Inspection on 30/01/09 for Oaklands Residential Home, Barnstaple

This is the latest available inspection report for this service, carried out on 30th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oaklands Residential Home,... 23/03/06

Oaklands Residential Home,... 05/10/05

Oaklands Residential Home,... 02/03/05

Oaklands Residential Home,... 26/07/04

Oaklands Residential Home,... 03/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oaklands Residential Home, Barnstaple Oaklands Westfield Avenue Sticklepath Barnstaple Devon EX31 2DY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Taylor     Date: 3 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. Copies of the National Minimum Standards – Care Homes for Older People 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Oaklands Residential Home, Barnstaple Westfield Avenue Oaklands Sticklepath Barnstaple Devon EX31 2DY 01271374231 01271374231 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr John Patrick Hall care home 25 Number of places (if applicable): Under 65 Over 65 25 25 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 Oaklands, is a care home found in a residential area on the outskirts of the market town of Barnstaple and provides personal care and accommodation for up to 25 people. The home is registered to provide care for people over 65 years of age who have general care needs and needs associated with a dementia type illness. Care and services are provided in a large extended detached house, close care bungalows have been built in the grounds but the home continues to have some views of the Taw estuary and accessible areas outside for residents. The accommodation at the home includes a large lounge and a large dining room; residents rooms are for single use, most of these are on the ground floor. The 3 residents rooms on the first floor are reached either by stairs or a stair lift. Fees charged range from 395 pounds to 450 pounds per week, with additional charges Care Homes for Older People Page 4 of 29 Brief description of the care home levied for things such as hairdressing, chiropody, toiletries, newspapers, own telephone line and taxis. Copies of previous inspection reports are available in the entrance foyer of the home. Care Homes for Older People 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is Two stars. This means the people who use this service experience GOOD quality outcomes. This was a key inspection of Oaklands under the Inspecting for better lives arrangements. We were at the home with people for 9 hours. We looked at key standards covering: choice of home, individual needs and choices, lifestyle, personal and healthcare support, concerns, complaints and protection, environment, staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We met 9 people that live at Oaklands and observed how staff looked after Care Homes for Older People Page 6 of 29 them. We met 4 staff and the manager. We sent surveys to 15 people living in the home and received 11 back. We sent surveys to 3 GPs and 3 other healthcare professionals and received 4 back. We also sent surveys to 10 staff and received 0 back. The comments people made, the resulsts of our survey and our observations are in the report. In January 2009, the fees ranged between 395 pounds to 450 pounds per week for personal care. Additional charges are made for chiropody, hairdressing, newspapers and toiletries and these vary. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk What the care home does well: What has improved since the last inspection? What they could do better: Some of the people living in the home have complex nutritional needs. The home does not use a recognised tool to assess this to ensure that people get the right foods to keep them healthy. Peoples needs should be assessed in terms of occupation, interest and capabilities using an evidence based tool. This will ensure that activities are person centred and Care Homes for Older People Page 8 of 29 appropriate for the individual. The used of equipment such as plate guards would promote better independence for people with disabilities. Nearly all of the staff in discussion are able to give good examples of how the dignity of people is ensured, in practice a particular incident that we witnessed demonstrated that this does not always occur. This needs to improve to ensure peoples dignity is respected at all times and that people are protected from abusive behaviour. Future decoration and refurbishment should be done to best practice to ensure that the needs of people with dementia are taken account of and gives them the best chance of orientation to the environment they live in. Assessment of current infection control management should take place using the Department of Health Guidance to ensure that measures protect people that live in the home and staff that work there. The recruitment procedure has not been consistently followed. Ensuring that appropriate pre-employment checks are done before staff are allowed to work must protect people living at the home. We made a legal requirement about this. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 are supported to be fully involved in the process and information is gathered from a range of sources to ensure that individuals needs are met. The home does not offer intermediate care; therefore no judgement has been made about this. Evidence: In a survey 72 percent of people living in the home had been given a contract for their residency. 