Care Home: Oakdown House

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What the care home does well The service has excelled in several areas and is very proactive about supporting new residents to make the decision to come to the home and to settle in. The resident`s views are at the heart of the running of the home and they are involved in a wide range of decision-making processes. The management of the home was found to be excellent and dedicated to supporting residents and staff. The management team is well skilled and operates in an open and inclusive way in supporting both residents and staff and the continuous improvement of the service based on seeking the views of those involved with the service. The care offered is person centred and individualised according to need. The high level of quality activities, for those residents who wish to participate, ensures they enjoy a fulfilled life. Staff continue to be well trained and motivated, which is reflected in the positive atmosphere within the home. The large external grounds and garden areas are well maintained. Residents confirmed the food was `very tasty` and the kitchen met with all the requirements of the local Environmental Health Office. What has improved since the last inspection? The main lounge and dining area has been redesigned, with a large new conservatory being built. Residents who used this room commented on how much they enjoyed it. Several new carpets have been fitted and some new furniture purchased, it is recognised that this is an ongoing process. Two new tracking hoists and a new mobile hoist have been purchased. Residents also benefit from a new digital aerial to improve reception in the units. Radiator guards are now fitted throughout the home. The two flats and the Pavilion kitchen have been refurbished. Staff confirmed that maintenance work is now given a higher priority and work is completed more efficiently. Residents are fully involved with the recruitment of staff. What the care home could do better: The storage of medication needs to be improved and the home is advised to obtain copies of both the Royal Pharmaceutical Society of Great Britain guidelines for `The handling of medicines in Social Care and CSCI`s guidelines on `The safe management of controlled drugs in care homes`. CARE HOME ADULTS 18-65 Oakdown House Ticehurst Road Burwash Common East Sussex TN19 7JR Lead Inspector Sue McGrath Unannounced Inspection 6th February 2008 10:00 Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakdown House Address Ticehurst Road Burwash Common East Sussex TN19 7JR 01435 883492 01435 883369 oakdownhouse@tiscali.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Oakdown House Ltd Mrs Joyce Chapman Care Home 45 Category(ies) of Learning disability (45), Physical disability (15) registration, with number of places Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 2. Physical disability (PD). The maximum number of service users to be accommodated is 45. Date of last inspection 23rd January 2007 Brief Description of the Service: Oakdown House provides accommodation for forty-four adults with Learning Disabilities. The Main House provides for twenty-seven service users [Residents] on three floors, separated into three ‘flats’, each including a communal lounge/dining area and kitchenette. There are three bungalow flats, designed for two service users, which provide semi-independent living. Adjoining the Main House is a purpose-built special care unit for twelve service users with high dependency needs associated with their learning and physical disabilities [The Pavilion]. A communal area and assisted bathrooms are provided on each of the two floors, in addition to specialist aids, equipment and adaptations. At ground level there is a wellequipped day resource with an outdoor activity area and a sensory room. On-site workshops for daytime activities include craftwork, and a newly built computer suite. A range of work-based, educational and leisure activities are offered off site. The buildings and extensive gardens are set in a rural location with accessible village community facilities such as a church, public houses, and a bus route, a few hundred yards away from the main gate. Information on the range of fees charged is within the homes current statement of purpose/service user guide and currently ranges from £412 to £1443 per week. Service users [Residents] are additionally charged for Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 5 personal items such as toiletries and clothes beyond the basics provided and holidays, hairdressing, and additional restaurant meals. Inspection reports are not routinely sent out to families and advocates after each publication; copies are kept on display in the reception areas of the home and can be obtained via the manager. A service user guide containing the most recent inspection report is sent to anyone looking to move into the home. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place on 06/02/08 and was conducted by Sue McGrath, Regulation Inspector for the Commission for Social Care Inspection. The key inspections for care home services are part of the methodology for The Commission For Social Care Inspection, whereby the home provides information through a questionnaire process and further feedback is gained through surveys sent to service users and relatives and information provided from professionals associated with the home, wherever possible. The actual date of the site visit is unannounced. At the site visit, service users and staff were spoken with, records were viewed and a tour of the environment was undertaken. Judgements have been made based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the CSCI to be able to make an informed decision about outcome areas. Further information can be found on the CSCI website with regards to information on KLORA’s and AQAA’s (Annual Quality Assurance Assessment). The requirements made at the last inspection had been complied with. The inspector on leaving the home was satisfied that residents were both safe and well cared for and wishes to thank the manager and her staff for their assistance and hospitality. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: The storage of medication needs to be improved and the home is advised to obtain copies of both the Royal Pharmaceutical Society of Great Britain guidelines for ‘The handling of medicines in Social Care and CSCI’s guidelines on ‘The safe management of controlled drugs in care homes’. