Care Home: Oak Tree House

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What the care home does well People have enough information about this home before they come to live here.Staff get to know people well before they move in. This helps to make sure that the home will suit them.Each person has their own care plan. Staff support them to do the things they want to do. They help them to develop the skills they need to do this.The people who live here are helped to stay healthy.People who live here can choose what they want to do.They are supported to do as much for themselves as they can.This includes cooking, cleaning and shopping.They manage their own money and medication if possible.Some people go out and travel alone.The home encourages and enables people to have lots of interests. This includes employment or voluntary work and leisure activities at the home and in the community.The home is run in the best interests of the people who live there.They live in a comfortable homely place.They are kept safe. Their complaints are heard and acted upon.There is a small group of staff who work at the home. They are friendly.They are trained to care for people with learning disabilities.People told us that the staff listen to them and support them well. Staff make sure that the care and support provided is flexible, consistent and that it meets people`s changing needs. What has improved since the last inspection? The guide to the home now has information which is up to date.Each person living at the home has their own bank account. What the care home could do better: The home must make sure that it knows people`s needs and that their written support plans are up to date, so that people will get the right support if their needs change.The home should carry out some fire safety checks more regularly, to make sure that people will be protected if there is a fire.There must be a registered manager for this home, to make sure that there is someone in charge who can keep it running well. Key inspection report Care homes for adults (18-65 years) Name: Address: Oak Tree House The Vicarage Paddock Barnhay Bampton Tiverton Devon EX16 9NB The quality rating for this care home is: three star excellent 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: Rachel Fleet Date: 2 2 0 3 2 0 1 0 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 44 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 44 Information about the care home Name of care home: Address: Oak Tree House The Vicarage Paddock Barnhay Bampton Tiverton Devon EX16 9NB 01398331446 01398331446 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : www.selfunlimited.co.uk Self Unlimited care home 7 Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 44 A bit about the care home Oaktree House is owned by Self Unlimited. The home offers personal care and support for 7 people over 18 years old, who have learning disabilities. It does not offer nursing care. The home is in a village. People can easily walk to the shops, a GP and a pub. There is a train station at Tiverton, a town which is a bus ride away. Care Homes for Adults (18-65 years) Page 5 of 44 The home supports people to use buses or taxis on their own if they want to. The home also has a car. Most people at the home do not have a physical disability, so there are not many adaptations. The ground floor has level access. People with bedrooms upstairs have to be able to use stairs, as there is no lift. There is a large kitchen/dining room, a lounge and a toilet on the ground floor. There is also a small room with a payphone. Care Homes for Adults (18-65 years) Page 6 of 44 People are supported to use the laundry room to do their washing and ironing. Everyone has their own bedroom. No-one has to share a bedroom. One bedroom has its own toilet and shower. There are 2 bathrooms with handrails and a shower over the bath. There is a toilet in each bathroom. People living at the home share daily living tasks such as cleaning and cooking. Staffing levels are low, with staff supporting people to become independent. Care Homes for Adults (18-65 years) Page 7 of 44 The home has lawned gardens and a car park. Fees vary depending on peoples individual needs. The weekly fee is £675. This includes some of the cost of a holiday each year with staff support, and some use of the homes car. Fees do not include personal items, taxis, and use of the homes car for social outings. Care Homes for Adults (18-65 years) Page 8 of 44 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: three star excellent 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 Care Homes for Adults (18-65 years) Page 9 of 44 How we did our inspection: This is what the inspector did when they were at the care home The inspection was carried out by 1 inspector. In this report the term we will be used, as the report is written on behalf of the Care Quality Commission. The inspector was there from 10 am to 5 pm on Monday 22 March 2010. Most people at the home go out during the day. She told the home she was coming an hour before she got there, so that people could plan to speak to her if they wanted. Care Homes for Adults (18-65 years) Page 10 of 44 Some people were at work or with friends during the day. But we were able to speak to 5 of the 7 people who lived in the home. Someone who lived at the home showed us around the home. We talked with the support worker on duty and the manager. We looked at the care records of 3 people who lived in the home. Care Homes for Adults (18-65 years) Page 11 of 44 We looked at other records that told us how the home is run. This included staff records and health and safety records. Surveys were returned from 2 people living in the home. Two professionals and 3 staff surveys were also returned to us. Before our visit an Annual Quality Assurance assessment (AQAA) was completed by the manager. This is a form telling us how the home is meeting the needs of the