, however, the system does not provide for consultation with the people who use the service, only with their representatives. This requirement remains, this is to ensure that the Oxfordshire Learning Disability NHS Trust are making the improvements that are needed, and that the views of the people who use the service, are being taken into account and acted on. Care Homes for Adults (18-65 years) Page 8 of 34 The Registered Person must act upon the recorded areas of deficit recorded within the organisation fire risk assessment dated 20th October 2009. This is to ensure that people who stay at and who work at Oak House are not put at risk from avoidable issues and to further ensure that identified required actions are undertaken. The Registered Person must act upon the recorded areas of deficit recorded within the risk assessment dated 2nd September 2009 for the working environment at Oak House. This is to ensure that those who stay and work at Oak House are not put at any unnecessary risk and that appropriate action is taken as identified. Monies held on behalf of those staying at the service must be accounted for and correspond with records in place at the service. This will ensure that peoples money is audited and clearly accounted for. The Registered Person shall, having regard for the number and needs of service users ensure that the physical design and layout of the premises to be used as a care home meets the needs of service users. It is required that the Registered Person acts upon the recommendations of the completed disability access report in order to ensure that people who stay at Oak House are not restricted within the home due to to building not being fit for purpose. Improvements must be made to the lighting in the main corridor of the home, this is to provide a brighter, safer environment for those staying at Oak House. The Registered Person must act upon the recommendations of the disability access report completed in respect of making the building more accessible for those who have a disability. 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 34 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 34 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 who are provided with a service at Oak House have an assessment of their needs prior to a service being offered in order to ensure that these are able to be met by the service. Evidence: At this visit we requested to view the homes Statement of Purpose, this was not available. We requested that it be forwarded to us in order that we could check the contents of the document. This is in order to ensure that the information contained within it was sufficient in detail and provided the information needed for those who use the service. After our visit we were contacted by the manager of the service who informed us that the document was in the process of being updated in order to reflect the changes within the structure of the organisation. There have been a number of admissions for short breaks into Oak House since our last visit to the service in 2008. At this visit we saw that all of those who live at the home are funded by the local authority. For those people whose records were viewed we saw that the home had in place a comprehensive care management assessment in Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: order to make a decision on whether the home and the skills of the staff team are able to meet the individuals needs. At the time of our visit there was one person who had been admitted to the service earlier in the year as as part of an emergency placement, during our visit one other person was admitted to the home for a short break. For both of these people we spoke to the manager and the staff team about how these people are supported and what was known about them as individuals. Clear detailed information was given to us about these people, their likes, dislikes and about how they are supported during their stay in areas such as personal, healthcare, emotional and healthcare support. The information given to us had been well recorded within individuals assessments and within care records completed by the service. Within staff training records we saw that staff individually and collectively have the skills to meet the assessed needs of people who stay at Oak House. Within records we saw that staff are provided with core training and specialist training in areas such as person centred care, epilepsy care, infection control and emergency first aid. Care Homes for Adults (18-65 years) Page 12 of 34 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. Care plans are in place and individuals assessed needs are recorded and kept under review. Risks are generally well recorded, however, assessments are needed to evidence how people are support with their personal care. Evidence: During our last visit to the service, which was undertaken by us in November 2008 a requirement was made that peoples individual support plans and the associated assessments must be reviewed and updated where necessary. This was to ensure that peoples individual plans contain up to date information about peoples needs, and are fully completed in accordance with the services intentions. During this visit we reviewed the care and associated records for two of the people who live at the home. One was for an individual who has been at the service since May 2009, the other was for the person who was being admitted into Oak House that day for a short stay. No other people were at the service at the time of our visit. Within individuals files we saw that the home maintains care plans and the associated Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: strategies to support people. We saw that information recorded within the care plan covered areas such as the support required with personal care and healthcare, communication, accessing their day services, and also the support required for individuals with their health and emotional support. We saw that the service