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 and 5 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Significant time and effort is spent making admission to the home personal and well managed. Prospective residents and their families are treated with dignity, respect and understanding for the life changing decision they need to make. All new residents receive a full comprehensive assessment before admission. Clear information about contract/terms and conditions are available for individual residents and or their relatives. EVIDENCE: The registered manager was in the process of updating the home’s statement of purpose, so this area was not inspected at this inspection. This standard was scored at 4, excellent, at the last inspection. The home works hard to identify individual aspirations and needs through thorough assessment and ongoing dialogue with the residents. Where possible these aspirations are met, this can be evidenced by the high number of varied activities and from positive feedback from the residents themselves. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 11 Discussion with the registered manager, and records viewed on the day, indicated that a lot of time and energy is spent ensuring the assessment process identified all areas of need. Families were fully involved with the decision to move to Oakdown House and the assessment process. Prospective residents and their families can be confident every effort is made to ensure a smooth transition to residential life. Throughout the process relative’s views were sought and surveys undertaken to ensure all parties were happy with the process. The registered manager is fully aware of how important this stage is in ensuring the residents enjoy the move to the home. Prospective residents and their families are encouraged to visit the home prior to admission to gauge what is on offer. Each resident is issued with a contract/terms and conditions. The management team takes time to explain the process to the individual and involve families and/or their representatives where appropriate. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The care plans are person centred and focus on the individual’s strengths and personal preferences. The service has a ‘can do’ attitude and risks are managed positively to help people using the service lead the life they want. Residents are continually consulted on how the service runs and are able to influence key decisions in the home whatever their communication style. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 13 EVIDENCE: Several care plans were viewed and were found to be comprehensive and person centred. They were found to contain detailed information and gave good guidance to staff to ensure appropriate care was delivered. All of the plans viewed had regular and comprehensive reviews with all relevant people. There was also evidence that changes that had arisen out these reviews had been put into action and were found to be highly relevant to the needs of the individuals concerned. Regular reviews were also undertaken with care managers, which confirmed their ongoing satisfaction with the service. The key worker, together with the resident, carries out the care planning. Residents have access to their plans and choose who is to attend their review meetings. The care plan includes an assessment of all aspects of personal and social support and healthcare needs. The plans also contained an individualised daily planner to show staff what assistance is necessary for each resident. Risk assessments were found to be relevant and thorough. Risk assessments also formed part of the care planning process and are regularly reviewed. Care-plans for those with high needs were found to be comprehensive especially regarding personal care guidelines with both having useful communication passports with good use of clear photographs. Evidence was seen in the care plans and during the day of the inspection, that residents are positively encouraged to make their own decisions with regards to all daily living choices. Where this was not possible, it was very clear that staff were keen to ensure that the best outcome possible was a priority for the individual resident. Staff were seen to kind and caring but very aware to encourage independence where possible. Regular resident questionnaires are used to gain feedback on perceived quality of life, which incorporates home environment, lifestyle, activities, food, holidays and complaints. Symbols are used to ensure comprehension where necessary. Residents are encouraged to arrange regular flat meetings and they arrange the agenda and where possible chair the meetings. Day Centre meeting are also arranged and chaired by residents. All outings have feedback sheets to gauge level of interest and enjoyment. A number of the residents manage their own savings accounts and pocket money expenditure and have keys to their rooms. Those who do not manage their own money sign an agreement to allow the home to do this. This is subject to regular review. The home retains details of an Independent Advocacy Service, should any resident require this. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 14 Staff receive ongoing training in the importance of confidentiality and residents and families can be assured that information about them is kept confidential and secure. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. Routines are very flexible and residents can make choices in major areas of their life. EVIDENCE: There was a wide range of opportunities and activities on offer for residents to participate in and enjoy. The home has a dedicated day centre where a lot of the activities are undertaken. The Pavilion home for people with a more severe physical and learning disabilities, has its own purpose built activity centre within the home. The main day centre has a dedicated quiet room, which is often used for independent counselling. This assists with self-assertiveness, which includes assertive training for residents who require help in this area. