Care Home: Oakmount

What the care home does well It seemed the managers and staff were keen to provide a good service for the people living at Oakmount, one staff commented, "The home provides a safe place for service users to live. High quality care promotes independence and us as support workers encourage service users to be as independent as possible" People were being involved with making decisions about their support and lifestyles as part of the care planning process. They were being encouraged to develop Independence skills. Healthy eating was being encouraged and people were getting involved with menu planning and cooking. Support was being given with health-care needs, medication and appointments. The home operates a `Key worker System` which links individual residents with a specific staff member, to provide a more personal service. People were getting out and about in the community and were keeping in touch with families and friends. Any complaints or concerns raised were being taken seriously. People could spend time in their rooms when they wished, some had keys to their bedrooms to promote privacy and Independence. There was a low turnover of staff at Oakmount, which meant people were supported by staff they knew and were used to. To help make sure staff provide good support, they were being given regular training. Regular residents meetings meant people were being given opportunity to have their say and be consulted about their lives at Oakmount. What has improved since the last inspection? A new admission procedure had been introduced, to help make sure peoples needs and abilities are properly considered before they move into Oakmount. Individual contracts of residence had been reviewed and updated. Progress had been made in ensuring the risk of people having access to hot water in their rooms and bathrooms is properly considered. All staff had received POVA (Protection Of Vulnerable Adults) and Fire Safety training. Some parts of the home had been re-decorated and upgraded to provide a more comfortable and pleasant home. What the care home could do better: The management and administration of Oakmount must be more effective in complying with regulations and standards, this will ensure there are good outcomes for people using the service. To make sure people living at Oakmount have a good standard of accommodation, work was needed improve and upgrade some parts of the home. To make sure people using the service are properly protected, better recruitment practices were needed. Better arrangements were needed to make sure the home is kept clean for the health and wellbeing of the people living at Oakmount. Progress was needed with care plans, to make sure staff know exactly what to do in order to provide people with individual care and attention. To make sure people are properly and safely supported with their medication, some medication practices needed attention. To help promote a safe environment, some matters needed attention to help reduce risks to the residents and staff. So that managers and staff have up to date guidance on providing good support, further policies and procedures should be introduced. Key inspection report Care homes for adults (18-65 years) Name: Address: Oakmount 68 -70 Westgate Burnley Lancashire BB11 1RY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jeffrey Pearson     Date: 2 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Oakmount 68 -70 Westgate Burnley Lancashire BB11 1RY 01282458463 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): oakmount68west@msn.com Emmanuel Tendaiwo Dangare,Mrs Eunice Dangare Name of registered manager (if applicable) Mrs Susan Burnett Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: 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: Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 9 Date of last inspection Brief description of the care home Oakmount is a care home for 9 adults with a mental illness. The house is of the older type situated close to the town centre. Accommodation consists of kitchen, dining room, lounges, and utility room. There are 5 single bedrooms and 2 double bedrooms. There was a staff room and office on the upper floor. There is a small yard and patio at the back of the building. The owner of the home is a registered mental health nurse. Mrs Susan Burnett is the registered manager of Oakmount. The fees charged per Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 9 2 9 0 4 2 0 0 9 Brief description of the care home week depended on the nature of the support required and agreed by social services, with additional charges for some transport and leisure activities. The home had a Statement of Purpose and Service User Guide providing information about the support and accommodation provided, also the services people can expect if they choose to live at Oakmount. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced inspection which included a visit to the service was conducted at Oakmount on the 21st April 2010. The visit took over 9 hours and was carried out by one inspector. People using the service and staff were invited to complete surveys, to tell the Commission what they think about the support and care provided at the home, some were returned to us. Before the visit the manager was asked to complete and return to us an annual Quality Assurance Assessment (AQAA). This was to enable the service to show how they were performing and provided details about arrangements, practices and procedures at the home. The files and records of 2 people were examined as part of case tracking, this being a Care Homes for Adults (18-65 years) Page 6 of 32 method of focusing upon a representative group of people using the service. We spoke with residents, the senior care coordinator and staff. Various documents, including policies, procedures and records were looked at. Parts of the home were viewed. The home was last inspected on 29th April 2009. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? A new admission procedure had been introduced, to help make sure peoples needs and abilities are properly considered before they move into Oakmount. Individual contracts of residence had been reviewed and updated. Progress had been made in ensuring the risk of people having access to hot water in their rooms and bathrooms is properly considered. All staff had received POVA (Protection Of Vulnerable Adults) and Fire Safety training. Some parts of the home had been re-decorated and upgraded to provide a more comfortable and pleasant home. Care Homes for Adults (18-65 years) Page 8 of 32 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 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process helped ensure peoples individual needs, abilities and preferences were known and planned for before they moved into the home. Evidence: There was an indication in some service user surveys that people had been involved in choosing the home, also that they had received enough information about Oakmount to help them decide if it was the right place for them. The senior care coordinator, in charge at the time of the site visit, said a copy of the homes guide had been placed in each persons bedroom and that this information this had been reviewed in the last 12 months. The AQAA (Annual Quality Assurance Assessment) indicated that creating a more informative guide, was a plan for the future. It was suggested the residents could be involved and consulted with this task as an activity. There had not been any new admissions to Oakmount since the last inspection. However, the assessment and referral process was discussed with the senior care Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: coordinator, who explained that a new admission process had been introduced. The paperwork seen, supported various planned stages of admission, including introductory visits, staff meetings and gathering relevant initial information to ensure the persons needs could be met at the home, consideration being given to the existing group dynamics. The form to be used for finding out about people should help make sure good information is obtained and considered, such as, their mental health diagnosis, brief history, orientation, history of depression, self harm, medication, relationships and rehabilitation goals. It was advised the admission process also include the completion of initial risk assessments and risk management strategies as appropriate, this will help ensure any limitations on choices and personal health and safety matters, are appropriately considered, agreed and planned for. The senior care coordinator said individual contracts of residence had been reviewed and updated in December 2009, they had also been signed by the resident and owner. It was advised the contracts/terms and conditions of residence, include all the specifications outlined in standard 5 of the National Minimum Standards. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The support planning process at Oakmount helped ensure peoples needs were mostly known and responded to, but plans were insufficient in detailing person centered support and some risks had not been properly considered and planned for. Evidence: Systems were in place to help ensure the residents have their needs identified and responded to in an individual plan of care. The senior care coordinator explained that she had designated responsibility for the care planning process and that she was actively involved in their implementation, monitoring and reviews. It was apparent the residents had been involved in developing and reviewing their care plans. For example, they had been supported to include their perception of their support needs. Staff indicated in surveys that they were given up to date information about peoples support needs. Care plans seen, included some good information about peoples needs abilities and objectives had been set, plans seen were sensitively written. However, some Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: instructions were brief and did not provide proper directions for staff to follow. For example, regarding personal care, one plan stated, prompting and monitoring. Another plan included, support family contact and encourage activities. This meant providing person centered support was potentially reactive and largely dependent upon staff memory. However, the AQQA (Annual Quality Assurance Assessment ) did indicate that adding more short term goals to care plans, was a plan for future improvement at the home. Individual records were being kept of peoples daily living activities and personal circumstances, however, we were unable to read the content of some records as the writing was illegible and some comments appeared to based upon staff opinion. The senior care coordinator said staff had been guided on appropriate record keeping, but agreed to give this matter further attention. People living at Oakmount were being involved with decisions about their lives, this being reflected within the care planning process, one to one activities and residents meetings.They were also involved with were involved with day to day matters, such as menu and activity planning. Several residents completing surveys indicated they were always or usually involved in making decisions each day, most considered they could do what they wanted. Some care plans included agreed limitations in relation to alcohol and smoking. We were told smoking was no longer permitted in the home, also that this change in arrangements had been discussed and agreed with the residents. It was suggested house rules be defined with the residents, to promote agreed general expectations and mutual respect. We were advised action was being taken to ensure the rules on smoking in the home were being effectively monitored and implemented. Progress had been made in ensuring the risk of residents having access to hot water in their rooms and bathrooms, is assessed and responded to individually. We found generic and individual risk assessments be carried out in relation to various activities, in and out of the home. However, there were no risk assessments in relation to individuals safely and appropriately, leaving the home alone, which meant proper consideration had not been given to their vulnerability to ensure a reasonable balance is a achieved between personal safety, autonomy, rights, choices and fulfillment. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Oakmount were being supported to engage in activities, use community resources and keep in touch with families and friends. Evidence: The various options for activities and outings were being discussed and agreed in residents meetings. Activity plans were available which provided a basic outline of the various activities offered each day. The AQAA (Annual Quality Assurance Assessment) showed that obtaining the residents satisfaction with activities, was being focused upon as an area for improvement. People using the service spoke of the various individual and group activities they were involved with, including, shopping, swimming, Greenspace, day centres, cooking and walking. As previously indicated, care plans needed to take better account of peoples social and lifestyle needs to ensure a more person centered approach. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Independence living skills were being encouraged, people had some responsibilities for domestic chores, such as cleaning, washing up and laundry as part of the rehabilitation process. One comment from staff was, We as support workers continually support and encourage service users to be as independent as possible. Routines in the home seemed flexible and were influenced by peoples planned activities and lifestyles. People could spend time in their rooms when they wished, some had keys to their bedrooms to promote privacy and Independence. Records and discussions showed peoples relationship needs were being considered, people were being supported to keep in touch with families and others as appropriate. The residents indicated they were happy with the catering arrangements at Oakmount. Some helped with shopping and all prepared their own breakfasts, lunches, drinks and snacks. We can have what we what, said one person. Menus were being discussed and agreed in the residents meetings and various options were routinely offered. Specific dietary and nutritional needs were being monitored and responded to individually, as appropriate as part of the care planning process. Healthy eating was being encouraged, residents and staff had received some training on this topic. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most health and personal care practices and procedures ensured peoples individual needs are appropriately met. Evidence: The home operates a Key worker System which links individual residents with a specific staff member, to provide a more personal service. People living at Oakmount needed minimal support with personal care needs. The care plans seen included brief details on peoples agreed support needs in relation to health and any personal care. People were generally being supported to take an interest in their appearance, hairdressing and clothing, it was apparent individual choices and preferences were being respected. We were told the registered manager cuts most of the residents hair, which did not promote independence skills and social inclusion, it was therefore advised this arrangement be reviewed. Most interactions observed between people using the service and staff appeared sensitive. Most staff were genuine and respectful in their approaches when providing support and guidance. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Records and discussion showed people had contact with GPs and other medical professionals such as consultants. We were told arrangements were in place for people to have annual health checks when their medication was reviewed. People were being supported to attend routine and urgent medical appointments as necessary. Some residents make their own health care appointments. Mental health and physical conditions were being monitored and responded to as part of the care planning process. Most residents were having eye tests undertaken in the home by visiting opticians, this practice did not promote independence skills and social inclusion, it was therefore advised this arrangement be reviewed. Medication storage was found to be clean and secure, however, one item was being kept unsecured in the fridge, the senior care coordinator agreed to take action to address this matter. We were told all staff had received training in medication practices and further training was being arranged, there were no records to show staffs competence in managing medication had been evaluated. Medication polices and procedures were seen to be available, it was advised The Royal Pharmaceutical Societys guidance Handling Medicines In Social Care be obtained for reference. We were told regular audits were being carried out of medication management practices, but records in support of this were unable to be located. The medication administration records seen were clear and up to date. Individual assessments had been carried out with people who were managing some, or all of their medication. It was advised the assessment should clearly indicate the rationale for the decisions being made, also, the monitoring of support practices needed to be better reflected in the care planning process. Some residents were prescribed medication to be taken when required and with a variable dose, there was some guidance for staff to follow about such items, however, the rationale for the decisions made was not clear it was therefore advised this information be noted. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies, procedures and practices supported the complaints process, but did not always provide effective safeguards for people using the service. Evidence: Most residents completing surveys indicated they had someone they could speak with if they were not happy at the home, most said they knew how to make a formal complaint. Residents spoken with during the visit had a good understanding of the complaint process and were confident in raising any concerns with the manager or staff. Residents meetings provided the opportunity for people to voice their opinions and raise any issues. The complaints procedure was included in the homes guide each person being given a copy. The procedure seen provided clear guidance on how to make a complaint. It was suggested the CQC contact details be amended to include the National Contact Centre in Newcastle. It was advised Social Services and the owners contact details also be included in the complaints procedure. There had been 2 complaints in the last 12 months, both were dealt within the 28 day period. Records and discussions showed systems were in place to manage and respond to complaints. Complaints processes were discussed with the senior care coordinator, including being objective and ensuring appropriate investigation strategies are devised and accountable records kept, to show clearly how complaints have been managed. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: The AQAA (Annual Quality Assurance Assessment) indicated all staff had received POVA (Protection Of Vulnerable Adults) training. The senior care coordinator said further safeguarding training was being arranged. Staff indicated in surveys that knew what to do if someone had concerns about practices at the home. Since the last inspection, the safeguarding policies and procedures had been reviewed and updated to provide step by step guidance for managers and staff to follow in the event of an allegation, suspicion or incident of abuse. However, it was advised the instructions be more specif to ensure any incidents are appropriately alerted to the relevant agencies. There were no policies and procedures available to provide staff with guidance on physical intervention and restraint, this meant the rights, best interests and safety of the residents may be compromised. As previously indicated, risk assessments had not been carried out on peoples vulnerability when leaving the home independently. We again found recruitment practices were insufficient in ensuring the required minimum checks are carried out, prior to new staff commencing work in the home. (See Staffing) Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Oakmount offers some suitable accommodation, but not all areas were clean and maintained to a satisfactory standard for the comfort and well being of the people using the service. Evidence: People spoken with expressed an appreciation of the accommodation provided at Oakmount, in particular their bedrooms. Since our last site inspection some parts of the home had been been redecorated and new floor coverings fitted, the residents had been consulted on the choice of colour schemes. Vertical blinds had been fitted in the lounge on the residents request. One bathroom had been upgraded provide better facilities. The residents had been provided with new bedding. Individual risk assessments carried out regarding the supply and use of hot water in bedrooms. Oakmount has a long history of not providing a satisfactory standard of accommodation for the comfort and wellbeing of the residents. At this site visit we again found areas of the home to be in need of attention, including some general decorating, in particular in the vacant bedroom, which was also missing a wash hand basin. One bathroom was found to be in a very poor state, the wallpaper was coming away from the walls, the bath was stained and the bath panel had uneven filler along the top edge. There was a thick build up of a slimy residue around the taps and there Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: were discarded toothbrushes covered in hair and fluff. The radiator shelf was hanging off. A recent health and safety walk around check record indicated the bathroom was excellent. Some of the bathrooms were not fitted with suitable locks. The carpet in the en-suite shower room had black stains around the toilet. Some bedrooms did not have lockable facilities for the occupants use. Some areas of the home were found to be excessively dusty. Three residents indicated in surveys the home was usually kept clean, one said it was never clean. Again at this site visit, there was no evidence available to show the electrical wiring and gas appliances/connections had been appropriately tested for safety. (See conduct and management of the home) The laundry area provided satisfactory facilities, however, we noted the ceiling was in need of attention, as the paint work was peeling away. The senior care coordinator said significant environmental changes were being considered and planned for at the home, including upgrading the kitchen and laundry area. However, we found the home had failed to comply with previously set requirements in relation to the environment and given the homes history of none compliance, we were not assured that proposed improvements will be made in a timely manner. Care Homes for Adults (18-65 years) Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment practices and procedures were not effective in safeguarding people using the service. Evidence: People spoken with were generally satisfied with the support they received at Oakmount, they described the staff as alright. Staff rotas and discussions showed that sufficient staff available to properly provide for peoples individual support needs. Staff completing surveys considered there were enough staff at the home and that they were supported by the management, however, three indicated that they felt there should be better rates of pay. The AQAA (Annual Quality Assurance Assessment ) indicated there was a low turnover of staff at the home which had helped promote stability and continuity for the residents. We were told that staff had received appropriate training, including NVQ (National Vocational Qualifications) levels 2 and 3 however, we again found there were no reliable records of such training being arranged and undertaken, the senior care coordinator explained that a computerized training database was in the process of being utilised. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: At this site visit we again found significant weaknesses in the recruitment practices, which meant the home had failed to comply with previously set requirements and that they were still not ensuring all appropriate checks are carried out for the protection of the residents. Staff had commenced work without protection of vulnerable adults clearance checks being obtained. Reasons for leaving previous employment had not always been obtained. Two written references were not available, a reference had not been sought from an applicants previous employer. Applicants had not been required to declare if they were registered with any professional bodies. There were no records of discussions regarding issues declared on application forms and applicants were not routinely asked to declare any cautions or any disciplinary action. Dates of education had not been requested which would ensure full and satisfactory audit trail of peoples backgrounds. The AQAA showed staff induction training to be an area for future improvement. Staff spoken with and those completing surveys, confirmed induction training had been carried out, however, the induction training records of more recent employees were unable to be located. The senior care coordinator was not aware if initial training had been given. Care Homes for Adults (18-65 years) Page 24 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration practices at Oakmount were not always effective in