had within the care plans also incorporated a more person centred approach and evidenced that individuals themselves had been involved in the development of their plan. Information seen by us included; People who know me say, What matters to me during my stay at Oak House and the support that I need to make sure they happen, Things that matter to me, Things that are important to me.We found that care plans had been generally well written and those seen by us had been kept under review and updated as required. The requirement had been met. Within the records we reviewed we saw that people are supported and enabled to make decisions about their life, these were well recorded.We saw that when required that service had arranged for independent advocacy support for people and have sought advice and information for people in order that they can make an informed choice. Staff at Oak House enable people who use the service to take responsible risks, this is recorded within individual risk assessments and is incorporated within individuals plan of care. Risk assessments seen by us included the use of transport and engagement with social and leisure activities. We did not find any assessments in respect of personal hygiene support, it is required that a risk assessment is completed in respect of the support that individuals require with bathing and showering, this is to evidence that all issues in respect of the risks associated with this area have been evaluated, assessments must be recorded and incorporate the use of any aids and the level of support that is required. Prior to our visiting the service we received four comment cards/surveys from people who use the service, within these people indicated good levels of satisfaction of the service they receive, people told us; The home offers good respite care and support, including stays at short notice. Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to take maintain activities and engage in appropriate leisure activities. Evidence: Staff enable people to have the opportunity to maintain social, emotional, communication and independent skills. Prior to our visit feedback was received from a relative of an individual who stays for short breaks at Oak House, they reported that their relative appears to be satisfied at the home and that as a family they feel their relative is treated well and is happy. At the home there is a dining area for individuals to have their meals in. The Home operates a rotating menu and staff confirmed to us that people who stay at the home are able to make choices about their meals and also that those who live at the home Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: are supported to prepare their own packed lunch and snacks. The home have been awarded a five star food hygiene award. This was issued by Swindon Borough Council based on standards provided by the Food Standards Agency. The home is to be commended for achieving this award. Within the AQAA completed by the home and sent to us prior to our visit the home had recorded; Oak House provides a fun, relaxing and supportive environment with a support team that knows individuals well. Each person is treated as an individual, staff are responsive to their individual needs. There service told us that that have good, honest and open relationships with families and carers, dialogue and information exchange is encouraged. Furthermore the service informed us that they; Offer varied and nutritious meals with individual options available. And also that; We aim to maintain friendships by booking people in together and planning stays for people that are compatible. Ads Oak House provides short breaks for people its purpose is to maintain already established links. We saw that people are supported to participate in social and leisure and to maintain relationships with others, within individuals records we saw that people attend day services, go horse riding and visit places of local interest. Within individuals records we saw that information had been obtained about their preferred routines, we saw that within daily records completed by staff these these corresponded with the wishes of individuals staying at Oak House. we reviewed the information recorded within individuals Listen to me, workbooks, these provide staff with information in order to support people in they way they choose, information included; Who are the people in my life?, What others like about me and What I do on evenings and weekends. Staff spoken to were fully aware of these contents of these documents for the people in their care. We observed staff to be effective communicators and caring and supportive in their approach. Care Homes for Adults (18-65 years) Page 16 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are well supported to ensure that their emotional and physical health needs are met. Medication is managed well at the home. Evidence: Oak House provides short term accommodation and personal care for up to seven adults, male or female, who have a diagnosis of learning difficulties. At the time of our visit there were two people staying at the home. People are supported with their primary healthcare needs such as the dentist, chiropody and optician, these had all been recorded. We are aware that prior to our visit a person who had been staying at Oak House had been supported by the community district nursing service. During our visit we saw that the home contacts an individuals GP or any required healthcare service promptly when a need has been identified. During our last visit to the service in November 2008, two requirements were made in respect of how medication is handled at the home. These were that controlled drugs Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: must be stored in a cupboard that meets the current storage regulations: the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007. This was to ensure that controlled drugs are stored safely. The second requirement that was made by us was that