100 percent of people were given sufficient information before moving into the home that enabled them to make a decision about moving into the home. We met the newest resident and talked to them about how their needs were assessed. The person told us that they had chosen to live at Oaklands because they had heard good things about it. The manager meets with a person before they move in to the home to do an assessment. A newly admitted resident told us that the manager had gone through a Care Homes for Older People Page 11 of 29 Evidence: questionaire and found out about them. The assessment template recorded the diverse needs that the person had, for example what significant people were important to them and detailed information about the persons physical disability and sexuality . However, the assessment obtains information about peoples marital status therefore we recommend that this should be amended to embrace the concept of diversity. A social and economic history had also been completed. Additional information about this persons needs had been obtained from the local authority supporting the move into the home. This information provided the team with a picture of the social network a person has, hobbies and interests, and past working life. We looked at 3 other care files for people living in the home and casetracked their needs. Assessments completed covered how to move the person and what risks there were. Additionally, the potential risk of falls had been assessed. A person with parkinsons disease was highlighted to be at high risk of choking but did not have a nutritional assessment on their file. We discussed this the manager who showed us information that had been obtained from the speech therapy department. The manager said that she would contact the speech therapist and ask for a nutritional assessment to be done for this individual. This will ensure that all staff have access to detailed information about the types of and presentation of foods that are appropriate for a person with swallowing difficulties. The manager verified that intermediate care is currently not provided at Oaklands. Care Homes for Older People Page 12 of 29 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive effective personal and healthcare support that is person centred and is based upon the rights of dignity, equality, fairness, autonomy and respect. Medicines are handled safely and ensure that people are given the right medication at the right time. Evidence: We casetracked 4 people by speaking to them and also observing the care they were given. We read their care plans and concluded that individual personal preferences, routines and social activities were well known by staff and had been documented. This has ensure that all staff have a good understanding of how each person prefers their care and support to be delivered. We looked at 4 care files, which demonstrated that the home has good professional relationships with general practitioners, nurse specialists and the consultant psychiatrist. For example, a person with dementia had been visited at the home by the consultant psychiatrist and their medication had been reviewed and changed. In Care Homes for Older People Page 13 of 29 Evidence: addition to this there are good links with the mental health and social services teams. Letters seen on files indicate good communication and partnership working that ensures that people living in the home receive appropriate care. Similarly, 4 healthcare professionals in a survey commented that whenever they have a problem they will give me a call and manage it as advised and they have good staff that seem very able in health and social care needs. The home had clear policies and procedures about risk assessment and management, which had been robustly implemented. All of the care files had guidance on action to be taken to minimise identified risks with regard to tissue viability, falls, manual handling, and continence. All of the assessments had been regularly reviewed. Where a high risk of development of pressure ulcers had been highlighted, we read similiar entries in the persons care plan and saw that the individual was sitting on pressurerelieving equipment and their skin was intact with no pressure sores. There was a good standard of information to ensure that care and health needs were assessed and monitored. Verbal information and feedback in respect of individuals personal and health care needs is given to staff at the start of each shift. This process was observed at the beginning of the afternoon shift. This handover also gave staff time to ask questions and give their view about how an individual was doing. The home uses a monitored dosage system. Senior staff are responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. All medication was kept in a secure place; controlled drugs were stored in accordance with legislation (Misuse of Drugs Safe Custody Regulations 1973). The system was easy to audit and we tracked medication given to 4 people. Records accurately reflected medication having been given as prescribed by the GP. We observed medicines being given out and best practice was followed that ensures people are given the right tablets at the right time. We observed that staff always knocked on doors before entering peoples rooms. People told us that care was always done in the privacy of their room and that staff treated them with respect and kindness. One person said they all treat you nicely. Care Homes for Older People Page 14 of 29 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. Routines and activities are flexible for people and they are listened to regarding the choice of daily activity. These could be individualized further to take account of the diverse needs of people living there to ensure that everyone leads a full and stimulating life. People are encouraged to maintain contact with friends and family in the community, which demonstrates a commitment to the principles of inclusion. Evidence: Information provided by the manager verified that 100 percent of people living at Oaklands are of christian faith. The home has links to the local churches and people said that they enjoyed a carol service during the festive period. We observed that people have unrestricted access all areas of the home. From observation and in discussion with people they told us they were free to do as they chose depending upon their abilities. According to information sent to the Commission, 6 people currently living at Oaklands have dementia. We wanted to establish how peoples needs were met with regard to meaningful activity. An hour