Care Home: Oakfield House

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What the care home does well People are supported to do a range of activities that they enjoy so they live fulfilled lifestyles. Health and safety is well managed to ensure peoples safety. People get good support to meet their health care needs and stay healthy. People have their own bedroom and are encouraged to personalise their rooms to reflect preferences and tastes. People are supported by staff who are enthusiastic about their job and are trained so they understand peoples needs. People are supported to keep in touch with family and friends so they maintain relationships that are important to them. Peoples care needs are well recorded in their care plan so staff know how to support them and meet their needs. There is a choice of healthy food so people are supported in their diet to eat well. There is a low turnover of staff so people are supported by staff who know them well. What has improved since the last inspection? Some areas of the home have been painted and decorated and new flooring has been put down in some bedrooms so the environment is more welcoming for people. An audit of maintenance matters has been completed so repairs and improvements are better managed. Senior staff have had further training so they are up to date with current legislation and can support the staff team in the work they do. Some improvements had been made to medication procedures so ensuring people receive their medication safely. Training booklets have been produced so staff have up to date information about how to support people well. Diversity training for staff has been provided so staff have more knowledge about meeting people`s diversity needs. A health and safety team has been established so promoting the health and well-being of people living there. Improvements have been made to staff recruitment checks so ensuring only suitable staff are employed. What the care home could do better: The owner of the home should visit every month to speak to people living in the home and make sure it is being well run. The systems for medication need some further improvement to ensure people get the medication they need safely. Key inspection report Care homes for adults (18-65 years) Name: Address: Oakfield House 6-12 Oakfield Road Selly Oak Birmingham West Midlands B29 7EJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Donna Ahern     Date: 1 8 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Oakfield House 6-12 Oakfield Road Selly Oak Birmingham West Midlands B29 7EJ 01214711913 01214140017 evem@autismwestmidlands.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: autism. west midlands care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 20 Date of last inspection Brief description of the care home The home offers accommodation for up to 20 people with autism spectrum disorder. Oakfield House is a three storey Victorian style terraced building which has been converted and extended to create a 20 bedded home and a Recource centre. The home is spacious and includes four lounges, two separate offices and a large room for staff meetings. All bedrooms are single rooms. The extensive garden to the rear of the property offers scope for large functions to be held. The home is not equipped to provide services for people with physical disabilities. Current fees for people living at the home range from one thousand and seven pounds per week as recorded in the statement of purpose for the home. Visitors to the home can see a copy of CQC Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 20 Brief description of the care home reports if they wish to do so, these are located in the entrance hall. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Home did not know we, the Commission were going to visit. Seventeen people were living at the home at the time of our visit, two people were on holiday. We case tracked three peoples care. This involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Time was spent observing care practices, interactions and support from staff. We met with the manager and four staff.We looked around some parts of the home to make sure it was warm, clean and comfortable. We looked at a sample of care, staff and health and safety records. We were sent an Annual Quality Assurance Assessment (AQAA) by the home. This tells us about what the home think they are doing well and where they need to improve. It also gives us some numerical information about staff and people living at the home. We also looked at notifications received from the home. These are reports about things that have happened in the home that the home must tell us about. Care Homes for Adults (18-65 years) Page 6 of 29 Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? Some areas of the home have been painted and decorated and new flooring has been put down in some bedrooms so the environment is more welcoming for people. An audit of maintenance matters has been completed so repairs and improvements are better managed. Senior staff have had further training so they are up to date with current legislation and can support the staff team in the work they do. Some improvements had been made to medication procedures so ensuring people receive their medication safely. Training booklets have been produced so staff have up to date information about how to support people well. Diversity training for staff has been provided so staff have more knowledge about meeting peoples diversity needs. A health and safety team has been established so promoting the health and well-being of people living there. Improvements have been made to staff recruitment checks so ensuring only suitable staff are employed. Care Homes for Adults (18-65 years) Page 8 of 29 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the arrangements in place ensure their needs will be met upon admission. Evidence: The service user guide and statement of purpose tell people and their representatives what they can expect from the home. They had been written in a style that is easier for the people living there to understand and included pictures and photographs. There have been no new admission to the home for over four years with very few admissions over the last ten years. We looked at the policy for admissions and saw that very detailed procedures are in place. These include pre admission assessments and visits to the home before any placements are agreed. If these procedures are followed they should ensure that only people whos needs could be met would be admitted to the home. The annual quality assurance assessment completed told us that great care would always be taken so that an already established group are not destabilised by an inadequate assessment of compatibility. Care Homes for Adults (18-65 years) Page 11 of 29 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. People have detailed care plans in place so staff support them in a way that meets their individual needs. Evidence: We looked at the care provided to three people. We looked at peoples care plans these tell us what each persons needs are and the care and support they require from staff to make sure these needs are met. The