people that live there. Care Homes for Adults (18-65 years) Page 12 of 44 What the care home does well People have enough information about this home before they come to live here. Staff get to know people well before they move in. This helps to make sure that the home will suit them. Each person has their own care plan. Staff support them to do the things they want to do. They help them to develop the skills they need to do this. Care Homes for Adults (18-65 years) Page 13 of 44 The people who live here are helped to stay healthy. People who live here can choose what they want to do. They are supported to do as much for themselves as they can. This includes cooking, cleaning and shopping. Care Homes for Adults (18-65 years) Page 14 of 44 They manage their own money and medication if possible. Some people go out and travel alone. The home encourages and enables people to have lots of interests. This includes employment or voluntary work and leisure activities at the home and in the community. Care Homes for Adults (18-65 years) Page 15 of 44 The home is run in the best interests of the people who live there. They live in a comfortable homely place. They are kept safe. Their complaints are heard and acted upon. Care Homes for Adults (18-65 years) Page 16 of 44 There is a small group of staff who work at the home. They are friendly. They are trained to care for people with learning disabilities. People told us that the staff listen to them and support them well. Staff make sure that the care and support provided is flexible, consistent and that it meets peoples changing needs. Care Homes for Adults (18-65 years) Page 17 of 44 What has got better from the last inspection The guide to the home now has information which is up to date. Each person living at the home has their own bank account. What the care home could do better Care Homes for Adults (18-65 years) Page 18 of 44 The home must make sure that it knows peoples needs and that their written support plans are up to date, so that people will get the right support if their needs change. The home should carry out some fire safety checks more regularly, to make sure that people will be protected if there is a fire. There must be a registered manager for this home, to make sure that there is someone in charge who can keep it running well. Care Homes for Adults (18-65 years) Page 19 of 44 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Rachel Fleet CQC South West Citygate Gallowgate Newcastle upon Tyne NE1 4PA 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 20 of 44 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 21 of 44 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. Individuals can get good information about Oaktree House, in various ways, to help them decide if it is a suitable place for them to live. People who move into the home will be supported and enabled as the individual that they are, because staff work hard to get to know their particular needs. Evidence: The people who live at Oaktree House tend to move there from a larger care home in the area also owned by Self Unlimited. Thus they often know a lot about Oaktree House already, and have met the staff or people who live there. The home rarely has vacancies, with some people having lived at the home for several years. In surveys, people who live there said they were asked about whether or not they wanted to go to live at the home, and they had enough information on which to make their choice. The written guide to the home had been reviewed after our last visit, and was currently being updated again to show the new fees being charged from April 2010. The manager said she would ensure that people living at the home received the updated guide as is Care Homes for Adults (18-65 years) Page 22 of 44 Evidence: required in the regulations. Information was provided in an easy read format, although the home will try to provide it in the form individuals find most helpful. Staff discuss written information with people so that they understand it or know about any changes made when it is updated. Each person is assessed before going to live at Oaktree House and before they choose to live there long term, to make sure first that the home can meet their needs and wishes. This assessment is in a comprehensive Getting to know you pack, and includes sections called How I communicate, What I must have in my life, and What people need to know and do to support me. Individuals could also ask people important to them to tell the home about the persons strengths and qualities. Information is obtained about their preferred daily routine, and about courses or training they have done or are doing, for example. We met one person who had moved into the home since our last visit. They told us they had visited Oaktree House whilst living at the home at Blackerton. We saw the home had written to them inviting them to stay at Oaktree House for a short while, to see if they would like living there, after the person said they might like to live there. Their views on this visit were recorded, and a note kept of their other visits to the home. These were used as part of the assessment of their needs. Another letter had later been sent to the person, offering them a place at the home. People who already lived at the home had been asked how they felt about people who were thinking about moving in. If more than one person wants to move in, people at the home vote to say who they think should move in, after they have all met. A professional thought the homes assessment arrangements always ensured that accurate information was gathered and the right service planned for people. Care Homes for Adults (18-65 years) Page 23 of 44 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. Each person living at the home has a plan of care that is all about them, what they want to do and need to do, and how they might do it. This includes being supported to develop the