was spent in the lounges observing how staff interacted Care Homes for Older People Page 15 of 29 Evidence: with the people. This highlighted examples of good practice. During the period of observation, staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. We asked staff what they did to help these people pass the time. Staff said that it was difficult to sometimes know what people could actually do or wanted to do. We were told that one person, whose care we tracked, was known to liked singing and were doing so when we met them. The manager verified that staff tended to act on instinct and information obtained from families rather than on assessed knowledge. Activities were group based and did not always reflect the level of ability that the person had given the stage of their dementia. To illustrate this point, some people might be more responsive to sensory activities such as painting or aromatherapy. Alternatively other people might be more responsive to cognitively based activities, such as a reminiscence quiz. We discussed specific tools that might be useful to gain in depth information about individual capability and interests. This would also ensure that activities are person centred and pitched at the right level for people. The Home has a menu that rotates on a weekly basis. The home displays a copy of the weeks menu choices on a notice board. Each day there is a choice of three meals at lunchtime however the kitchen will prepare alternatives if neither are acceptable. We observed the experiences of 3 people at lunch. Staff assisted people to eat by sitting with each person, attending to them and by supporting them at a pace that suited each person in an unrushed manner. Food was served plated to people. A pureed meal had sections separated and other meals were nicely presented. No eating aids seen, which would promote independence for people living in the home that have physical disabilities. One person had a plate but no plate guard and some food did fall off the plate. The same person also finger fed themselves at one point. We also heard other people make positive comments about the lunch such as The food is excellent and I really enjoyed my lunch. The record of meals provided demonstrated that meals are varied. Care Homes for Older People Page 16 of 29 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Oaklandss policies ensure that people are able to voice their concerns, safe in the knowledge that these will be acted upon and any potential abusive behaviour stamped out. Evidence: Information sent to us by the manager tells us that complaint procedure has been improved to ensure that complaints are consistently recorded and acted upon. Similarly, people are also encourage to make suggestions about how the service can be improved. In surveys, 100 percent of people living in the home tell us that they are satisfied that the home listens to them and deals with any concerns in a timely way. The Commission received no complaints before or during the inspection. We saw a copy of the Alerters guide. The home also had a whistle blowing policy, which all of the staff we spoke to clearly understand. At lunchtime we observed an isolated incident in which a care assistant was seen to say your not the only one who needs help here you know when a person asked for icecream. We met the carer concerned and presented them with the scenario we had observed and asked them whether they felt it was abusive and what action they would take. They said that it depended on the circumstances, but if that response was given in a bullying tone they would attend to the persons needs then speak to the member Care Homes for Older People Page 17 of 29 Evidence: of staff and report the matter to the manager. At the end of the discussion the person recognised that they had made this comment and said that on reflection they should never have responded in that way and said it could have come across as bullying. The member of staff verified that they had attended a Deprivation of liberty course and Abuse training in 2008. We made the registered manager aware of our observation and subsequant discussion with the carer. The manager welcomed our the feedback and said that the behaviour was totally unacceptable and that she would deal with this under the supervision process. We concluded that member of staff clearly understood what constituted abusive practice and on realising that their interaction with an individual was seen as being potentially abusive was horrified and had reflective about how they would change this behaviour. Other interactions that we observed throughout the day were kind, caring and staff were attentive to peoples needs. Staff engaged positively with people who had dementia and demonstrated genuine warmth when engaging those individuals. Information sent by the provider told us that 62 percent of the staff holds an NVQ in care, part of which is about safeguarding people. Staff told us that policies and procedures are discussed with them. We looked at training records and saw that Safeguarding Adults training had been provided for staff. Information sent to us by the manager verified that no safeguarding or POVA referrals had been made since the last inspection. Care Homes for Older People Page 18 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, 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. 