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 16 The day centre is optional and residents can come and go as they please. There was an IT room used by residents, which consisted of four computers that had internet access. One of the computers had a touch screen for those unable to use a mouse. There were other computers equipped with a specialised mouse for easier use. One computer had a large pad keyboard plus another with a colour-coded keyboard. A tutor comes in every Friday to assist the residents. ‘The Friends of Oakdown House’ a voluntary fund raising group, had contributed to the purchasing of some of the equipment. There was dedicated woodwork room, which was currently not in use as the tutor had left. However the home had several applicants to interview and it was hoped that this facility would be up and running very soon. Several of the residents said they really enjoyed the woodworking sessions and were missing them. Several of the residents also showed the inspector samples of the work they had completed and these included clocks, tables, chairs, bird tables, nesting boxes and model cars, all of which were made to a very good standard. Another very popular activity was the weekly ‘African Drums session’, which was arranged by ‘The House of Rhythm’. There was a wet room for painting and another room for craftwork. Music and movement and drama sessions were also available. A belly dancer also visited the home on a regular basis. A group meets twice a week to write a directory of places to visit for people with a learning disability. Residents visit the places and record the outcomes. These are written with the support of a tutor who visits. The residents also research the places through the Internet and it is hoped to eventually get the work published. Safety Training for residents is also undertaken and includes road crossing safety and not talking to strangers. The home is starting to implement ‘Staying up Late’ a new initiative to encourage residents and staff to look again at bedtimes etc. The aim is to encourage staff to be aware that they must follow the wishes of residents and not shift patterns. To this end several evening activities were organised with some outside visits taking place in the evenings. The regular discos were very popular with the residents and several commented on how much they enjoyed the ‘Tuck Shop’. The residents are encouraged to participate in a magazine, which is published by the home, and includes photos of events, jokes and paintings etc. This way media skills are taught. There was a kitchen in which to practise independent living skills and to encourage independence. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 17 Literacy and numeracy classes were run by Sussex Down College for two sessions a week. Some external college courses are available via ‘The Mohair Centre’. The residents also benefit from a sensory room with a snoozelum. Other activities include visits to a Hydrotherapy pool, swimming, reflexology and massages. A qualified aroma therapist undertakes the latter and extra charges do apply. Six residents regularly attend the local church and one likes to occasionally help to ring the bells. The inspector spoke with many of the residents in the day centre and all said how much they enjoyed the activities on offer and were keen to show there completed work. It is acknowledged that not all residents wish to participate with the activities and these residents appeared content to remain in their lounges for most of the day. Several were spoken with and all confirmed they preferred to stay in the lounges and watch television or just to relax. One resident explained that he was trying to set up a bowling team within the home and his ultimate aim was to challenge other homes to games and perhaps form a league. Equality and diversity issues are well managed with men’s and ladies meetings arranged, where any personal issues can be raised and professional support given. Residents can talk in confidence on matters of sexuality and managing relationships. There were good support mechanisms in place for the residents to take advantage of. Advocacy support groups were also in place. Last year all residents went on a holiday. Some went to Spain, one went to France and a large group went to Somerset. Several residents also enjoyed Butlins. Plans are afoot for this year’s holidays and residents are currently being asked where they would like to go. Spain, Somerset and Butlins are again favourites. Day trips to France are also popular. The length of the holiday arranged is normally according to need but is usually one week. Some residents benefit more from single days out. Normally the home provides 50 pf the costs, the rest being met by the resident. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 18 Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents receive personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each person centred plan or health action plan. EVIDENCE: Guidance seen in the care plans indicated that residents are supported in a consistent and professional way. The home manages the care of residents with epilepsy well and has varies strategies in place to ensure they remain safe and secure. Staff spoken with were familiar with the protocols and written guidelines and carried them out to the best of their abilities. Staff have received various training sessions to ensure they have the necessary skills. Some resident have a very high dependency level, but again this is well managed on the specialist unit. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 20 The home works hard to ensure not only physical needs are met but that emotional and social needs are also taken into consideration. The home uses the skills of other health professional and seeks advice at the earliest opportunity. The home has its own Maketon trainers to assist in communications. The inspector viewed the administration of medication and one of the medical rooms was seen. The inspector also observed the administration of lunchtime medication in the main building. The condition of the medical room was disappointing; with the carpet being very dirty and cobwebs were seen hanging from the ceiling. The room was generally dusty and in particular the bin needed replacing. It appeared to have been a room that had been partially adapted and bare stud walls were seen. This would have made cleaning very difficult. The room felt warm and the temperature was not recorded. The room did have a dedicated medical fridge but the temperature was only recorded monthly. It is advised that the room and fridge temperature is recorded daily to ensure medicines are stored at the correct