Inspection on 11/09/07 for Oak House

This inspection was carried out on 11th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Oak House 17/04/07

Oak House 30/10/06

Oak House 02/11/05

Oak House 06/06/05

Oak House 20/12/04

Oak House 08/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Oak House 19 Queens Road Weybridge Surrey KT13 9UE Lead Inspector Sarah MacLennan Unannounced Inspection 11th September 2007 10:00 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 Oak House DS0000049203.V344717.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. Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak House Address 19 Queens Road Weybridge Surrey KT13 9UE 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) 01932 851925 mandie@surreyresthomesltd.co.uk Surrey Rest Homes Ltd Post vacant Care Home 16 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (3), Old age, not falling within any other of places category (16) Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age range of the persons to be accommodated will be over 65 years of age with the exception of one resident aged 60 - 65 years. 17th April 2007 Date of last inspection Brief Description of the Service: Oak House is a large detached property situated within walking distance of Weybridge town centre. The home provides accommodation and care for up to 16 older people, 4 of who may also have dementia. The home has a large TV lounge, a smaller quiet lounge and a separate spacious dining room. All bedrooms are single occupancy and are arranged over two floors, all except one have en-suite facilities. Bathrooms are situated on the ground and first floor and both have a chair hoist fitted. There is also a further toilet on the ground floor. The first floor may be reached by a passenger lift or stairs. The home has a good sized, enclosed and well- maintained rear garden that is accessible to the service users. The current fees range from £572 - £593 per person per week. Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit formed part of the key inspection process and took place over 6 hours commencing at 10:00 and ending at 16:00. Sarah MacLennan, Regulation Inspector, carried out the visit. As part of the inspection process a partial tour of the premises took place. Various written records were examined, including three care plans and service user assessments, four staff personnel files, samples of staff training records, the complaints record, the medication storage facilities and a sample of the medication administration records. The inspector spoke to a number of service users and some staff members. Some of the comments made to the inspector are quoted within this report. The inspector would like to thank the staff and service users for their time, assistance, and hospitality during the visit. What the service does well: What has improved since the last inspection? The home has an acting manager in post. She has been in post since May 2007 and her application with the Commission to become the registered manager is in progress. The homes adult protection policies had been reviewed and updated in order to meet the requirement at the previous inspection. The homes staff levels had been reviewed and increased. All service users spoken to felt that there were enough staff on duty at all times. Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oak House DS0000049203.V344717.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 Oak House DS0000049203.V344717.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users had been assessed prior to admission to the home and felt that they were provided with enough information prior to moving to the home. The home does not offer intermediate care. EVIDENCE: The inspector was advised that either the acting manager or the deputy manager carry out a pre-admission assessment on all prospective service users. Three service user care plans were seen and had comprehensive pre-admission needs assessments completed. Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 9 Service users spoken to felt they had received enough information prior to moving to the home. Oak House DS0000049203.V344717.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home was not able to evidence that the service users health and personal care needs were met. EVIDENCE: The service user care plans and files were randomly sampled; three service user files were looked at in detail. The service user files contained risk assessments including the risks of falls and pressure sores. Assessments had been completed with regards to manual handling, behaviour, mental health, and nutrition. None of the nutrition assessments contained a date. There was no evidence of any action being taken with regards to identified problems. The assessments had been reviewed monthly. Some of the assessment reviews had additional comments completed, but there was no evidence that any action had been taken. Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 11 One service users falls risk assessment stated, in July 2007, that they required assessment in the falls clinic; this requires a GP referral. There was no evidence that this had been completed or discussed with the service users GP. The homes accident records were randomly sampled, there was no evidence that the incidents of falls were audited to assess if any preventative action was required. Discussion with one of the senior managers form Surrey Rest Homes LTD evidenced that all incidents of falls was required to be audited by the homes acting manager, but that this had not been completed since March 2007, prior to the current acting manager taking up post. The information regarding falls was not linked to the service users individual falls risk assessments or care plan instruction sheet. The service user files also contained a care plan instruction sheet; none of these records sampled contained a date. The care plan instruction sheets did not detail action to be take by staff and did not provide enough information to enable staff