files we looked at had detailed information about how to meet peoples individual needs in relation to communication, health care, personal care, social activities and likes and dislikes. We saw that staff work closely with people and complete a person centred plan. These detail the persons likes, dislikes and preferences and are used to keep the care plan up to date so people continue to receive support in a way that meets their individual needs. We spoke to four staff. They told us about the care needs of individuals and how these needs are met. What we saw during the visit was consistent with what we read in peoples care plans. This means that people receive consistent support from staff who know peoples needs well. Peoples care plans are reviewed formally on a annual basis with peoples Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: family and funding authorities are also invited to attend. The annual quality assurance assessment told us that all the people who live there have a plan for individualised support which is based on a thorough assessment of need. Staff told us that most of the people who live there have a dislike of change because of their specific needs in relation to autistic spectrum disorder. Staff spoke with confidence about how they support people and encourage them to make choices where possible and have control over their daily living. We saw some incidents when some people became a little agitated staff dealt with these situations calmly and consistently. We saw that behaviour management plans are in place and these give details of triggers to behaviours and tells staff how to support people in a way that promotes their dignity and keeps them safe. A number of risk assessments had been completed. These detailed what action staff need to take to ensure risks to people are kept to a minimum. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to do a range of activities that suit their individual needs so they live fulfilled lifestyles. People eat a healthy diet maintaining their wellbeing. Evidence: We looked at peoples care plans and daily records to establish that people are leading meaningful lifestyles and taking part in activities that they enjoy. We also spoke to four staff members and observed care and support on the day. We saw that people are supported to take part in a wide range of activities.The home has its own resource centre with the facilities of an art room, computer room and therapy room. People are supported to access these facilities each weekday as well as accessing a wide range of community facilities including local college courses, swimming, visits to places of interest, meals out and shopping. We saw that people have a weekly timetable in place and these are planned according to the needs and Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: interests of the individual. On the day of the visit some people had been out for the day on a long walk and had also had their lunch out. Some extra funding for one to one staffing had been agreed for one of the people. Staff spoke very positively about how this had really made a difference to the person lifestyle. The activities they were supported to do where specific to the individual. A lot of work continues to be done around communication and each of the people has a detailed communication strategy in place. Staff told us that it can be difficult for a lot of the people with autism spectrum disorder to make choices but where possible this is encouraged. We saw people make choices at the evening meal about what they wanted to eat, drink and where they wanted to eat their meal. People also made choices about how they spent their time in the evening. Some people spent time in their own rooms whilst others spent time in the communal lounge. We saw people go to their own room when they wanted to. Although there was some routine such as meal times we saw that there was flexibility around this. People are supported to maintain links with family and friends we saw information on peoples files to support this. Links are maintained with relatives through regular meetings of the Friends of Oakfield House group who meet bi monthly. At these meetings relatives are kept up to date with developments at the home. The manager did a recent presentation on safeguarding so relatives are informed of the procedures in place to keep people safe. The meetings are also a forum for relatives to share views and plan fund raising activities. The manager sends out surveys to peoples relatives. We saw a number of surveys that had been completed. Comments included I think our relative is very fortunate to have such an interesting life Very pleased with the way Oakfield house takes care of X We are entirely satisfied Feel safe and secure with the staff . The home has a four week rotating menu. We were told that the cook has worked at the home for many years and is knowledgeable about what people like. The menu showed a varied choice of meals are available. The evening meal was served in the main dining room and staff supported people to get their meal from the serving area and either sit in the main dining room or some people choose to take the meal to another room. Staff sat and ate with people ensuring meals times are relaxed, sociable and are an opportunity to promote peoples social skills. Most people had the main meal which was very well presented. People who had eaten out at lunch time choose to have a lighter evening meal including salads and sandwiches. We saw people being offered a choice of drinks. Records are kept of food eaten ensuring that staff can monitor that people eat a varied and balanced diet to promote a healthy lifestyle . Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place ensure people receive the support they need so their personal care and health care needs are well met. Medication practice generally ensures the wellbeing of people. Evidence: Care plans included detailed information about how people prefer to be supported with their personal and health care needs. We saw that peoples clothing, hair and personal care were well presented indicating they receive good support from staff to meet these needs. People all have a named staff member who is their key worker. Part of this role is to ensure that people have clothing that is suitable for them in terms of their age, culture, gender and the activity they are doing. Staff said people where possible are supported to shop for their own clothes. We looked at health care records for three people. Health action plans are in place these are personal plans about what a person needs to stay healthy. The plans have been produced in a visual format and were very detailed and well organised. They Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: cover all aspects of a persons health care needs and identify any health care needs that require further attention. We saw that where possible people are supported to attend community health care facilities. However for some people attending medical appointments can cause high level of anxiety. The Home has worked closely with health care professionals to alleviate some of the anxiety and where needed home visits by