skills which help them to take appropriate decisions and risks, in order to live fulfilling lives. The plans are not always kept up to date, so there is a risk that people may not get support they need. Evidence: Each person who lives at Oaktree House has an individual support plan, in a file which they are enabled to keep securely themselves. One person showed us their file, explaining their keyworker had helped in putting the information together. Two professionals thought the home was good at monitoring, reviewing and meeting peoples social and care needs. However, some written care plans and risk assessments we read had not been updated for over a year, and so did not fully reflect individuals current abilities, achievements or support needs. We brought this to the managers attention. One persons plan dated February 2009 indicated they were being assisted to plan a particular holiday. Staff told us they had had this holiday, and daily notes showed Care Homes for Adults (18-65 years) Page 24 of 44 Evidence: they were now arranging another holiday. The support plans we saw were very person centred or individualised, with goal oriented care and support. Each person, with the help of their key worker, thinks about what they would like to achieve and works out what they need to do to achieve this. This includes learning new skills or building on old skills. One person told us they were hoping to move to another area, for example, and this was reflected in their plan. Part of this care planning process is about taking risks. Staff work with the individual to ensure that risks are not seen as barriers to achieving goals, with timescales only set when appropriate, to avoid failure. Records showed how peoples confidence had grown and their abilities had developed, increasing their quality of life. Each person has their own bank account. We saw risk assessments and varying levels of planned support relating to these in peoples care records, and were told about it by staff. The home does not keep any money on individuals behalf, a development since our last inspection. Records relating to transactions were kept as relevant, in the care file each person held. We saw from care notes made by staff that some people had asked for help reading their bank statements, for example. Staff we spoke with were clear that they did not look at peoples bank statements unless asked to. This promoted peoples privacy and independence. Care Homes for Adults (18-65 years) Page 25 of 44 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Oaktree House have their quality of life enhanced by the range of opportunities and activities they are enabled to enjoy. They benefit from a healthy diet which they plan and cook themselves. Evidence: Our day at the home and the records we read showed that people who live at Oaktree House enjoy busy lives - kept occupied by jobs or voluntary work they do in the local community, by their preferred pastimes or interests, and by household duties such as cooking and cleaning. When we arrived, 1 person was at the home and they were busy with various housekeeping tasks. Another person was on a long week-end away with a friend. The other 5 people who lived at the home had either gone to work, or to People First – an advocacy service which is managed and operated by people with learning difficulties. Professionals thought the home generally supported people to live the life they choose. Care Homes for Adults (18-65 years) Page 26 of 44 Evidence: We found that to do this, the home carried out risk assessments and used innovative ways of managing risks, seeking advice from other professionals in relation to this also. People we spoke with said staff were supportive and helpful. They were very happy about their own particular achievements, and told us about their plans for the future. One person told us they would like to go to college. The manager explained that funding options were being explored. Some people attend local social clubs such as Gateway, a church, and have an active role as members of a first aid charity. Some people visit local towns regularly for shopping trips, some attend local sporting events, go swimming, etc. One person told us they went to the local pub in the evening. Care plans and daily notes reflected that people are encouraged to use their mobile phones, when out, to inform staff if they change their plans for the day. Everyone is enabled to develop skills to use public transport and be out as independently and safely as possible. This has included obtaining relevant travel passes, road safety skills, and what action to take in an emergency (including use of public pay-phones, and how to safeguard themselves from people who may try to take advantage of them or who treat them badly). Where people chose not to use public transport, other transport options had been discussed with them. Home alone time has been introduced for each person, subject to individuals preferences or wishes and on a risk assessment basis. Thus individuals may be at the home without support workers being there, for up to 1.5 hours at present. When we rang the home on the morning of our visit, someone who lived at the home answered the phone. They asked us to wait outside until the manager returned, as she wasnt at the home. We later learnt that this was part of the specific training given to people about being at the home on their own, which included ensuring that they could respond appropriately in a variety of emergency situations. We noted that people had been consulted about how long they might want to be alone at the home, between what hours of the day, who else they were happy to be in the house with at such a time, etc. Some people told us they have satellite television and laptops, using Self Unlimited facilities to access the Internet. People can also use the computer in the office, in the evenings. The manager confirmed that people are given information