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, comfortable and well maintained home. Evidence: Information sent to the Commission verified that equipment is regularly serviced, that staff keep the home clean, tidy and odour free and that each time a new resident moves in if appropriate the bedroom to be occupied is decorated. We carried out a tour of the home and visited almost every persons individual room. We also looked at maintenance records spoke with 4 people using the service, the Registered Manager, and staff. We also considered the results contained in the surveys we received and read 3 peoples care records. We did an indepth observation of the suitability of the environment for people with dementia. Much of the paintwork was cream and hand rails were cream. We did not see any specialist adaptations that would enable people with dementia orientate them to particular rooms like the bathroom, their own bedroom or to discourage entry to unsafe areas. We observed 1 person wandering in and out of the lounge. We discussed this with the manager and recommended that further research about this should be done to ensure that environmental changes also take account of the needs of people with dementia. Care Homes for Older People Page 19 of 29 Evidence: 100 percent of people in a survey commented that the home is always clean. We found that all areas of the home were clean and odour free. We found that the communal areas are well furnished and provide a homely environment for people to enjoy. Fire exits were safe, which people could freely exit from in the event of a fire. A maintenance book demonstrated that routine maintenance and renewal of the fabric and decoration of the home is done. We read contractors certificates that showed equipment is regularly maintained. There is an internal courtyard garden that is attractive with strubs and flowers in planters and appropriate seating for people. Relatives told us that they enjoy sitting out in this area with their relation on dry days and is very well used by people. This area provides a safe area particularly for people with cognitive impairment to use. We found that call bells are accessible in every room and that there is a stair lift to assist people when needed, in addition we saw grab rails and other equipment to assist people. We observed that a hoist is used by staff when moving the position of a person that is currently bedridden. From our discussion, no other people living in the home had an assessed need that required a hoist to be used to move them safely. However, the manager verified that if this situation changed another hoist would be purchased. Furniture has been replaced in the dining room and the lounge was going to be decorated and refurbished soon after the inspection. Radiator guards fitted throughout the home. Therefore, people we spoke to felt that their surroundings were much improved and provide a comfortable place for them to live in. The home has guidance on infection control that is accessible to staff. Information sent to the Commission verified that the Department of Health Guidance Essential Steps had not been used to audit practices to establish the effectiveness of infection control measures in place. We spoke to the manager about this and have made a recommendation to them to use this to audit systems in place. We did, however observe that protective clothing is accessible for staff to use and we observed staff regularly washing their hands after caring for people. This demonstrates good practice and protects people living in the home from the risk of infection. Information sent to the Commission verified that 5 staff has done infection control training and further in house sessions are planned. We looked at the laundry, which is situated in the home. We met the member of staff who was doing the laundry and saw that there is a good system in place that ensures clothes and linen and washed separately for infection control purposes. Similarly, we observed that linen and clothes are taken to the Care Homes for Older People Page 20 of 29 Evidence: laundry in receptacles and clean clothing is returned to people the same day after being washed, dried and ironed. People looked well turned out in their own clean clothes. Care Homes for Older People Page 21 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. Recruitment practices are not robust and fail to protect residents. The training and development programme ensures that knowledgeable staff cares for people. Evidence: 11 people living in the home returned surveys, and all verified that they always received the care and support they needed. Their comments included Staff are always so kind. At the home, we asked people whether staff were available when they needed help, and they told us that staff are very attentive to them. We observed this to be the case for people that had difficulty communicating their needs. We spoke to the manager about recruitment and they told us that they had appointed 4 new staff since we last inspected. We examined the files for these individuals to establish whether the recruitment procedure was robust and had been followed. CRB and POVA checks had been obtained for all new staff before employment. However, other pre-employment checks such as references had been obtained after the individual had been employed. In the first file we read an undated hand written testimonial. The person had previously worked in a care service and no reference had been requested or obtained from that provider. The member of staff had commenced employment on 2/12/08 (verified by the manager and duty rosters). In the second file, a testimonial had been obtained. A written reference arrived by fax during the Care Homes for Older People Page 22 of 29 Evidence: inspection from another care service and was satisfactory. The individual started employment on 29/12/08. We looked at duty rosters and established that the individual had worked on 12/12/08. A third file contained a written reference that was dated 1/12/08. The employment date for the individual was confirmed by the manager as being 1/12/08. Finally, a fourth file contained two undated testimonials. The manager verified that the individual did not have previous care experience and had been self employed so had found it dificult to obtain professional references. We concluded that recruitment procedures are not robust and people living in the home are unprotected because of this. We discussed our findings with the manager and made them aware of the Commissions publication on recruitment practice. Information sent to us by the manager tells us that 62 percent of staff hold NVQ level 2 in care and 100 percent have completed the induction