CARE HOMES FOR OLDER PEOPLE
Oak House Oak House 19 Queens Road Weybridge Surrey KT13 9UE Lead Inspector
Marianne Barham Unannounced Inspection 2nd November 2005 11:20 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.V252975.R01.S.doc Version 5.0 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.V252975.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Oak House Address Oak House 19 Queens Road Weybridge Surrey KT13 9UE 01932 857952 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) Dr Ajit Prasad Mrs Nishi Prasad To Be Confirmed 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.V252975.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 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. Of the 16 service users accommodated 3 may be within the category DE(E). Of the 16 service users accommodated 1 may be within the category DE. 6th June 2005 Date of last inspection Brief Description of the Service: Oak House is a large detatched property situated within walking distance of Weybridge town centre. The home provides accommodation and care for up to 16 older people, 3 of whom may also have dementia. There are currently no vacancies in the home. 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 passenger lift or stairs. The home has a good sized, enclosed and well maintained rear garden that is accessible to the service users. The home has its own mini-bus, used to facilitate service users activities, and ample parking to the front of the building. Oak House DS0000049203.V252975.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out at 11.20am by Marianne Barham, lead inspector for the service. The inspection was undertaken over a period of three and a half hours and was the second inspection in the Commission for Social Care Inspection (CSCI) year April 2005 to March 2006. The manager Yvonne Connock, who is not yet registered with CSCI, was present and a total of ten service users two visitors and three members of staff were spoken with during this inspection. Records relating to the care of service users and management of the home were examined. What the service does well: What has improved since the last inspection?
All service users now have a lockable cabinet/drawer in their rooms to store valuables, meeting a requirement made at the last inspection on 6th June 2005. A training programme for the staff has been put into place with a formal, written induction process and individual training records are now kept. This meets a requirement made at the last inspection. Oak House DS0000049203.V252975.R01.S.doc Version 5.0 Page 6 Service users care plans are now signed by, the service user or a representative to show that they or their families were involved in the process. This meets a recommendation made at the last inspection. A record is now made of actions that were taken about issues raised at service users meetings as recommended at the last inspection. 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. Oak House DS0000049203.V252975.R01.S.doc Version 5.0 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.V252975.R01.S.doc Version 5.0 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): N/A These standards were not assessed at this inspection. Please see report dated 6th June 2005 for detail on these standards. EVIDENCE: Oak House DS0000049203.V252975.R01.S.doc Version 5.0 Page 9 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): 8 and 9 Service users health needs are met and they are protected by the home’s policies and practices for dealing with medicines, however handwritten entries on the medication charts need to be signed. EVIDENCE: All service users are registered with a local GP practice and specialist healthcare professionals are accessed through these. The district nurses attached to the GP practices visit the home regularly as needed. A domiciliary NHS dentist and NHS optician visit the home every six months or as needed and a private chiropodist visits every six weeks. A hairdresser also visits the home every two weeks. All service users have their health needs assessed and reviewed regularly and have risk assessments undertaken for daily activities of living. The manager stated that the assessments are reviewed on a regular basis, however no record is made of any changes in need. A recommendation has been made that this is done. Oak House DS0000049203.V252975.R01.S.doc Version 5.0 Page 10 The home has a policy and procedure in place for dealing with medicines that is in line with the guidance issued by the Royal Pharmaceutical Society. Medication is delivered mainly in blister packs and the dispensing pharmacy to the home carries out medication audits every six months and provides guidance and training to the staff. The manager is due to attend an advanced medication course in the near future. All medications were seen to be stored securely and appropriately and medication administration charts are maintained accurately. Profiles detailing the medication, indications and possible side effects are in place for each service user. The medication administration records were examined. These were mostly maintained in good order, however one handwritten entry had not been signed by the person writing it and also it was unclear whether the medication was ‘as required’ or a regular medication. A requirement has been made to address this. Oak House DS0000049203.V252975.R01.S.doc Version 5.0 Page 11 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): 15 Service users receive a balanced diet in pleasant surroundings, according to their individual needs and preferences. There are insufficient members of staff around at mealtimes to support them appropriately. EVIDENCE: The home has four weekly menus that offer a good variety of balanced meals. The menus are produced in consultation with service users and are reviewed according to the season. The kitchen was seen to be clean, well equipped and had a good stock of appropriately stored fresh produce and groceries. The menu is put on the notice board each day and service users can then inform the staff if they want something different. The dining room is large and the tables are nicely laid with tablecloths and napkins. The meals are served at the table, offering the service users’ greater choice of what they have and portion size. Staff members were seen to support service users to have their meals in a caring and dignified manner, encouraging them to socialise with one another. Service users spoken with all said that the food in the home is good and that they can have what they want to eat. All said they were able to have a drink