temperature. The issue of the condition of the medical was discussed with the manager who stated that remedial work would be carried out as soon as possible. The deputy manager showed minutes of a recent meeting when issues around the medical room had been raised. Prompt action had not been taken. The actual administration of medication was carried out in a competent manner and no errors were found on the MAR sheets. Some of the medication was usually crushed before administration, but this was done with the agreement of the G.P. and was appropriately recorded. The home does not currently have a dedicated controlled drugs book or cabinet and a recommendation will be made for them to purchase the item. Discussion took place around the administration of Phenobarbitone and whether this is considered a controlled drug. Advice was sought from the Pharmacy Inspector for CSCI. Her advise was that Phenobarbitone was a Schedule Three Controlled Drug, but is exempt from the safe custody regulations i.e. not required to be stored in a Controlled Drugs cupboard. The law does not require records to be kept in a Controlled Drugs register, but this is a good practise recommendation. This information was given to the home after the inspection. The home was advised to obtain a copy of The Royal Pharmaceutical Society Guidelines ‘The Handling of Medicines in Social Care’. This has recently been updated. The CSCI also has guidance on its website called ‘The safe management of controlled drugs in care homes’ and again the manager was advised to obtain a copy for future reference. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff working at the service know when incidents need external input and who to refer the incident to. EVIDENCE: The home operates its complaints procedure in an open and positive way, which encourages residents to raise views or concerns. This continues to ensure that the homes complaints process is effectively used. The home continues to write to individual residents to show how they are dealing with their concerns. The Commission had not received any complaints about the service since the last report. The staff spoken with displayed a good understanding of adult protection and of how to prevent and report abuse. They continued to benefit from adult protection training. Staff were found to be aware of the home’s complaints recording policy and procedure. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 22 All staff had received training in the Protection of Vulnerable Adults. There was policy guidance for staff to adhere to. This is covered in new staff ‘s induction and via periodical training with sessions taking place regularly throughout the year. The manager has completed a Social Services’ run, Protection of Vulnerable Adults course. She has also completed training on the Mental Capacity Act, which she is intending to cascade to all staff. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26,28,29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs. The home is a very pleasant, safe place to live. EVIDENCE: The main building was toured, as was the Pavilion for 12 people. The 3 bungalows, which house 1-2 people in each was not viewed on this occasion. Some bedrooms were also looked at. The lounge and dining room in the main building had been redeveloped and now had a large conservatory for residents to enjoy. This has made the living space more open and spacious and all of the residents spoken to enjoyed the extra space. The gardens were currently being redeveloped and a secure area Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 24 had been provided with safe equipment, including a trampoline. A sensory garden was also in the secure area. As with the IT suite, funding had been provided from ‘The Friends of Oakdown House’, for the development of the gardens. New carpets had been fitted on the ground floor and some new furniture had been provided on the first floor. Various other carpets had also been replaced. It is recognised that carpet replacement was an ongoing progress. One resident told the inspector that his flat was separate and that he had a new kitchen fitted and that a new boiler was due to be fitted. He stated that he was very happy with his flat. The manager confirmed that both flats had been upgraded Several of the sinks and various parts of the plumbing systems had also been updated. Investment had also been made in two new tracking hoists and one mobile hoist. A new digital aerial system had also been fitted. The manager confirmed that all radiators were now guarded. The kitchen in the Pavilion had been refurbished and the external door highlighted in the last report had been replaced. One issue form the last report was that maintenance work was taking a long time but staff confirmed this had improved recently and a new system to identify problems was in use. Many of the bedrooms were visited and all were found to be clean, well personalised and comfortable. The Pavilion was well designed for the current residents and met their profound needs well. Evidence was seen that suitable equipment was provided and staff were trained in its use. Sensory equipment has been introduced into specialised rooms along with new alarm systems. The kitchen area was clean and tidy and met the requirements of the local Environmental Health Office. A number of residents were found to have keys to their rooms and their own lockable storage facilities. Staff and management were found to have received additional infection control training and advice with all using belt mounted gel hand wipe packs. Before leaving the inspector was given a copy of the replacement and refurbishment plan that included plans up until 2012. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The staffing structure is based around delivering outcomes for residents and is not led by staff requirements. The home puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people in a person centred way. EVIDENCE: Rota’s inspected showed that staffing levels meet assessed needs and the staff on duty on the day of the inspection were seen to be caring and supportive to the residents and clearly had developed suitable professional relationships with them. When spoken with staff were familiar with what was expected of them and all had clear job descriptions. Staffing routines are now more closely monitored. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 26 Some staff files were viewed and, although a little untidy, held all of the required information including POVA first checks, CRBs (criminal records bureau checks), two references and details of the interview process. The management has sought to involve residents with the process of recruitment to the home and suggestions were taken of the construction of the job descriptions for new care staff. Residents are also involved with the interview process and they are the ones who tell the successful candidate the outcome of the interview. They are then encouraged to show the new member of staff around the home. The manager believes this evidences to the new members of staff, how important the residents are to the safe running of the home and how much their input is appreciated. The home employs a dedicated training officer whose role is to identify and arrange the training for all staff. This is again given very high priority by the provider and consequently staff receive training in a wide range of subjects and can then transfer these skills into the workplace. All staff receive an excellent range of training, which also includes a focus on learning disability as well as Health and Safety training such as food hygiene and moving and handling, and fire awareness. Strong emphasis is also put on quality induction and the home uses the Common Induction Standards for induction and has worked with Skills for Care to set the standards. The home is also a City of Guilds approved Centre so can verify their own courses. City and Guilds carry out regular checks to ensure the quality of the courses. Records maintained by the training officer indicated that 70 of staff had attained a National Vocational Qualification (NVQ) to at least level two. All are encouraged to go on to level three. All senior staff must have NVQ level three. Training is provided for night staff and for people with family commitments. Extra time is allocated for training staff with dyslexia/ language difficulties. Equality and diversity are seen as values to be respected, promoted and celebrated within the culture of the home. Staff are train in induction to respect and promote equality and diversity and this is reinstated in training on person centred planning and safeguarding vulnerable adults. Specialist training has also been delivered on disability awareness and disability equality by a registered blind person. Although induction is prioritised by the home, one area of the home has recently had a large turnover of staff and the existing staff were finding the influx of new staff overwhelming. The senior staff in the group were anxious to resolve the problem and were advised to discuss this with the registered manager. It would appear that some staff required more practical training before working on the floor. This was also discussed at the end of the inspection and the registered manager was aware of the issue and was intending to address the issue as soon as possible. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 27 Staff confirmed they received written supervision every 6-8 weeks Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38, 39 and 42 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The registered manager has the required qualification and experience, is highly competent to run the home and meets its stated aims and objectives. The views of both the people who use the service and staff are listened to, and valued. The home has a comprehensive range of policies and procedures to promote and protect residents’ and employees’ health and safety. EVIDENCE: The registered manager has 40 years of relevant experience in this field of work. She has undertaken periodic training to update her knowledge and skills Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 29 relevant to the needs of people with learning disabilities both younger and older. The manager is a Registered General Nurse holding a Diploma in social work. She has also achieved the Registered Managers Award. One of the three deputy managers has National Vocational Qualification level 4 with the other two deputies achieving National Vocational Qualification level 3. The management team through discussions again displayed their knowledge of the needs of residents. The directors of the organisation are also helpfully involved in the overall management of the service and support via monthly inspections of the premises and give support and resources to the manager. Minutes were seen of regular staff and resident meetings with outcome recorded when completed. The management team works hard to include all the views of the residents and families and other stakeholders of the service. This has resulted in an open and accessible management style, which is appreciated by all concerned with the home and puts the residents at the heart of daily life and decision making within the home. Residents spoken with also confirmed they felt involved with the running of the home and that staff listened to their views. The monthly section 26 visits reports were undertaken by the Main director [Responsible Individual] and indicated they were fully involved and supportive of the home. The health and safety of the residents and staff was promoted and manager confirmed that all the required checks were being carried out. Maintenance work is now completed more speedily than at the last inspection and there is a planned maintenance programme in place. Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 4 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 3 3 LIFESTYLES Standard No Score 11 4 12 4 13 3 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 4 4 4 X X 3 X Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 31 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement The registered person must ensure the medication is suitably stored. Timescale for action 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations It is a good practice recommendation that the home obtains copies of the Royal Pharmaceutical Guidelines for the handling of medication on Social care and the CSCI’s ‘The safe management of controlled drugs in care homes’ It is a good practice recommendation that the home obtains a dedicated controlled drugs cabinet and hard backed controlled drugs book. 2 YA20 Oakdown House DS0000021177.V359564.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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