Inspection on 27/06/06 for Five Oaks

This inspection was carried out on 27th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Five Oaks 21/05/07

Five Oaks 15/11/05

Five Oaks 30/06/05

Five Oaks 20/10/04

Five Oaks 03/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Five Oaks 377 Cockfosters Road Hadley Wood Hertfordshire EN4 0JT Lead Inspector Mr Teferi Degeneh Key Unannounced Inspection 27th June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Five Oaks Address 377 Cockfosters Road Hadley Wood Hertfordshire EN4 0JT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8449 7000 020 8449 7311 Scimitar Care Hotels Plc Ms Lynnsey Mitchell Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2005 Brief Description of the Service: Five Oaks is a private residential home owned by Scimitar Care Hotels PLC. The home is registered to provide personal care for 44 elderly people. Following an application by the owner to amend the category of registration, it has been agreed that six of the people accommodated at the home may have dementia. The home is purpose built; facilities include 42 single rooms and two double rooms on three floors; service users are never asked to share a room so the double rooms are used as single rooms. There is a large lounge with interconnecting doors to a dining room, a smaller lounge, the garden room, and a sitting area in the lobby, furnished with comfortable armchairs. The three floors are accessible via two shaft lifts. There is a well-maintained garden with patio, accessible, through French windows. The home is located in a quiet residential area. At front of the building there is a parking space for staff and visitors’ cars. The home is also accessible by public transport. The Cockfosters underground station on the Piccadilly line, is a few minutes’ car drive from the home. The weekly charges are £650.00. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A number of people who live at the home were observed and spoken to individually and in groups. Discussions were also held with the care staff and the managers. Health and safety documents, the rotas, the menus, visitors’ book, complaints’ book and training records were examined. This key inspection is also based on the assessment of staff and service users’ files. The premises and the facilities of the home were inspected through guided tour, facilitated by the registered manager, Ms Lynnsey Mitchell. Ms Sylvia Sanderson, the training and health and safety manager, was present during most part of this inspection. What the service does well: What has improved since the last inspection? What they could do better: Five areas that need improvement have been identified during this inspection. The needs of all new service users must be assessed before admission. It is only after people are assessed that the home can decide whether or not their needs can be met. It is also important for the registered person to ensure that Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 6 appropriate facilities, staff with specialist knowledge, and services that meet people’s needs are available when and if people are to be admitted for intermediate care. Risks to the health and safety of service users must be reduced. Window restrictors must be adjusted or must be provided in all rooms. There must be evidence to show that all staff have undergone satisfactory CRB check. Raw food must not be stored next to ready-to-eat food. The temperature recordings must be accurate. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, and 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The preadmission assessments are not satisfactory and service users confident if the home knows and meets their needs. EVIDENCE: Six service users’ files were assessed. Only three of these contained evidence to confirm that assessments have been completed before service users were admitted. The registered person said the other three service user came for emergency placement and as a result the home has not completed their assessments. She said that some of the service users come for a respite service and there has not been sufficient time to assess their needs. It was discussed that all people who live at the home, including those who come for respite or intermediate care, need to have their assessments completed so that appropriate support, equipment and facilities can be provided. Conversations with the registered person and those people who have been admitted for intermediate care indicated that there have been no special provisions or plans made for them. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 9 At the last inspection the registered person was required to apply to the CSCI to change the category of registration to allow a limited number of people with dementia to be accommodated at the home. Following an application to the CSCI, the certificate of registration has been changed to allow six people with dementia to be accommodated at the home. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at the home have benefited from the home’s processes of care plans and risk assessments. Service users’ health needs are met by the system of the home which has ensured that the people who use the service have access to regular health care. EVIDENCE: At the last inspection the registered person was required to consult service users and revise their service plans. Even though, as mentioned above, preadmission assessments have not been completed for some of the people who use the service, the registered person has formulated and updated care plans for the service users. From records and discussions with the registered person it is evident that service users have been supported to access health care. The registered person confirmed that a general practitioner visits every week and that dentists and opticians come to the home as and when needed. Health records in service users’ files showed that a district nurse, a hygienist and an incontinence nurse also visit the home. A diary of health care input has been kept in each service user’s file. A range of activities are available for service users. The list of these activities are displayed on the wall in the main lounge. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 11 The people who were spoken to confirmed that they enjoy different activities provided by various individuals. Each service user has a risk assessment in their files. Telephone lines are also provided in each bedroom. Discussions with the registered person and some service users indicated that service users use the telephones in their bedrooms to contact their friends and relatives. Medication is administered by senior staff who have completed relevant training. One service user self-administers their medication. The service user who self-administers their medication has been assessed to confirm that they are able to take their medication as prescribed by their doctor. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are engaged and their needs with regard to control over their lives, and contact with families are met. The food provided at the home is good but the manner it is served can be improved. EVIDENCE: The service users spoken to said they are happy with the range of activities provided at the home. On the day of the inspection, after lunch, it was evident that a number of people who use the service were participating in exercise session facilitated by a person who came for this purpose. Service users’ files contained records of their social interests. Programmes of various activities organised by the home are displayed on the wall in the main lounge. The activities provided by the home include music entertainment, bingo, reminiscence sessions, group interactions, quizzes, and going out to coffee shops. One person said they do gardening as part of their leisure activity. Those people who would like to bring pets are allowed to and indeed a trained pet comes to the home and is used as a therapy. Discussions with the registered person confirmed that some people attend places of worship and others worship at the home. All service users have telephone in their bedrooms. A service user said they arranged a taxi by themselves to go out to visit their relatives. A number of people were seen visiting service users during Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 13 the course of inspection. The home’s visitors’ book also contained evidence of people visiting service users. The home does not manage people’s money. However, there is an agreement that ensures service users to obtain personal items, for example, newspapers or toiletries, and be invoiced by the home. The registered person said this arrangement has worked well both for the home and for the people who use the service. There is a four-weekly rotating menu offering varieties of food and alternatives during all meals. Discussions with the registered person and the cook showed that special dietary needs of people are catered for. The people spoken to said the food is good. During the lunchtime there were members of staff to in the dining hall to help people with cutting or feeding. A bowl of fresh fruits is kept in the lounge and people are free to help themselves. The registered person said the staff ensure that the fruits are taken to all people so that they can choose what they want. At the last inspection it was commented that the way the meals are served is not efficient with some individuals having to wait for a longer time than they would prefer. The registered person said she would look into how to resolve this issue. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has satisfactory systems in place to ensure that service users are protected from abuse. The people who use the services are reassured by the home’s complaints procedure. EVIDENCE: The home has a clear complaints procedure. The people spoken to said they can talk to the staff or the manager if they have concerns. Complaint records showed that the home takes complaints seriously and each of the people’s concerns have been recorded and investigate. There have been thirty complaints recorded since the last inspection. All these have been resolved after being investigated by the registered person. There is a policy on the protection of adults from abuse. The registered person has also obtained the local authority’s relevant adult protection policy. A number of staff, who were spoken to formally and informally, demonstrated good understanding of how to ensure that people are protected from abuse. Training records showed that the staff have attended training on adult protection. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have benefited from the spacious, safe and well-maintained environment in which they live. However, some service users’ health and safety is at risk due to window with unsatisfactory restrictors. EVIDENCE: There is a fulltime handyperson who checks and ensures that the building and equipment are maintained and repaired. The home has also three domestic staff with a responsibility to clean bedrooms and communal areas. A laundry assistant ensures that service users’ clothes are washed, ironed and folded. There is an infection control policy and the staff were observed using gloves when transporting clothes to the laundry room. Fire alarms and water temperature are regularly checked and recorded. The home has a generator, which automatically turns on if and when there is an electric supply failure. The home is accessible to wheelchair users and there are two passenger lifts for accessing the entire floors from the basement to the third floor. The lifts are tested every month. Handrails are provided in the stairs. The corridors are Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 16 spacious. An environmental health officer (EHO) visited the home on 22/05/06 and made two recommendations regarding the storage of raw food and the recording of temperatures. A requirement is made below, under National Minimum Standard (NMS 38), for the registered person to ensure that the recommendations of the EHO are complied with. During the tour of the premises it was noted that the windows of room number 45 could be opened wide, without appropriate restriction. This was discussed with the registered person who confirmed that the window an action would be taken to adjust the window restrictors. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have benefited from staff team who are trained, experienced and provided in adequate number. However, the vetting procedure of the staff is poor as evidenced by CRB’s of some staff. This has potentially put service users at risk. EVIDENCE: The rota, which was examined, showed that there are seven care staff on shift in the morning and six in the afternoon. Three domestic staff, a cook, two kitchen assistants, a laundry assistant, entertainers and a handyperson also work at the home during the days. Night shifts are covered by three waking night carers and an on-call senior member of staff. The manager is on shift between 9am and 5pm Monday to Friday. Eight care staff have achieved NVQ (Care) Level 2 qualification and five others have embarked on training to achieve a similar qualification. The staff files showed that they have attended various training programmes including basic food hygiene, fire prevention, diabetes, dementia, and infection control. The home has a training manager who organises and facilitates training for the staff. A training programme has been developed to monitor and to ensure that staff undergo training relevant to their duties. The people who live at the home commented that the staff are friendly and provide support with respect. A service user said that the staff always knock on the doors to seek permission to enter bedrooms. The home has a recruitment procedure and all staff have two written references in their files. Forms of identification have also been obtained by the Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 18 home in respect of all staff. The CRB certificates of the staff, which were examined, showed that twelve of them were obtained as part of their previous employment. The registered person is aware that all staff have a satisfactory CRB undertaken for the purpose of their current job. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Good progress has been made in terms of the home’s quality assurance. Service users are confident that the home safeguards their personal possessions. Even though the facilities, equipment and the building are well maintained, the practice of storing raw food next to ready to eat food and the incorrect method of recording temperatures have compromised service users health and safety. EVIDENCE: The staff and service users spoken to said the manager is approachable and they can talk to her. The manager is supported by the training manager and the operation’s manager. The management structure is clear and service users said they know who to talk to if they have concerns. The registered manager confirmed that she regularly attends training to keep herself update with new policies, procedures and care practices. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 20 The home has recently formulated questionnaires for service users and visitors as part of a system of quality assurance. The questionnaires have been sent out but are yet to be collected, collated and analysed. The registered person said the responses from the people would be sent to the head office. Discussions with the registered person indicated that service users and visitors give informal feedback which is considered by the home as part of the feedback gathering process. The manager said the home also sees complaints positively and uses it as a useful tool for improving the quality of service. As part of Regulation 26, the owner undertakes monthly visits to the home to monitor the facilities and services. Reports of these visits are emailed to the CSCI. It has been mentioned above that the home does not manage people’s finance but there is an arrangement for people to obtain personal items for which they are invoiced. The registered person keeps a list of each service user’s personal possessions. It has been noted earlier above that an environmental health officer (EHO) visited the home on 22/05/06 and made recommendations: raw food not to be stored next to ready to eat food and the recording of temperature of the fridge freezers. The facilities and equipment in the home are checked regularly. The passenger lifts are serviced every three months the last date being on 25/05/06. The water temperature, fire alarms and emergency lights are also regularly checked and recorded. The home uses electric heaters and there are no gas boilers. The electric generator is checked regularly. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 3 X 2 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1)(a) (b)(c)(d) Requirement Timescale for action 31/08/06 2 OP6 14(1)(d); 18; 19 3 OP19 23(1)(2) 4 OP29 19(1)(2) (3) The registered person must ensure that the needs of new service users are appropriately assessed by a suitably qualified person before they are admitted. The registered person must 31/08/06 ensure that there are appropriate room facilities, medical arrangements and trained staff to meet the need of people admitted for intermediate care. The registered person must, before admitting people for an intermediate care, satisfy himself that there are appropriate services and facilities to meet their needs. 31/08/06 The registered person must ensure that the window restrictors in room 45 are adjusted and fit for the purpose. The registered person must reassess all windows and ensure that they are fitted with restrictors. The registered person must 31/08/06 ensure that all staff employed by and working at the home have satisfactory current CRB checks DS0000010660.V296739.R01.S.doc Version 5.2 Five Oaks Page 23 5 OP38 16(1)(2); 17; 23 undertaken for the purpose of working at the home. The registered person must ensure that the persons without a current CRB certificate apply for a CRB check. The staff without a current CRB must work only undersupervision. The registered person must 31/08/06 ensure that all matters raised in the environmental health officer’s (EHO) report are complied with. Written evidence of satisfactory compliance of EHO’s recommendations must be forwarded to the CSCI Inspector. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations The registered person should review the arrangements for serving meals to people so as to identify a more effective way in ensuring residents are served their meals at the same time. Inspectors are of the view that residents should not have to wait seated for their meals for an unnecessarily long time. Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Five Oaks DS0000010660.V296739.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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