to help them use the Internet safely. We saw individuals favourite pastimes (jigsaws, videos, etc.) in the day rooms. House meetings included discussion of issues that can arise in a communal setting, such as fair use of shared areas such as the lounge. Care records included information about people important to each individual living at the home. Friends and relatives are free to come and visit, and may join people for the meal they have cooked. The day we visited, a friend of some people at the home came in for a coffee before they all went out for the day. One person told us they go to visit a friend who lives where they used to live. Care Homes for Adults (18-65 years) Page 27 of 44 Evidence: Meals are planned and prepared by the people living at the home. They each write on the menu sheet what they intend to make when it is their turn to cook. They are responsible for making the shopping list, which is kept in the kitchen with the weekly menu. Whether the main meal of the day is at lunch or dinner depends on what the cook is doing with their day. People can make something different if they wish to, as one person explained. They can make themselves a meal if they are going to be out when the others are eating, for example. Information is provided on healthy eating. There was a bowl of fruit in the lounge, and one person we asked about it appreciated having it there. People may make themselves a snack if they wish, but are not to cook anything if there is no support worker at the home. Most people used the main kitchen area, but one person cooked independently for themselves, showing us the homes separate training kitchen that they used. Care Homes for Adults (18-65 years) Page 28 of 44 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are met through sensitive, enabling support and proactive healthcare management. They manage their own medications to a degree that suits them. Evidence: Most people living at the home when we visited did not need help with their personal care, and others received a very minimal amount of support. Discussions with them, with staff and the care records we read, showed that individual choices about personal care were respected. Additional relevant information was given to individuals so that they could make more informed choices. Peoples preferences about the gender of their carer were strictly adhered to. There was a file of information about peoples individual support needs, kept for support workers who did not work at the home regularly (- such as bank staff). The content of the file had been provided by each person, giving them control of the information that was shared about them. Professionals thought the home respected peoples privacy and dignity. They also said the home always or usually sought advice, acting on it to meet peoples social and health needs and improve their well-being. Care Homes for Adults (18-65 years) Page 29 of 44 Evidence: People we spoke with felt enough attention was paid to their health, and said that staff noticed if they were a bit under the weather. One person had been given a ground floor bedroom as they had mobility problems that affected safe independent use of stairs. People are helped to access specialist services and to attend routine health appointments, the homes transport being available free of charge for such occasions if needed. The manager confirmed that everyone is offered an annual health check. We saw from care records as well as hearing from staff that people chose whether support workers accompanied them on such appointments. Reasons were given why they might want or need someone with them. Specific care records were kept to show what health checks people had had and when. We saw people visited dentists, chiropodists, opticians, community nurses and their GP. One person told us someone had visited them at the home to attend to their communication aids. Another person had begun to attend a memory clinic. We saw in peoples files guidance to be used to ensure that consent was obtained properly for any medical procedures, should an individual need more complex health care. There were suitable storage facilities for medication to be held by the home, including storage for controlled drugs. We saw a record was kept of medication received into the home for each person, as is required by regulation. The manager confirmed that the home - rather than individuals - is responsible for returning unwanted medication to a pharmacy. We saw records were kept relating to such items - where, in one case the homes medication audit had found an item to be out of date, for example. People were prescribed relatively little medication. They were being supported to manage their medications to a degree that suited them as an individual and based on a risk assessment. This included responsibility for keeping them securely and keeping their medication records. We found from such records that when people were unwell or had greater health problems than usual, they were given additional support with their medication. We were told that some people collected a weekly stock of medication from staff, rather than keeping the monthly supply prescribed. This meant the person took medication from the containers provided by the pharmacy and put it into a weekly dossette box, with staff present for support. We clarified with the manager that secondary dispensing by staff was not occurring. We also discussed whether the pharmacy could supply medication in a more suitable way for individuals, which the manager said she would follow up. Care Homes for Adults (18-65 years) Page 30 of 44 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples complaints are used positively to improve their lives and their self-confidence. They are protected from abuse in a variety of ways that arise from the homes ethos, policies and practises. Evidence: The Commission has not received any complaints about this home since our last