arrangements must be made for the safe handling and recording of medication received into the home. This means ensuring that the services procedures for dealing with medication are adhered to, and appropriate records are maintained. This was to ensure that medication is safely managed and the people who use the service are not at risk because the appropriate procedures are not being followed. We reviewed the systems of medication administration at Oak House. This included an evaluation of the medicines prescribed and a review of the records in place. We noted that medication is stored in a secure cabinet, within a locked room. The home also has suitable facilities to store controlled medication. We saw that each person has a printed medication administration sheet which detailed each individuals medication type, dose and when to be taken. Records were clear and medication given had been signed for as required. We saw that the home had a individual profile for medication given which detailed what people were taking, why and how they were to be supported. The staff member we spoke with was able to provide us with full information about individuals health requirements and medication given. Staff told us about the training they received in order to be deemed competent to give medication. They told us that their medication competency is reviewed on an annual basis at the home. Care Homes for Adults (18-65 years) Page 18 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be assured that any complaints they have will be listened to and acted upon and that they will be safeguarded from harm. Records of money held on behalf of service users must be better accounted for. Evidence: Within the AQAA completed by the home and sent to us prior to our visit the home had recorded; A dedicated Listen supporter, is available to to support people, the service has a whistle blowing policy in place that will support staff who feel the need to report cases of suspected abuse. The service informed us that all staff are subject to an enhanced CRB check and clearance prior to taking up their post and that staff are trained in Protection of Vulnerable Adults ( POVA) and that know how to record concerns. Within the completed AQAA the service also informed us that staff are provided with a staff guide No secrets in Swindon and Wiltshire and posters and information is displayed in the building, these were seen by us. Within the completed AQAA the service informed us that they; Deal promptly with concerns and complaints. As part of this visit we reviewed how the service deals with and responded to complaints or concerns that area raised to them, we saw that issues are dealt with effectively, promptly and in a timely professional manner. No complaints were raised to us during, or prior to our visit to Oak House. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: Staff at the home have completed protection of vulnerable adults training. One of the staff members was asked about their understanding of what constitutes abuse and what their responsibilities in this area would be; the staff member told the inspector of the protection of vulnerable adults training they had undertaken, ensuring the rights of the resident were upheld, not making judgement and the importance of reporting and recording. This staff member demonstrated a sound understanding of this subject and linked it into their knowledge obtained whilst undertaking a NVQ, National Vocational Qualification in care practice. Records of recently employed staff members were viewed and evidence was in place to show us that the service had obtained personal information and a record peoples identity. Other information seen included, record of previous employment, and evidence of satisfactory Criminal Record Bureau disclosures. The home has good systems in place to manage any monies they hold on behalf of the people who stay there, however, during this visit the account of one person was checked against the records held and they did not tally. The manager was able to account for the money, however, this is not good enough. It is required that money held for safekeeping on behalf of people who stay at Oak House must be clearly accounted for and recorded, to evidence transactions and safeguard people. Minor accidents and incidents were recorded and more serious accidents and incidents affecting the well-being of people who stay at Oak House are reported to the Care Quality Commission. Care Homes for Adults (18-65 years) Page 20 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment provided is functional. Consideration must be given as to whether the premises provided are fit for purpose. Evidence: Oak House Short Term Breaks is run by the Oxfordshire Learning Disability NHS Trust (O.L.D.T.). O.L.D.T. were registered in May 2008 to run the service, which was previously being provided by the Swindon Primary Care Trust. The service is designed to give people with learning disabilities and their families a break from their usual living arrangements. The service is predominately for people living in the Swindon area. The number of breaks available is agreed at the referral stage, being based on the needs of individuals, and their family situations. The service is provided at a property on the outskirts of Wroughton. This property has had a number of institutional type uses over the years, and there are plans for the service to move into new, purpose built accommodation during 2009. This has not happened. We spoke to the manager about this and about the concerns we have about the current accommodation provided. We were informed that there had been some difficulties which had delayed the proposal for a new purpose built accommodation and that at the time of our visit no timescales were able to be given Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: about the new build and it is anticipated that this will be no time soon and is more of a long term plan. Upon our approach to the home our first