ensuring the home is run for the benefit of people using the service. Evidence: The registered manager was not on duty at the time of this site visit. However, the senior care coordinator who was in charge, had attained appropriate qualifications in care management and demonstrated a good working knowledge of her role. She was cooperative and proactive in her response to the inspection process. Regular meetings were being utilised to consult with the residents, progress requests and respond to issues raised. The residents had also been given opportunity to complete satisfaction surveys, however, it was not clear how the information received was evaluated and responded to. It was not clear if consultation surveys had been offered to relatives, staff and other professionals with an interest in the service. The AQAA (Annual Quality Assurance Assessment) was very brief in detail, it did not provide sufficient information to show that all aspects of the service had been properly evaluated, we were therefore unable to use the AQAA to help make a judgment about Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: some of the outcomes for people. The AQAA indicated several key policies/codes of practice were not available at the home. Action should therefore be taken to define and introduce such policies, to help ensure managers and staff have all the appropriate guidance to support the day to day running of the home. There were some matters in need of attention, to show there was an appropriate response at Oakmount to promoting health safety (See environment and staffing). We were told Fire Safety training had been provided, fire safety risk assessments were seen to be available, however, they were not dated therefore it was clear if they were up to date and current. There were no formal health and safety risk assessments in relation to the home and outside areas, therefore it was not clear that effective action was being taken to identify and minimize risks to people using the service, staff and visitors. This inspection showed some progress had been made at Oakmount. However, there were some matters as highlighted previously within this report which had not been sufficiently addressed, in particular, the standard of the accommodation was not compliant with the minimum standards and regulations. Also, the poor recruitment practices had potential to put people using the service at risk. We also identified further matters which were in need of attention for the benefit and wellbeing of people using the service. We intend to carefully consider the registered persons response to the findings of this inspection and this will influence our future regulatory activity of the service. Care Homes for Adults (18-65 years) Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 24 23 All Part of the home must be 05/06/2009 maintained and decorated to a satisfactory standard including those areas mentioned in the report and the owner must submit a further action plan to the commission by the date given So that residents live in a pleasant and safe environment. 2 34 19 The staff recruitment 05/06/2009 procedures must be in accordance with the Care Homes Regulations. Staff must not commence work in the home until all the checks have been obtained including the criminal records bureau and protection of vulnerable adults checks and two satisfactory written references from employers or genuine character referees. Also suitable records of the Induction training must be completed To help protect residents from unsuitable staff and to show that staff have the necessary skills and knowledge to begin work. 3 42 13 All elecrical installations must 30/06/2009 Page 27 of 32 Care Homes for Adults (18-65 years) 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 be appropriately tested. To ensure the health and safety of residents and staff. Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 Effective arrangements must 04/06/2010 be made to ensure the home is maintained and decorated to a satisfactory standard. This will promote the well being, safety and comfort of people using the service. 2 30 23 Effective arrangements must 21/05/2010 be made to ensure the home is kept reasonably clean. This will provide people using the service with a pleasant and hygienic environment. 3 34 19 All relevant recruitment checks must be carried out in accordance with the regulations, prior to staff commencing work in the home. This will ensure appropriate action is taken to help protect people using the 14/05/2010 Care Homes for Adults (18-65 years) Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action service from unsuitable staff. 4 35 18 All new employees must receive appropriate structured induction training. This will ensure they are able to provide appropriately support people using the service. 5 42 13 Effective arrangements must 31/05/2010 be made to identify and reduce potential risk and hazards in and around the premises. This will promote the well being and safety of people using the service. 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 28/05/2010 1 6 To provide people with effective support, care plans are to include detailed instructions on responding to individual needs, abilities, goals and behaviours. Individual risk assessments and risk management strategies should be completed in relation to people leaving the home alone, this will ensure proper consideration is given to peoples personal safety and independence. Appropriate physical intervention and restraint policies and procedures should be defined and introduced, this will help ensure people are supported safely and in their best interests. 2 9 3 23 Care Homes for Adults (18-65 years) Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 26 Action needs to be taken, to ensure all bedrooms have the furniture and fittings as specified in the National Minimum Standards. A suitable checklist should be devised and introduced to support the recruitment process. Appropriate records should be kept of identified, arranged and completed staff training. Action should be taken to introduce a more effective approach to quality assurance processes, this will ensure people using the service and other stakeholders, are consulted and involved in developing the home. 5 6 7 34 35 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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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