inspection. In surveys from people who lived at the home, they said that they knew how to make a complaint, and what to do if they were unhappy. They said staff always listened and acted on what they said, and that staff always or usually treated them well. People we spoke with said they felt able to say if something was wrong and that staff would listen to them and try to sort it out. They said they would go to their keyworker or the manager. Professionals surveys said the home always or usually responded appropriately if they or anyone else raised any concerns. We noted that people had their own copy of the complaints procedure, but it had not been updated with our new contact details. The manager said she would ensure this was done. We saw the home kept a record of complaints they received, and how they were responded to. The manager confirmed the home had not received any complaints since 2008. She told us that staff offer people support to make a formal complaint when they Care Homes for Adults (18-65 years) Page 31 of 44 Evidence: raise an issue, recording if they decline to do so. Some people had completed complaint forms themselves, and we found the blank forms were available in the pay-phone room. There was also a board here that people used to communicate matters they wanted their peer representative to take up - a Speaking up resource set up by someone living at the home. During our visit, the manager let the individual know that there were some messages there for them. Staff told us discussions at the house meetings include how people can make complaints or deal with issues, within the home and outside, as a way of helping them to have more control over their lives and enabling them to confidently speak up for themselves. Conversations with support workers and our observations during the visit showed that they are very mindful of maintaining individuals privacy and confidentiality in relation to written and spoken information. When individuals asked support workers certain questions about other people who lived at the home, they were guided to ask the person themselves about the matter, for example. Staff were also clear that people could choose what information they wished to share with them, such as about personal finances or health matters. But we also found evidence that safeguards were in place and had been used as a final strategy, to ensure peoples finances or their welfare were sufficiently protected. People told us they felt safe with staff, with one going on to talk about their role regarding health and safety matters when we asked if they also felt safe at the home. The home has appropriately and sensitively made some safeguarding alerts since our last visit, to protect the welfare of individuals at the home and which upheld their rights. These were dealt with under the local authoritys safeguarding procedures. When we asked staff and the manager what they would do if an allegation of abuse was made, they showed us guidance displayed in the office. This included a step-by-step checklist they were to use if actual or alleged abuse or assault was reported to them. This guided them clearly through appropriate procedures, including contact numbers for relevant outside agencies with safeguarding responsibilities. There was also a clear policy defining abuse, and the local authoritys guidance was available. The availability of this information addressed a requirement made at our last visit. Care Homes for Adults (18-65 years) Page 32 of 44 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Oaktree House have a home that suits their needs, is clean and generally safe. Certain maintenance checks are not always done, which may create a risk to peoples welfare. Evidence: People we spoke with said they were happy with the facilities in their bedroom and the home generally - the furniture, lighting (including in the evenings), heating, supplies of hot water, etc. One bedroom has an en suite facility, with a shower in it. The lounge and dining areas have lots of natural light. We saw people had keys for their bedrooms, as well as having a lockable unit provided. They told us they had a key for the front door as well. The local fire authority had visited the home in June 2009, and were satisfied with the fire safety arrangements at that time. Records showed the fire safety system had been regularly serviced by an external company. The home had systems for weekly or monthly in-house checks, although we brought to the managers attention that these were not always carried out as regularly as guidance in the log book indicated. There are lawned areas around the home, with mature trees and some garden furniture but little else of interest. The manager said this was work in progress, with a support Care Homes for Adults (18-65 years) Page 33 of 44 Evidence: worker recently employed to undertake garden maintenance and try to encourage people living at the home to take up more gardening. One person spoke to us about having a garden pond. Another had made the wooden garden compost holders we saw in use. In the AQAA, the manager reported that appropriate maintenance checks had been carried out in a timely way for systems such as the electrical hard wiring. She confirmed that annual servicing of heating systems had been done since the AQAA was sent to us. During our visit, people told us that repairs were dealt with quickly by the homes maintenance man. Of surveys from people who lived at the home, one said the home is sometimes fresh and clean, while another said it was always so. One indicated regular cleaning was something the home did well. It looked clean, and homely yet organised when we arrived at a relatively early time. During our visit, someone was discretely encouraged to carry out their housekeeping responsibilities for the day. People told us that they cleaned their own bedrooms, some saying staff supported them with this, and all had a role