the G.P and dentist will be made. The Homes annual quality assurance assessment told us that they have worked jointly with other health care professionals in order to support people who require medical treatment. An example of this was the dentist agreed to have their photograph taken and of dental surgery equipment in order to prepare visual aids for people in the home. Pre visits to the surgery have also taken place as part of the preparation before treatment. We saw that risk assessments were in place for people who have epilepsy. However these did not include how long people should be observed by staff following a seizure to ensure their safety and well being. We looked at the arrangements in place for the administration of medication. Medication is kept in a locked cupboard in the office. Staff who administer medication have received training to do so. The manager also carries out an in house medication assessments annually to ensure staff continue to administer medication safely. One of the people administers their own insulin with support from staff. Some really good visual aids have been developed by the manager so there is a clear protocol in picture format so they understand and can follow the process. We observed staff giving out the evening medication. The Homes procedure is for two staff to be present when medication is prepared for administration. The staff member checking the medication signed the medication administration record (MAR chart) and the staff member administering medication to people was signing a separate record chart. The medication administration record must be signed by the person who gives the medication to people as it is a legal record confirming that the staff member has given the medication to the person and they have received it safely and in a way that they prefer. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to listen to and respond to complaints about the service. Arrangements are in place so people should be protected from the risk of harm. Evidence: We saw the complaints procedure which is written in an easy read format so it is easy for people to follow and understand. There is a comments book available in the entrance hall for visitors to the home to record their comments. We had not received any concerns or complaints about this home since our last visit. Due to the nature of peoples disabilities there are very few people living there who would be able to make a complaint. In the annual quality assurance assessment the managers states There are few service users who would understand both the concept of the process for making a complaint so staff are vigilant in terms of what might be considered a service user complaint. We saw that policies and procedures are in place for safeguarding people. These are available for staff to read so they would know what to do if an incident happened. Staff who we spoke to told us they knew what to do if someone had a concern about the home and what to do to keep people safe. Staff receive training on safeguarding with specific reference to supporting people with autism spectrum disorder. We saw that the organisation has produced a very useful and informative booklet on safeguarding and vulnerability these are issued to all staff so they are aware of their responsibility to protect people. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: The home has good systems in place for recording incidents and a record of all incidents reported to us is kept. Detailed daily records are kept in the daily records for each person. The manager does an analysis of incidents so that any patterns in behaviour are identified. We spoke with the manager about Social Care and Healths lead role in determining when further investigation around incidents may need to happen so the well being of people living there is promoted and protected. Senior staff have had training in the Mental Capacity Act and Deprivation of liberty Safeguards so they understand their responsibilities under this legislation and can support the staff team in their role. We saw that there are comprehensive computer systems in place for managing finances. Support staff are employed to ensure these are well managed. The computer records are supported by paper records that care staff sign to confirm money that has been taken in or out. We saw that receipts are kept of purchases and saw entries for theater tickets, drinks and meals out, trips to the local pub and visits to places such as the science museum. These could be tracked back to the computer records. The systems in place ensure peoples money is well managed and safeguarded. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean safe and comfortable home that generally meets their needs. Evidence: The home is a large Edwardian property. The main kitchen is fitted with industrial type equipment and is locked at certain times when not in use. There is a smaller kitchen which can be used for making drinks and snacks. The laundry is not domestic in style but is not locked and staff said people are encouraged to use the facilities with staff support to promote their independence. There are benefits for some people to live in smaller type living arrangements compared to the larger group living arrangements that are in place at Oakfield. An extension to the main building provides three people with smaller more domestic type living arrangements including bedrooms a bathroom and a lounge with a small kitchenette. The arrangements seem to work well and provide people with more privacy. Access to the extension is through the main home. We saw people come and get their meals and take them back to their own lounge. One of the people who live there showed us around and proudly showed us their art work which was displayed on the lounge wall. The extension clearly was the personal space of the three people who live there. It may benefit some of the people if further smaller living arrangements were provided. We acknowledge that there are also benefits to having a large spacious home. When people became agitated we saw there was plenty of space to support people safely and people could be supported to access Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: a different part of the home. There is also a really good choice of communal areas with four separate lounges for people to use. The home also has the benefit of a large secure garden for people to enjoy. Three people showed us their bedroom and we looked at a further two bedrooms. One of the people told us I like my room. Bedrooms were very individual and really reflected the culture, gender and preference of the person. Bedrooms seen were well decorated. The annual quality assurance assessment told us that there is ongoing work to upgrade peoples bedrooms. All the areas we visited were clean and fresh with good arrangements in place for infection control so any risks to peoples wellbeing is minimised. The annual quality assurance assessment told us since our last visit the art room and sensory room have been refurbished. The main lounge has been decorated. The extension has been redecorated and new carpets and curtains fitted. Some bedrooms have had new flooring. There are