to know what care to provide to service users. One service users care plan instruction sheet stated that the service user ‘refuses to have a bath’ there was no documentation available to the inspector to evidence that the service users hygiene needs were met. The requirement form the previous inspection that care plans must be reviewed to ensure that they are fully completed and clearly document how support is to be delivered to residents has not been met. The inspector was informed that the care plans had not changed since the previous inspection. The inspector was informed that service users had access to health care services, including chiropody and dentist. There was no evidence to support this. Service users were registered with a local GP, who visited on request. All service users spoken with stated that they were happy at the home and happy with the care they received. One service user stated that she was only allowed to have a bath on a Tuesday because that was her bath day, however, she also stated that she was happy with this and did not want it to change. Another service user stated that the time she gets up is decided by when the nurses comes to take her downstairs for breakfast, she also stated that getting up early suited her and that she was very happy at the home and with her care. The homes storage and recording of medication were seen and found to be in order. The home had a suitable policy for the administration of medication. The Commission had been notified of a recent medication error, all appropriate action had been taken at the time of the incident; the service user suffered no ill effects and had been adequately monitored. There was no evidence that this incident had been investigated and no evidence of any action taken to prevent a similar incident occurring. The homes documentation evidenced that the member of staff concerned had not received any training in the Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 12 administration of medication since March 2004. There was no evidence available to the inspector that the acting manager had taken any action regarding this incident. Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is reviewing the provision of activities in order to meet the needs of the service users. There was no evidence that service users were given appropriate choices. EVIDENCE: Some staff members had recently received training in the provision of activities for service users with dementia. The inspector was informed that the current activities programme was under review as a result of this training and comments received from service users. This will be monitored at subsequent inspections. The home employs a care assistant who also has the title of activities coordinator and is responsible for the provision of activities within the home. Daily records were kept of the activities undertaken by the service users. They included bingo, poetry and reading, singing, quizzes, word games, armchair exercise to music, ball games and reminiscence. Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 14 Comments from service users included ‘not many activities’, ‘it’s a bit boring’ and ‘there’s not much to do’. From the evidence seen by the inspector and comments received, the inspector considers that this service would not be able to provide a service to meet the needs of individuals of various religious, racial or cultural groups. There was no evidence that service users religious needs were assessed and met. All service users spoken to stated that they were happy with the food provision within the home. Service users were observed to eat lunch during the inspection. The menu was on a five weekly rota. The inspector was informed that alternatives were available on request, but that this was not documented. There was no information available regarding service users likes and dislikes. Staff were observed to treat the service users with respect and care was provided in an unobtrusive and dignified manner. There was no evidence that service users were given a choice regarding their care or how they spend their day. One service user spoken to stated that they ‘don’t get a lot of choice regarding bathing or getting up’. Another service user stated that the staff ‘could tell you more what you are going to do, or even ask you what you wanted to do’. Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a simple and accessible complaints procedure; service users stated that they felt safe at the home. EVIDENCE: The home had a simple and accessible complaints procedure. Service users spoken to during the inspection were aware of the complaints procedure. There had been one complaint since the last inspection. One service users spoken to said ‘I have no complaints’ another stated that she knew who to complain to. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. All appropriate safeguarding adults policies and procedures were in place and readily available to staff. Staff spoken to were aware of these policies and procedures and their whistle blowing responsibilities. Staff had received training in the protection of vulnerable adults. All service users spoken with stated that they felt safe at the home. Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was found to be clean, tidy and suitable in layout for its purpose. EVIDENCE: The inspector toured areas of the home. The premises were seen to be adequately maintained with service users able to access all areas of the home and grounds. The home was suitable for the needs of the service users. The décor was domestic in nature and general standards of maintenance were satisfactory. It was seen to be clean, tidy and free from offensive odours. Service users spoken to stated that the home is always clean, other comments from service users included ‘my room is very nice, it’s full of my things’. Oak House DS0000049203.V344717.