impressions were that the building was derelict, its windows and exterior was shabby and the home appeared to have not been well maintained. One of our concerns was about the first floor of the premises, this is unused and has not accommodated people for a number of years. We were informed that the windows for this floor are to be boarded up and that the stairway leading to the upstairs would be closed off. This was not the case when we visited. We viewed this area and were appalled by what we saw, we had concerns about the impact of this part of the house in respect of fire safety and the health and welfare of people who live and work at Oak House. Further reference will be made about this within the management section of this report. At our last visit to the services in November 2008 a requirement was made by us that the premises must be fit for the intended purpose, and meet the needs of the people who use the service. The Commission received a copy of the building audit report, which included confirmation of the action being taken in respect of items of work, including any relating to fire, that had been identified, this requirement will remain this is to ensure that items of work are being appropriately identified and actioned, and that people who use the service stay in accommodation that is safe and meets their needs. On 2nd September Swindon Primary Care Trust completed a risk assessment for the service of the working environment within this report a number of concerns were noted, these identified hazards associated with the unoccupied/unused areas of the upper floor, some of these concerns were; Increased risk in the event of a fire due to missing ceiling tiles and large gaps in the ceiling giving direct access to roof space, an increased risk in the event of a fire due to poor housekeeping; rubbish and combustible materials strewn throughout the top floor. The report also noted open holes in the building structure allowing access to vermin and birds. Risk of trapped and dead animals spreading infectious diseases, dead birds in this area were seen by us during our visit. In respect of the upper floor the report also commented on the safety of utilities and reported that these were uncertain due to removal of appliances and accessories. The reported stated about the electric shower had been removed, bare wires were left exposed, there are suspect labelling of outlets -415volt label on a 220 volt outlet and there is no flowing water in drains, risk of vermin and noxious gases. We noted that the Swindon Primary Care Trust had an action plan in place to Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: respond to the identified areas of concern, most of these being addressed in March 2010, consideration should be given to bring these works forward should it be identified that any persons living or working at the service are at risk. It is required that The Registered person must act upon the recorded areas of deficit recorded within the risk assessment dated 2nd September 2009 for the working environment at Oak House. Upon arrival to the home it was a bright, sunny day, however, the main corridor was dull and dark with many light bulbs not lit, the manager confirmed to us that there are people who stay at Oak House who have visual impairment. This area requires improvement to the lighting to ensure that those who stay there are staying in a place that is well lit with suitable lighting. Each person who stays at Oak House was their own room furniture and fittings and suitable and sufficient to meet the needs of people who stay there. Since our last visit to the service the home have a new shower facility, within the AQAA completed prior to our service we were informed; Service users with profound physical needs (with the exception of one) are able to access new shower facility, making this facility not suitable for all. During our visit the manager told us about an assessment of the premises which had been undertaken in order to review the disability access for the people who use the service, a number of areas of shortfalls in respect of access for people were told to the manager, these included poor access to the garden and to other areas within the home. It is required that the Registered Person acts upon the recommendations of the disability access report in order to ensure that people are not restricted within the home due to to building not being fit for purpose. The home has sufficient bathroom areas for individuals with both shower and bathing facilities in place. The home was found to be clean and odour free at our visit. Care Homes for Adults (18-65 years) Page 23 of 34 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. Individuals are cared for by sufficient numbers of competent staff that are provided with training and supervision in order to fulfill their roles and responsibilities. Safe vetting and recruitment procedures are in place. Evidence: On the day of the site visit there were sufficient numbers of staff on duty with flexible working by staff in order to meet individuals needs and aspirations. Staffing provision appeared to be consistent with levels and skills needed due to assessed care needs of the individuals. The staff team have a varied range of knowledge and skills, they were observed by the us to be good listeners, effective communicators and were interested and motivated in meeting the needs of those living at the home. When we spoke with staff staff they spoke positively about their role and the work they do and were able to give a number of examples of areas within their role which gave them job satisfaction such as one to one time with individuals, supporting people in they way they prefer. Staff were disappointed that the service had not transferred to new premises and commented that they felt devalued to work in a Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: building that was so dated and in need of upgrading. We received four completed surveys from staff prior to our