plans in place to replace flooring in the dining room. A new estates manager is now in place and we saw a full audit had been completed of the building identifying maintenance issues that need to be completed so the home is well maintained. The manager told us that a painting programme will be established so the home is kept in good decorative order. Care Homes for Adults (18-65 years) Page 22 of 29 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. The arrangements in place for staffing ensure that the needs of people are met. Evidence: Interactions between people living there and staff were relaxed and support was given to people in a polite and confident manner. Staff we spoke to had a very good understanding of peoples needs and how these should be met. The annual quality assurance assessment told us that nineteen of the twenty nine staff have achieved a National Vocational Qualification and six are in progress of completing. This means that people are supported by well qualified staff. We looked at the staffing rota for September and saw that five staff are on each shift during the day and up to seven staff work in the resource center (Monday-Friday). At night there are two staff working and one person sleeping in on call should extra assistance be needed. Staff said there was enough staff on duty to meet peoples needs. We saw during the visit that people got good support from staff and staff responded promptly to request from people. The home has a large team of relief staff who are trained and supervised the same as staff on a permanent contract and work regular shifts in the home. The manager said their flexibility means that agency staff are not used so people continue to receive a consistent service from staff who know their needs well. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: The annual quality assurance assessment told us that all staff have completed an induction it stated Upon commencement of employment staff are required to work shadow shifts during their induction period. The deputy manager ensures staff undertake a general induction and also one which relates specifically to Oakfield House. Staff told us they have received the training they need to do their job. We saw that some staff files did not have up to date records of training. However the manager could confirm that they had completed mandatory training. The manager told us that there is a computerised system at the organisations head office that flags up when training updates is required. We could see that specialist training does take place including training on autism spectrum disorder. Training scheduled for September included studio 3 which is specialist training in supporting people whos behaviour could be seen as challenging. Training in diabetes was taking place on the day of our visit. Diversity training had taken place last year as recommended at our last visit and should ensure that staff have a greater awareness when meeting peoples needs. We saw that epilepsy training had not taken place for some time and the manager agreed to arrange refresher training so staff have up to date knowledge and skills so they can support people safely. We looked at the recruitment records for two staff. Checks undertaken include criminal record bureau checks and written references are sought before people starting working in the Home. This should ensure people are protected from the risk of having unsuitable staff working with them. Care Homes for Adults (18-65 years) Page 24 of 29 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 well managed home. Arrangements in place ensure the health, safety and welfare of people is promoted and protected. Evidence: The manager is registered with us . She has worked at the home for a number of years and has a significant amount of experience. She has completed an NVQ 4 and the Registered Managers Award. The manager has kept up to date with current legislation and attends training to update her knowledge skills and competence. The manager completed the annual quality assurance assessment when we asked for it. It was completed to a very high standard was detailed and informative and reflected what we saw during our visit. It told us what the home does well and where it could improve. The home is very well managed. We found that the style of management was relaxed, open and inclusive. The manager respond well to all feedback comments that we made. It was evident that the manager continues to develop the service for the Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: benefit of the people living there. The home is part of an accreditation system with the National Autistic Society. This involves an assessor with specialist knowledge of autism carrying out an audit of the service. Relatives and people living in the home have the opportunity to contribute to the accreditation scheme. Following the audit an action plan is put together to make any improvements identified. It is the responsibility of the the organisation to ensure that their representative visits monthly to monitor the home and report on standards. This is when matters of concern should be picked up and dealt with. We saw that only four visits have taken place in the last nine months which tell us that visits are not being done as required. We saw that records about peoples care are well maintained. Staff record what care has been given and how people have responded to care and support. We identified that some changes must be made to the procedure for giving out medication so the systems in place protect people. We looked at some health and safety records including safety checks for fire appliances and equipment. We saw that these are checked and serviced regularly. The work place fire risk assessment had been completed to ensure the wellbeing and safety of people living there. The annual quality assurance assessment told us electrical, water, heating and gas service test had been carried out as required so people live in a safe environment. An annual health and safety independent audit is carried carried out so advice on health and safety matters can be sought and acted upon. There is also a Health and Safety group established who look at safety matters on a day -to- day basis to promote safe working practices. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 Medication administration records must be signed by the staff member who administers the medication. To ensure that people have received their medication safely and in a way that they prefer. 30/10/2009 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 19 Risk assessments in place for people with epilepsy need some further information so it is clear what staff should do to keep people safe. Refresher training on epilepsy should be provided so people have the up to date knowledge and skills they need to support people to be safe. The home should be visited monthly by the representative of the provider and a report made of the visit to ensure the provider is overseeing that the home is being run in the best interest of the people living there. 2 35 3 39 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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