in keeping communal areas clean and tidy. We noted that staff dont immediately intervene if someone has not done what was expected, leaving others who live at the home to speak to their peer about it if they wish, in the first instance. People told us they do their own laundry and ironing, hanging washing outside in better weather. They were happy with the facilities in the laundry room. People are specifically guided not to bring their laundry through the kitchen area and use another route, for hygiene reasons. Washing machines had programmes suitable for thorough cleaning of items. The manager told us that a staff member was to booked to attend an infection control course, in order to take on the role of Link staff member for infection control matters. Staff audited supplies of disposable items such as gloves, aprons and soluble laundry bags, which were used for reducing cross-infection risks, thus ensuring they were always available if needed. There were paper towels and liquid soap provided around the home. Someone who lived at the home pointed out the hand-washing facilities in the kitchen, explaining the importance of hand washing as they did this. Another told us a new dishwasher had just been put in. People wore cloth aprons when cooking or preparing food. The manager confirmed these were laundered daily, which is recommended practise. We saw each person had their own pair of rubber gloves for use when doing housework. Care Homes for Adults (18-65 years) Page 34 of 44 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 who live here benefit from a small staff team who, through appropriate recruitment, training and support, can meet their needs. Evidence: When we arrived, we found the manager on duty on her own, which she said was the usual minimum staffing level for the home. She confirmed there was a lone working policy for staff, kept in a file with other relevant policies for whoever is on duty to easily consult. She usually worked Monday to Friday, 9am to 5pm. Another support worker arrived after lunch, who was going to be at the home until the next day. Extra staff are rostered to cover specific support needs. This might be to accompany someone in the community if they have not completed their training on using public transport, or to go with them to a health appointment, for example. There was one person at the home through the morning, a second returning at lunchtime, and 3 people arriving back at various times before we left later in the afternoon. There is one sleep-in staff at the home overnight. People confirmed that they can get hold of this staff member easily enough if they need them, with one person saying they Care Homes for Adults (18-65 years) Page 35 of 44 Evidence: phoned staff from their room if they wanted to (rather than going to find them). People we spoke with said that there were enough staff around when they wanted them. We observed that people were very independent and out for most of the day, as the manager had explained. The staff team consists of 4 permanent staff including the manager, 2 bank staff and a support worker to manage the garden. A fifth person is currently being recruited, to complete the team. The manager clarified that the home does not use agency staff, but uses the bank staff in order to cover sickness and holidays. This ensures that people are supported by a staff group who fully understand them and their needs. Staff told us they get the support and training they need. They said in their surveys that there were usually enough staff to meet peoples individual needs, and that informationsharing in the staff team usually worked well. We were told there were weekly meetings when support, consistency of approach, etc. could be discussed and clarified. Staff we spoke with showed an excellent understanding of the individuals they support and their rights to equality and a full life, conveying a real commitment to best practise and care. Professionals thought that the manager and staff had the skills and experience to support peoples needs. The manager reported in the AQAA that the staff induction programme was based on the nationally recognised Learning Disability Qualification (LDQ), and that further training was planned to meet the changing needs of the people currently living at the home. Staff told us of the specific training staff had already had in relation to 2 peoples changing health needs. Of the 4 staff permanent staff, 2 hold a National Vocational Qualification in Care to Level 2 (NVQ2) or higher. A third, who is undertaking the qualification, told us that modules had been carefully selected for their relevance to the aims of the home. They thus were not undertaking in depth training on medication, as people managed their own medication generally. Instead, they were undertaking a module on Services and facilities, to develop their skills for enabling people to use their local community, public transport, etc. The manager told us that no-one had been recruited since our last inspection, but she was currently processing someones application. The provider now uses an assessment centre for recruitment, which the person had attended. They had also been to the home and been interviewed by the people living there. Action had been taken to obtain a full police check and 3 references before the person started working at the home, although these were still awaited. We noted a gap in the persons employment record with no evidence that this had been explained. The manager told us that this had not been looked into yet because of the change in recruitment practise, but she would ensure this was addressed this before the person was employed, and in future recruitment processes. Page 36 of 44 Care Homes for Adults (18-65 years) Evidence: A staff member who had moved from another Self Unlimited care service to Oaktree House confirmed they too had been interviewed by the people who lived at the home before they