visiting the service within these staff had reported to us; The uncertainty of the service, not knowing where, or even when we are moving, seems to be making the staff edgy, Although the building is not good, I believe we do most things well. One person told us; The whole building needs to be pulled down and a new one built. A comment card received prior to the site visit, which had been completed by a relative of a service user, recorded that all staff appear to be caring and considerate. Generally there have been no significant changes in the numbers of the staff team since our last visit to the service and their remains a stable staff team at the service. At this visit the staff records for three staff members were fully reviewed and three staff members were spoken with as part of the inspection process. The home operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of people who live at the home. Written references, protection of vulnerable adults checks and criminal record bureau checks had been undertaken for staff prior to their commencement at work. In the front of each staff members file there is an information details sheet that shows what checks have been completed, by whom and when. During our last visit to Oak House in November 2009 a requirement was made by us that; A person is not fit to work at the service unless certain information has been obtained about their background, character and fitness. We also reported that records must be available of the information obtained and when this was received. This is is to show that there is evidence of a robust recruitment procedure being implemented, which protects people who use the service from being supported by unsuitable staff. Information seen by us and discussions with the manager confirmed to us that this requirement had been met. Records evidence that staff have undertaken training in the following areas; first aid, infection control, manual handling, fire safety, medication competency, food hygiene. The achievement of a National Vocational Qualification is well promoted within the home. We are satisfied that sufficient amounts of training have been provided. We saw that staff meetings are held regularly at the home and these provide an opportunity for staff to discuss their role and responsibilities in line with the assessed needs of people they are supporting. Care Homes for Adults (18-65 years) Page 25 of 34 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. Those who stay at Oak House benefit from the ethos, leadership and management approach of the home. The rights and best interests of people who stay at Oak House are safeguarded by the homes policies and procedures. The health, safety and welfare of people at the home are promoted and protected, however, the organisation must act upon identified risks to ensure people who stay and work at the service are not harmed by avoidable identified risks. Evidence: The manager Linda Dickie has a wealth of knowledge and experience in working with and supporting and of care of young adults and has management experience in developing and supporting a staff team. During the inspection Mrs Dickie was able to demonstrate a clear understanding of the aims and objectives of the home and of her role and responsibilities for both residents and the staff team. Staff spoken with said that they are positive that the management team are Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: committed to ensuring the needs of service users are met, that ideas and suggestion are listened to with regular team meetings being held for continuity of care and effective communication. During our last visit to the service, undertaken by us in a requirement was made that monthly, unannounced visits to the home must be undertaken in accordance with Regulation 26 of the Care Homes Regulations 2001. This was to ensure that the Oxfordshire Learning Disability NHS Trust meets its statutory responsibilities, and the people who use the service can be confident that the standard of care and the conduct of the home are being appropriately monitored and reported on. This requirement had been met and we have received copies of these visits on a regular basis, the reports showed us that staffing, records and the support requirements of people who use the service are monitored as appropriate, this requirement had been met. During our last visit to the service a requirement was made that a system for evaluating the quality of services provided at the service must be established and maintained. The system must provide for consultation with the people who use the service, and with their representatives. This is to ensure that the Oxfordshire Learning Disability NHS Trust is making the improvements that are needed, and that the views of the people who use the service, and of their representatives, are being taken into account and acted on. At this visit we spoke to the manager about this and saw minutes of meetings which have been held with representatives of those who use the service, (with futire meetings arranged), however, there has been no consultation with the people who use the service and there was no evidence that their views have been obtained, listened to and acted upon, we find this requirement to have been partly met and it will remain in order that we can monitor and review what the service is doing to obtain the views of people who use their service and to see if appropriate action is taken when needed. The service keeps us informed of incidents which affect the wellbeing of individuals who stay at the home. During this visit we reviewed incident/accident forms, individuals daily records and spoke with staff about incidents which have been reported to us. The home deal with incidents appropriately in order to ensure the safety and wellbeing of the individuals involved. We saw that the home contact specialist healthcare services as required with additional support also being provided by the home when needed, care planning and