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing arrangements in place on the day of the inspection were sufficient to meet the needs of the service users. EVIDENCE: Discussion with staff, service users and examination of the staff rota demonstrated that the staffing numbers and skill mix were appropriate to meet the assessed needs of the service users living in the home. All service users spoken to stated that they thought there were enough staff on duty at all times. Three staff files were seen during the visit and found to contain the required information and documents specified in paragraphs 1 – 9 of Schedule 2 of The Care Homes Regulations 2001 (as amended by The Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004). The staff training records evidenced that staff had received training in infection control, basic food hygiene, manual handling and protection of vulnerable adults. Not all staff responsible for the administration of medication had received recent training. Some staff had received training in communication, challenging behaviour and dementia. Two members of staff have just Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 18 completed NVQ level 2 in care and one staff member has achieved level 3. Four staff members are overseas nurses who have been accredited with an NVQ level 2 in care equivalent by the Home Office. The home had recently updated the induction for new staff; it included the skills for care common induction standards. It was not possible to assess how this was working in practice as no staff members had completed the programme. Service users spoken with were complementary about the staff at the home. Comments included ‘the staff treat me well’, ‘I am very well looked after’ and the staff are ‘very nice indeed’. Oak House DS0000049203.V344717.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users benefit from the management approach at the home, which provided an open, positive and inclusive atmosphere. EVIDENCE: The acting manager was not available at the time of the inspection. She has been in post since May 2007 and her application with the Commission to become the registered manager is in progress. There was no evidence available to the inspector that the acting manager had conducted an investigation or taken any action regarding a recent medication error. The home was not able to evidence that the service users health and personal care needs were met. Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 20 The inspector was informed that quality audit systems were in place to ensure the staff, service users and their relatives had a forum for airing their views. These included staff meetings, service users meetings, relative surveys and a comments book was available in reception. The visitors’ comments book was blank at the time of the inspection. All relatives were surveyed in June 2007; however only two had been returned to the home. The home had several ‘tick box’ audits, including a daily checklist, a weekly and monthly managers checklist. These checklists had been completed since May 2007. When asked if they felt their views were sought and considered by the home, one service user stated that ‘as we don’t complain, they take it that we are satisfied’. Procedures were in place to safeguard the financial interests of service users. No staff members are appointees for service users. Staff were aware of the need to maintain a safe environment. Required policies, procedures and safety checks were in place; samples of which were seen. Staff were observed to be following appropriate health and safety practices as they went about their work. Oak House DS0000049203.V344717.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 1 3 Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15(1) Requirement The registered person must ensure that the care plans are reviewed to ensure that they are fully completed and clearly document how support is to be delivered to the service users. This must include how to communicate with residents. This is the third time this requirement has been made. The registered person must ensure that all service users have access to healthcare professional services and that a record is kept of service users who receive treatment from healthcare professionals, specifically chiropodist and dentist. The registered person must ensure that the incidents of falls are audited in order that any preventative action is taken. The registered person must ensure that all identified service user needs are followed up and recorded, specifically risk of falls and services users hygiene DS0000049203.V344717.R01.S.doc Timescale for action 11/10/07 2. OP8 13(1)(b) 17(1)(a) Schedule 3(3)(k) 11/10/07 3. OP8 13 (4) 11/10/07 4. OP8 12 (1) 11/10/07 Oak House Version 5.2 Page 23 5. OP12 16 (2) (m-n) 6. OP12 16 (3) 7. OP15 16 (2)(i) 17 (2) Schedule 4 (13) 18 (1)(c)(i) 8. OP30 9. OP37 17 (1)(3) needs. The registered person must review the provision of activities within the home to ensure that it meets the needs of the current service users. The registered person must ensure that the service users cultural and religious needs are assessed and met. The registered person must ensure that a record is kept of all the food provided to service users, including alternatives to the menu. The registered person must ensure that all staff receive up to date training appropriate to their roles, specifically medication training. The registered person must ensure that all service user records are up to date and contain a date and signature, specifically nutrition assessments and care plan instruction sheets. 11/12/07 11/12/07 11/10/07 11/12/07 11/10/07 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 Further development is recommended regarding the nutritional assessment tool and specialist advice should be sought. Daily alternatives to the main meal should be shown on the menu to ensure residents know they have a choice. 3. OP15 Oak House DS0000049203.V344717.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oak House DS0000049203.V344717.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. 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