Oak House DS0000049203.V252975.R01.S.doc Version 5.0 Page 12 or snack if they wished. A visiting relative, staying for lunch said that the food is very good because it is home cooked. The home does not employ a cook therefore one of the staff members has to cook the meals. It was concerning to observe during the lunchtime period that one member of staff was in the kitchen and the manager was administering the medication, leaving only one member of staff to support all sixteen of the service users with their meals. A requirement has been made that staffing requirements be reassessed with a view to employing a cook or an extra care staff throughout the day shift to ensure sufficient staff are available to support service users at all times. Oak House DS0000049203.V252975.R01.S.doc Version 5.0 Page 13 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 Service users and their families can be sure that their complaints will be listened to and acted upon by the home. EVIDENCE: The home has a complaints procedure that has been placed in the service users guide given to each service user on admission. This document gives information to service users and their families on how to make a complaint in the home and also to the commission. Records are maintained of complaints and actions taken by the home to resolve them. No complaints have been received in the last year. Oak House DS0000049203.V252975.R01.S.doc Version 5.0 Page 14 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, 24 and 26 Service users’ live in a clean, safe, well-maintained environment and their rooms are comfortable with their own possessions around them. EVIDENCE: The home employs maintenance staff and has an ongoing programme of maintenance in place. The home is pleasantly decorated, comfortably furnished and well maintained throughout. A cleaner is employed and this was evident by the high standard of cleanliness in the home. Service users bedrooms are comfortably furnished and decorated according to the individual’s taste. All except one have en-suite facilities. All of the bedrooms are personalised with the service users belongings and reflect their individual preferences and interests. A requirement was made at the last inspection on 6th June 2005 for all service users to have a lockable facility in their rooms and it was pleasing to see that this had been done.
Oak House DS0000049203.V252975.R01.S.doc Version 5.0 Page 15 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 The skill mix of the staff team does meet the needs of the service users, however there are not always sufficient numbers of staff available to support service users. EVIDENCE: The home has an established, stable staff team with a good mix of skills and experience. The rotas were examined and show how many members of staff are on duty throughout the day and the night. As noted previously, there are insufficient staff numbers for several hours during the day owing to the home not employing a cook. A requirement has been made to address this. All members of staff on duty were spoken with and all were happy working at the home. They each reported that they received induction training, supervision and mandatory training such as fire safety and moving and handling. Oak House DS0000049203.V252975.R01.S.doc Version 5.0 Page 16 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): 33 Quality assurance processes do not ensure that the home is run in the best interests of the service users. EVIDENCE: The home holds service users meetings three to four times a year and these are recorded with any issues followed up and recorded in the next meeting. The service manager carries out monthly audits of the home, however no other process of internal or external quality assurance monitoring is in place. A requirement has been made to address this. Oak House DS0000049203.V252975.R01.S.doc Version 5.0 Page 17 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X 3 X 3 STAFFING Standard No Score 27 1 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X X X X Oak House DS0000049203.V252975.R01.S.doc Version 5.0 Page 18 NO Are there any outstanding requirements from the last inspection? 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 9 Regulation 13 (2) Requirement The registered person must ensure that all handwritten entries on the medication administration record (MAR) charts are signed by, the person writing the entry. The registered person must ensure that all medications recorded on the MAR charts state clearly when the medication is to be given and whether it is a regular medication or ‘as required’ medication. The registered person must review the staffing numbers on duty during the day with a view to employing a cook or an extra care staff during the day to ensure that there are sufficient numbers of staff on duty at all times to safely care for and support the service users in the home. The registered person must implement a process of quality assurance that takes into account the views of service users, relatives, friends and
DS0000049203.V252975.R01.S.doc Timescale for action 09/11/05 2 9 13 (2) 09/11/05 3 27 18 (1) (a) 09/12/05 4 33 24(1)(a) (b)(2)(3) 09/12/05 Oak House Version 5.0 Page 19 involved professionals. 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 8 Good Practice Recommendations It is strongly recommended when reviewing the health needs assessments that a record is made of the review and any changes to the assessed needs. Oak House DS0000049203.V252975.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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