went to work there, and that they had undergone an induction programme specifically for Oaktree House. This had included peoples individual routines and associated risk assessments. Care Homes for Adults (18-65 years) Page 37 of 44 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. People live in a home that is run in their best interests. The absence of a registered manager creates a risk to the effective, stable management of the home in the longer term. Evidence: There has not been a registered manager at the home since our last key inspection 3 years ago. Jolene Boyles, the current manager, is the third manager in that time. At the time of our visit, she had begun the application process for becoming Registered Manager, and has since told us that she has sent us her application forms. She has worked at Oaktree House since May 2009, having previously worked at the home in Blackerton. She is currently undertaking a higher level care qualification (NVQ4 in Care), hoping to complete it later this year. She intends then to enrol on further courses as necessary to obtain Level 4 NVQ in Leadership and Management for Care Services, a qualification expected of care home managers. Staff and the people we spoke with were very positive about her and the quality of life Care Homes for Adults (18-65 years) Page 38 of 44 Evidence: that people living at the home enjoy. Self Unlimited monitors and measures the quality of its services through surveys and other more informal feedback from people who use the services, healthcare professionals, etc. A business plan was available for the home. However, the surveys are not used in a way that provides feedback on a specific service - results being presented for Self Unlimiteds service users as a whole group. The manager discussed that she might carry out surveys for the home separately, to ensure that the service provided at Oaktree House and any developments of the service suited the people living there. She is also considering drawing up action points from house meetings, and checking progress on these at subsequent meetings, to more formally evidence ongoing development of the service in line with peoples wishes. People we spoke with confirmed that the regular house meetings noted in the AQAA were useful, and that changes were made as a result of these discussions. These meetings were run by the people living at the home. A staff member was present to take the minutes and for general support, which people we spoke with confirmed was a satisfactory arrangement. Fire drills are held and people told us what they do when this happens, which staff confirmed was the appropriate action. A drill had recently been held without warning, and people had responded well. The manager told us she has a recognised qualification in Health and Safety. Staff have received training and updates on safe working practises, such as First Aid, food hygiene, and health and safety. Training on these topics is also offered to people who live at the home, as we found through our conversations with them. We saw the home had obtained appropriate food hygiene guidance (Safer food, better business). Staff recorded temperatures of cooked food, fridges, freezers, etc., as is good practise. The kitchen area looked clean and orderly. As people who live at the home are generally physically able, staff are trained on safe handling of objects rather than safe moving of people. We saw records were kept of routine safety checks on hot water, the homes car transport and portable electrical appliances, for example. We were also shown a fire safety audit and a Health and Safety audit that had been carried out by an external company in August 2009, with an action plan for the findings. One person we spoke with said they opened their window wide to get fresh air. The manager checked this, as the homes windows have inbuilt restrictors to prevent falls from windows, and confirmed the window opening is restricted. We discussed that it might be prudent to include window restrictors in the routine checks. Care Homes for Adults (18-65 years) Page 39 of 44 Care Homes for Adults (18-65 years) Page 40 of 44 Are there any outstanding requirements from the last inspection? Yes  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 37 8 (a) An application to become the 30/06/2007 Registered Manager should be submitted to the commission to ensure that a competent manager supports the people who live here. Care Homes for Adults (18-65 years) Page 41 of 44 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 Description 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 Description Timescale for action 1 6 14 30/04/2010 You must keep the assessment of each persons needs under review, and update them when their needs change So that support can be planned and safely provided to meet individuals changing health & welfare needs appropriately. 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 It is recommended that care or support plans (along with associated records, such as risk assessments, that are used to inform the plan) are reviewed at the request of the individual they are written for or at least every 6 months, being updated to reflect changing needs. Care Homes for Adults (18-65 years) Page 42 of 44 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 24 It is recommended that you carry out fire safety checks in line with guidance from the local fire authority and according to the homes fire safety risk assessment. It is recommended that there is a registered manager for the home to ensure that it will be competently managed in the longer term to promote the welfare of people living there, and provide stability. 3 37 Care Homes for Adults (18-65 years) Page 43 of 44 Helpline: Telephone: 03000 616161 or 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. © 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. 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