training. Additionally, staff in a survey verified there are regular training sessions about dementia, manual handling, first aid. New staff said that their induction was thorough and they felt well supported. Care Homes for Older People Page 23 of 29 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. Management arrangements are meeting the needs of the people living in the home, and the quality of the service has improved. Evidence: The Registered manager has several years experience of managing Oaklands and has obtained the Registered Managers Award and NVQ level 4 in care management. The provider gave the Commission a reasonable picture of the current situation in the service, in a document entitled AQAA (Annual Quality Assurance Assessment). However, there were areas when more supporting evidence would have been useful to illustrate what the service has done in the last year, and or explicitly how it is planning to improve. Information within the AQAA verified that the home has a business plan. As discussed under the staffing section, our main concern is that the recruitment procedures are not robust and therefore do not protect people living in the home. We are confident, however that this matter will be rectified quickly by the manager as they had made some improvements to the procedures since the last inspection by ensuring Care Homes for Older People Page 24 of 29 Evidence: that POVA checks are obtained before employment of new staff. Throughout the inspection and the information provided demonstrated that the provider and managers aim to constantly improve the service for people living in the home. We observed that people are consulted about changes and asked for feedback. People we spoke to had been asked to complete a survey. In surveys we sent, all of the people responding told us that Staff are always so kind. Similarly, 4 surveys from healthcare professionals were positive about the management of the home. Their comments were very committed staff and whenever they have a problem they will give me a call and manage it as advised and have good staff that seem very able in health and social care needs and very good. Therefore, the provider and manager actively seek feedback from the people they and the team of staff care for. We looked at records showing how money is managed on behalf of 3 people that live in the home. All were accurate when crosschecked with the balance kept for safekeeping. Entries had been signed for. We concluded that peoples money is well managed and their financial interests are protected. We toured the building and observed that cleaning materials were stored securely. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. We observed hand sanitizer being used by staff to minimise the risk of cross infection. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home, relatives and staff told us that the alarm was regularly checked and sounded. Certificates verified that an engineer had checked the hoists. First aid equipment was clearly labelled. 3 staff on duty verified that they held a current first aid qualification. Good manual handling practice was observed as carers transferred a person from wheelchair to chair at lunchtime. Maintenance certificates were seen for the fire alarm system. The provider had verified in information sent to the Commission that a local electrician had inspected both the electrical system and appliances. Therefore, the health and safety of people living in the home is maintained. Care Homes for Older People Page 25 of 29 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 29 17 (2) The registered person shall 06/02/2007 maintain in the care homes the records specified in Schedule 4. (This refers to the need to safeguard residents by ensuring that all staff have two references, proof of identity and clearance in respect of POVA First prior to commencing employment within the home) Care Homes for Older People Page 26 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 29 19 The provider must ensure 05/06/2009 that no member of staff is employed to work at the home without first obtaining all the necessary information required, in this case two satisfactory written references. This will ensure that people are not put at unnecessary risk of harm. To ensure that people are not put at unnecessary risk of being cared for by staff that have not been properly vetted. 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 3 The nutritional needs of people living in the home should be known by being properly assessed. Staff should have access to detailed information about the types of and presentation of Care Homes for Older People Page 27 of 29 foods that are appropriate for an individual to ensure that the person has a balanced diet that is also safe for them. 2 12 The diverse needs of people are taken into account when organising individual and group activities so that everyone leads a full and stimulating life. For example, use an assessment tool like the Pool Activity level instrument to establish exactly what individuals are able to do and indentify suitable activities accordingly. The used of equipment such as plate guards would promote better independence for people with disabilities. Ensure that people in the home are not subjected to bullying behaviour, by supervising staff and taking a proactive approach to stamping out such behaviour. Future decoration and refurbishment should be done to best practice to ensure that the needs of people with dementia are taken account of. Resources such as Designing Interiors for People with Dementia ISBN 1-85769-179-2, University of Sterling. Tel:(01786) 467740 E mail: m.t.marshall@stir.ac.uk/dsdc should be used. Use the Department of Health guide Essential Steps to assess current infection control management to ensure that measures protect people that live in the home and staff that work there. 3 4 15 18 5 19 6 26 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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. 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