individuals risk assessments are updated where required in order to ensure that staff are provided with clear accurate information in order to direct and guide their practice. The fire logbook was viewed and was well maintained. The home was completing the Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: appropriate checks on the fire equipments and recording of training and testing of equipments were satisfactory. Staff have attended fire drills to ensure that they have clear knowledge of action to be taken in the event of fire emergency. The service forwarded to us a copy of the fire officers report at our request after our inspection as this was not available at the time of our visit. The report was completed following their visit to the service on 20th October 2009. Within the report eight areas of deficit were recorded;the four high areas of risk included; There is an unacceptable amount of combustibles stored at first floor level. It was recorded that whilst this does not constitute a direct risk it could be used if unauthorised access by fire setters occurred. The second area of high risk recorded was that there is an unacceptable amount of combustibles stored at first floor level. This indicates that there is little or no control over this area. It is imperative that the fire loading in this area is reduced considerably by the removal of all unnecessary equipment and combustibles. The assessment also recorded that attention should be given to the fabric of the building outside the emergency exit at the end of the corridor. The report stated that crumbling building materials outside this door could result in the door being obstructed, and persons injured.The report hight lighted that emergency lighting was not being tested as required and the assessment reported that the records show the last testing of the emergency lights as 3rd Feb 2009. They should be tested monthly and annually. It is required that the Registered Person must act upon the recorded areas of deficit recorded within the organisation fire risk assessment dated 20th October 2009 to ensure that people who stay at and who work at oak House are in an environment that is safe and free from avoidable risks, furthermore action would evidence compliance from the provider in ensuring they are providing a well maintained, safe environment. Care Homes for Adults (18-65 years) Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 24 23 That the premises are fit for 31/12/2008 the intended purpose, and meet the needs of the people who use the service. The commission must receive a copy of the building audit report, which includes confirmation of the action being taken in respect of items of work, including any relating to fire, that have been identified. This is to ensure that items of work are being appropriately identified and actioned, and that people who use the service stay in accommodation that is safe and meets their needs. 2 39 24 A system for evaluating the 31/01/2009 quality of services provided at the service must be established and maintained. The system must provide for consultation with the people who use the service. This is to ensure that the Oxfordshire Learning Disability NHS Trust is making the improvements that are needed, and that the views of the people who use the service are being taken into account and acted Care Homes for Adults (18-65 years) Page 29 of 34 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 on. Care Homes for Adults (18-65 years) Page 30 of 34 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 9 13 The Registered Person shall ensure that any activities in which service users participate are so far as reasonably practicable free from avoidable risks. A risk assessment must be completed. This is to evidence that all issues in respect of the risks associated with bathing and showering have been evaluated. 31/12/2009 2 22 17 The Registered Person must 09/12/2009 ensure that financial records of money held for service users are correct. Money held for safekeeping on behalf of people who stay at Oak House must be clearly accounted for and recorded 3 24 23 The Registered Person shall, having regard for the 25/02/2010 Care Homes for Adults (18-65 years) Page 31 of 34 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 number and needs of service users ensure that the physical design and layout of the premises to be used as a care home meets the needs of service users. Registered Person acts upon the recommendations of the disability access report in order to ensure that people are not restricted within the home due to to building not being fit for purpose. 4 24 24 The Registered Person shall, 26/01/2010 having regard for the number and needs of service users ensure that the physical design and layout of the premises to be used as a care home meets the needs of service users. The main corridor requires improvement to the lighting to ensure that those who stay there are staying in a place that is well lit with suitable lighting. The Registered Person shall, 25/01/2010 having regard for the number and needs of service users ensure that the physical design and layout of the premises to be used as a care home meets the needs of service users. 5 42 23 Care Homes for Adults (18-65 years) Page 32 of 34 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 The Registered person must act upon the recorded areas of deficit recorded within the organisation fire risk assessment dated 20th October 2009. 6 42 23 The Registered Person shall, 25/01/2010 having regard for the number and needs of service users ensure that the physical design and layout of the premises to be used as a care home meets the needs of service users. The Registered Person must act upon the actions required within the environmental risk assessment. 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 Care Homes for Adults (18-65 years) Page 33 of 34 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. 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