Inspection on 21/07/08 for Oak Lodge

This inspection was carried out on 21st July 2008.

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 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

Oak Lodge 30/08/06

Oak Lodge 31/01/06

Oak Lodge 05/07/05

Oak Lodge 21/10/04

Oak Lodge 27/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Oak Lodge 2 Peveril Road Old Duston Northampton Northants NN5 6JW Lead Inspector Stephanie Vaughan Unannounced Inspection 21st July 2008 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 Oak Lodge DS0000012875.V368750.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 Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak Lodge Address 2 Peveril Road Old Duston Northampton Northants NN5 6JW 01604 752525 PF 01604 75252 oaklodge10@btinternet.com 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) Restgate Limited Mrs Susan Emmerson-Ward Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Old age, registration, with number not falling within any other category (36) of places Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Restgate Limited is registered to provide personal care and accommodation at Oak Lodge Care Home for service users who fall into the following categories :Old age not falling within any other category (OP) 36 Dementia over 65 years DE(E) 36 The maximum number of service users to be accommodated at Oak Lodge Care Home is 36 30th August 2006 2. Date of last inspection Brief Description of the Service: Oak Lodge is situated in a quiet residential street in the Duston district of Northampton. The home is registered to provide personal care, without nursing, for up to thirty-six older people, including people with dementia related care needs. Oak Lodge is accessible by the local bus service from Northampton town centre, and there are local shops and other community facilities in the immediate locality of the home. Within Oak Lodge there is a passenger lift and stair lift. Oak Lodge currently has thirty single bedrooms with seventeen rooms having en-suite facilities. There are three double bedrooms, one of which has en-suite facilities. There is a garden to the rear of the building, which the service users are able to enjoy in the warmer weather. Accommodation fees currently range from £391 a week for a ground floor single en-suite bedroom; to £411 a week for a first floor shared room. An additional weekly charge is made for the care of residents with dementia at £17:00 per week. Additional charges that may apply include, hairdressing and chiropody and for personal items such as clothing and toiletries. The service has copy of the most recent Commission for Social Care Inspection report displayed in the main entrance. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 5 Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate. Prior to this statutory inspection, a period of four hours was spent in preparation. This comprised reviewing the Annual Quality Assurance Assessment, a document sent to us by the provider, the previous inspection reports and associated requirements, the service history and other documentation. A total of 10 Comment cards were sent to people who use the service and 10 comment cards were sent to staff. Comment cards for relatives were supplied to three of the residents during the inspection to pass on to their relatives. We have not yet received any of the completed questionnaires however we received some questionnaires on September 2007 that provided some information and this has been used to inform this current inspection. The Commission have received no concerns or complaints about this service. However there has been one Safeguarding Adults allegation, which was subject to an independent investigation under the Local Authority Guidelines on the Safeguarding of Adults. The investigation concluded that there had been some shortfalls in the care that had been received by one resident, however the service has taken appropriate action to prevent further incidents. The Commission have a focus on Equality and Diversity and issues relating to this are also included in the main body of the report. This site visit to the home was conducted over a period of seven hours during which the inspectors made observations and spoke to the people who use the service and staff. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of four residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. The service specialised in the care of people who have dementia, as such some have limited abilities to recall and communicate their experiences. In these circumstances observations are used to inform the inspection activity. The Registered Manager was present during this inspection. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 7 What the service does well: People who use the service can be confident that the service will make sure that they have enough information so that they can make an informed choice about whether they would like to live there. One Resident commented ‘I was visited at home by the manager and received enough information, the staff very friendly and obliging’. The service also makes sure that it obtains the right information so that they can care for people properly once they start to live there. The staff work closely with the local General Practitioners and District Nursing Service. People who are at risk either due to the effects of pressure or nutrition receive the right support. People who use the service also have access to a range of external health professionals and services. People who use the service told us that they felt that they were well looked after and that the service was able to meet their needs. They commented about how caring the staff were towards them and that they felt that the staff knew how they liked and needed to be cared for. One relative commented ‘I visit frequently and she always looks great and has settled quickly into the home. The staff are good, attentive and caring so I feel that she is safe and well looked after’. People who use the service are able to receive their medication as prescribed and there are good systems in place to ensure that this is managed safely. Staff speak to residents in their preferred form of address, knock on residents bedroom doors before entering and to relate well to them at all times. There is a varied activities programme including visiting entertainers and outings. People who use the service told us that they are able to make decisions about how to spend their time, are able to keep in touch with family and friends and maintain their faith. People who use the service told us that they have at least three meals a day and that the portions are of a good size. They say that the food is very good and that there are always alternatives on the day should they not want to have any of the options from the menu. People who use the service told us that they were able to raise their concerns with senior staff about any aspect of life at Oak Lodge. The said that they particularly liked the fact that they could go to the office and talk to the Registered Manager. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 8 People who use the service told us that they felt safe living at Oak Lodge; they said that the staff were very attentive and that they were nice to them. The service makes sure that there are enough staff on duty, that they have the right checks before they start working there and that they have the right training to care for people properly. The service makes sure that it does the right checks to make sure that the home is safe and that they know what the people who use the service think about it. The staff support people who use the service to manage small amounts of money and they keep it safe and have the right records in place. What has improved since the last inspection? What they could do better: The Statement of Purpose needs to be updated to make sure that people have access to accurate and up to date information. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 9 The management need to make sure that people who use the service have up to date information included in their individual contracts. People who use the service have an individual plans of care which sets out how people are to be cared for, at present these are basic and do not contain all of the right information. Daily records do not show how the people who use the service are able to make decisions in their daily lives or that the necessary care is consistently provided. Individual plans of care need to be reviewed on a monthly basis and people who use the service or their representatives should be involved in the care planning and review process. The staff need to make sure that dental cleansing agents are stored safely and that there are the right checks in place so that they can be used safely. The service needs to make sure that people are assessed for the risks associated with old age such as falls, falls from the bed, the risks of pressure and nutrition. The staff need to make sure that they conduct detailed risk assessments to identify people who are able and wish to manage their own medication. When the assessment shows that staff need to do this formal written consent should be obtained from the resident or their representative. The management need to make sure that they have the right storage facilities for all types of medication. One of the residents rooms was is fitted with a radiator cover and in these circumstances an appropriate risk assessments needs to be conducted to reduce and manage the associated risks. The management have consulted the residents about their wish to have locks fitted to their bedroom doors, some of these have been fitted however they are not fit for the intended purpose as they do not have an appropriate over ride facility which means that people may become locked in their rooms. The service needs to consult the fire officer about the practice of keeping fire doors open, including the use of wedges or other items to prop open doors. They should also consider fitting automatic losing devices to doors that remain open for long periods of time. The management need to make sure that they are sending us information that we need about the home and the well being of the people who live there. The management need to ensure that when accidents occur the right checks are conducted and the details are consistently recorded. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 10 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 Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 11 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 Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 12 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): 1,2 3, & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have good information to enable them to make an informed decision about whether they would like to live at Oak Lodge. EVIDENCE: The service has a Statement of Purpose, which is available in the home and in general complies with the criteria set out in schedule one of the National Minimum Standards. However this needs to be updated to accommodate recent changes to the certificate of registration. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 13 There is also a Service Users Guide, which tells people what the service offers; this is included in a welcome pack that is given to people who might wish to use the service. This is produced in a standard English language format, this meets the needs of the exiting residents and the Registered Manager confirmed that information could be provided in alternative formats upon request. People who use the service told us that they had been able to visit the home, chat with other residents and staff to find out what it was like to live there and had received enough information to help them decide whether they would like to live there. All of the people who live at Oak Lodge have written contracts in place, some of these are not up to date and need to be reissued to accommodate the increased charges that have occurred over a period of time. People who use the service told us that they had been assessed to make sure that the service could care for them properly. Each resident has an individual plan of care, which shows that assessments are obtained from the funding authorities and that the service conducts their own preadmission assessments, which are used to form the basis of the individual plans of care. One Resident commented ‘I was visited at home by the manager and received enough information, the staff very friendly and obliging’. The service does not provide intermediate care. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 14 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): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The content of the individual plans of care is basic, this means that the management of health, personal and social care that people receive in not proactive. EVIDENCE: Each resident has an individual plan of care, which provides instruction to staff about how the resident is to be cared for. At present these are not person centred and only contain minimal information about how the residents needs and wishes to be cared for. They do not cover the full range of the resident’s personal, health and social care needs or provide sufficient detail about how these needs are to be addressed. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 15 Each resident has a Movement and Handling care plan which details how residents are to be assisted with their movement and good Movement and Handling practices were observed. The Movement and Handling assessments contain some basic reference to the prevention of falls. However individualised risk assessments for the prevention of falls need to be developed, based on current guidance issued by the Health and Safety Executive and in line with current best practice. Guidance should also be sought from the Falls Coordinator regarding the prevention of falls and residents who have a history of falls should be referred to the falls clinic. Detailed risk assessments also need to be developed regarding the risks of falls from the bed. Daily records are maintained however these are also basic and need to have more detail to show how the people who use the service are able to exercise choice in their daily lives and to provide an accurate record of the care that is provided. Individual plans of care are not reviewed on a regular or monthly basis to ensure that the information is up to date and there is little evidence that either the resident or their representative is involved in the care planning and review process. There was some evidence that residents are supported to maintain their oral health, however this was not consistently documented. Some of the existing residents prefer to use dental cleansing agents, this was not stored securely and there were no risk assessments in place to ensure the safe storage and useage. However during the course of the inspection arrangements were made for the safe storage of these products. Only one of the residents case tracked had an assessment for the risks associated with pressure and this had not been reviewed for a period of six months. However there was evidence that the service works with the District Nursing Service in the event that people require nursing care and that the appropriate pressure relieving equipment is obtained. There was no evidence that residents are regularly assessed for their nutritional risks, however there was evidence that residents receive nutritional supplements when required. There was no evidence within the individual plans of care that residents are referred to the Continence Nursing Services although there is evidence that the service works closely with local General Practitioners and also have access to other health services such as Psychiatrists, the Community Psychiatric Nursing Services, dentists, podiatrists opticians and hospital services. One relative commented ‘My Father receives appropriate medical care’. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 16 However despite the poor standard of record keeping people who use the service told us that they felt that they were well looked after and that the service was able to meet their needs. They commented about how caring the staff were towards them and that they felt that the staff knew how they liked and needed to be cared for. One relative commented ‘I visit frequently and she always looks great and has settled quickly into the home. The staff are good, attentive and caring so I feel that she is safe and well looked after’. Another stated ‘I am satisfied with the care that my father received at Oak Lodge, Staff appear to adhere to my fathers wishes and requirements’. In general outcomes for people who use the service appear to be satisfactory, residents are well presented and appear to be well cared for, there was evidence that they are supported to express their personality and gender through their choice of clothing, hairstyle and the use of make up. Medication systems were reviewed and found to be in good order ensuring that people who use the service receive their medication as prescribed. Appropriate records are maintained and safe practices were observed. The medication is stored in a locked cupboard and none of the existing residents require the use of Controlled Medication, for which the service does not yet have the recommended storage facility. There is some evidence that residents are assessed for their ability to self medicate, however these assessments need to be further developed to demonstrate how these decisions have been reached. Where residents are assessed and being unable or do not wish to manage their own medication formal written consent needs to be obtained from the residents or their representative. Privacy and dignity is managed well, staff speak to residents in their preferred form of address, knock on residents bedroom doors before entering and to relate well to them at all times. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 17 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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activity and meals are both well managed, are creative and provide daily variation and interests for the people who use the service EVIDENCE: People who use the service told us that routines are flexible in the home and that they are able to choose how to spend their time. They told us that there was an activities programme and that they enjoyed these events, most of which are in house activities or visiting entertainers. However there was also some evidence that there are external activities that are arranged such as regular concerts in a local park. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 18 People who use the service also told us that they are supported to maintain their faith either by attending their own church or by participating in the monthly Communion and Songs of Praise services. They also told us that they had made friends with other residents at the home and that they were able to choose to sit near them in the lounge and also to share the same dining room table. Individual plans of care show that information about the residents previous lifestyle is recorded and there is also some evidence that information about the routines and preferences are also recorded. People who use the service told us that they are able to keep in touch with their family and friends. This is by going out with them to local restaurants, or on home visits. Residents are also able to receive their family and friends at Oak Lodge in either one of the communal areas, their own private accommodation or in one of the many quite areas situated throughout the home. People who use the service are able to make and receive phone calls and also to receive their mail unopened. People who use the service told us that they are supported to maintain their independence and are able to bring their own personal possessions into the home. Individual plans of care showed that advocacy services are accessed when needed and the management confirmed that they were familiar with the requirements of the Mental capacity Act 2005. Meals and meal times are managed well, the food is all home cooked and the menu is displayed on a daily basis. A cooked breakfast is available on most days and there is always a choice of two main courses for the lunchtime service. All of the existing residents are British and as such the menu if reflective of the people who use the service. People who use the service told us that they have at least three meals a day and that the portions are of a good size. They say that the food is very good and that there are always alternatives on the day should they not want to have any of the options from the menu. Meals are served in one large and one small dining room in pleasant surroundings; the staff offer discreet and sensitive assistance. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 19 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are appropriately protected by sound policies and procedures that ensure safe practice. EVIDENCE: People who use the service told us that they were able to raise their concerns with senior staff about any aspect of life at Oak Lodge. The said that they particularly liked the fact that they could go to the office and talk to the Registered Manager. They also said that when they had raised concerns that these had been addressed to their satisfaction. Staff spoken to were also able to demonstrate a good understanding of their responsibilities in the management of complaints. The service has a complaints procedure, which is displayed throughout the home and is also included within the Service Users Guide. Verbal concerns are recorded and showed that arrangements are made to take corrective action. There is also a complaints file, which holds information about formal complaints and shows the investigation report and the outcomes of the investigation and action taken to prevent reoccurrence. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 20 The service has received one formal complaint since within the last twelve months the investigation concluded that the complaint was not upheld and the response to the complainant was sent within 21 days. The Commission have received no concerns or complaints about Oak Lodge. People who use the service told us that they felt safe living at Oak Lodge; they said that the staff were very attentive and that they were nice to them. Both staff and management were clear about their roles and responsibilities in the Safeguarding of Adults. There has been one Safeguarding Adults allegation regarding this service since the last inspection, this was investigated independently in compliance with the Local Authority Guidelines on Safeguarding Adults. The investigation concluded that there had been some shortfalls in the care that had been provided to one resident, however appropriate actions have since been taken to prevent further reoccurrence. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 21 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): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a homely environment that has been improved by the ongoing programme of development. EVIDENCE: The premises is an extended period property situated in a convenient location close to local amenities. People who use the service told us that they had lived locally and had been aware of the home before they had decided to live there. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 22 Some of them told us that they had friends and relations that had been previously cared for at Oak Lodge. A Requirement was made at the previous inspection regarding the lack of a lock on the door of a downstairs lavatory; there was clear evidence that the providers have complied with this Requirement. The home appears to be well maintained and to offer a safe and comfortable place for people to live. Since the last inspection there have been major changes including a new extension and internal decorations involving all common areas and residents’ bedrooms. Residents were involved in the decision-making. New furnishings and fittings have been installed in the lounge and carpets have been replaced in all common areas. The grounds have also recently been improved to offer an enclosed pleasant terraced area and gardens, which are easily accessible to the residents through the conservatory. Most areas of the home are accessible to wheel chair users and there is also a passenger lift, rooms on the second floor are occupied by the more active residents. People who use the service told us that the home was comfortable and one person particularly stated that they like their own room. People who use the service are able to bring in their own personal possessions and to have their rooms arranged in the way that they like. They have access to call bells and other fixtures and fittings. In general rooms are fitted with appropriate safety devices such as window restrictors and radiator guards, where these are not in place appropriate risk assessments need to be developed. Arrangements had been made to replace a broken window restrictor on the second floor within the week. Residents are consulted about their wish to hold a key to their rooms and there is evidence that these are supplied, however the type of lock that is currently being provided does not have the appropriate override facility to ensure that people can get out of their rooms without the use of a key. This was discusses with the Registered Manager who has agreed to ensure that these locks are replaced as soon as possible. Door wedges are in use for some of the doors to the communal areas to enable easier access; the Registered Manager confirmed that these are removed at night. However she commented that some of the residents do like to keep their bedroom doors open and sometimes use items to prop open their doors. Further guidance needs to be sought form the fire officer regarding this practice and the service should consider fitting automatic door closing devices in these circumstances. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 23 The premises were clean and hygienic throughout; One relative commented ‘ The Home always fresh and clean’. The service employs domestic staff and also has access to maintenance staff. Staff confirmed that all equipment including the laundry facilities were in good working order. The hot water temperature was checked and this continued to run at a tepid temperature for at least 2 minutes. This was discussed with the Registered Manager who has arranged for a plumber to address this on the same day. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 24 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): 27, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels and staff training are maintained to ensure that resident’s needs are met and that they are in safe hands. EVIDENCE: Staffing levels at Oak Lodge appear to be adequate; there are four care staff on duty throughout the day, in addition to the Registered Manager and the Deputy Manager, who work opposite shifts at the weekends. There are also additional staff, including a cook and domestic staff. There are three care staff on duty during the evening and two waking staff at night. Additional coverage is achieved by staff working extra hours to cover any absence and the use of agency staff is rare. All of the existing staff is white European, which is in general reflective of the culture of the existing residents. All care staff are currently female, this means that the male residents are not able to receive personal care from staff of the Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 25 same gender. However the management are mindful of the need to ensure that the staff group reflects the gender of the existing residents. Staff files are kept in a locked cabinet and the keys were not available during the inspection. However staff were able to confirm that appropriate recruitment practices are in place. Staff conformed that they had attended an interview, that they had supplied two written references and that the right checks had been conducted before they were able to commence working in the home. They also confirmed that they had received induction training and had been supervised until they were assessed as being competent to fulfil their roles. Staff were also able to confirm access to National Vocational Qualification in Care level 2 and mandatory training such as Movement and Handling, Basic Food Hygiene, First Aid, Health and Safety. Staff also have received other training specific to the needs of the individuals and further training in the management of dementia is planned for the near future. Staff supervision is conducted on a monthly basis. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 26 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): 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager is experienced and runs Oak Lodge sensitively and in the best interests of the residents. EVIDENCE: The Registered Manager has been in post for several years and has confirmed that she has commenced the Registered manager Award and National Vocational Qualification in Care level 4. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 27 Both the people who use the service and the staff tell us that she provides good leadership and has the right skills to manage the home. The service has an internal quality assurance system, which includes environmental audits, audits of medication. There are staff meetings, residents meetings and one to one discussion with residents to seek their views. The service also conducts formal satisfaction surveys on a regular basis involving residents and their representatives. The results are collated and used to inform service development. The service holds small amount of resident’s money on their behalf. We were unable to conduct any checks on this during the inspection, as the key was not available, however the Registered Manager was able to confirm that residents money is stored in individual locked containers within a locked facility. In addition accurate records are maintained including money received, a record expenditure including receipts and a balance bought forward. Staff told us that they have access to the required training. The Registered Manager confirmed that notifications are sent to the Commission when incidents occur which affect the wellbeing of the residents. It is not clear why some of the notifications regarding attendance at Accident and emergency departments have not been received. However The guidelines regarding this should be reviewed and are accessible on the Commission for Social Care Inspection professional Website. The service is currently disadvantaged by not having access to the intranet and the sources of information available such as the Health and Safety Executive, National Institute for Health and Clinical Excellence and Commission for Social Care Inspection. However the management confirmed that there are plans to install Internet access for both management purposes and the benefit of residents who may wish to access this service. Accident records were reviewed and seen to be recorded on a standard format, however these do not appear to be consistently completed for all incidents and this needs to be addressed, in addition when accidents do occur there is no system to ensure that people are followed up at regular intervals to ensure that they have sustained no adverse effects or to prompt staff to notify the appropriate people and record that they have done this. Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 28 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 3 X 2 Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 4. Requirement Timescale for action 30/09/08 2 OP7 15. 3. OP7 13. 4. OP7 13. The Statement of Purpose must be reviewed to ensure that it contains up to date and accurate information and complies with the criteria listed in schedule 1 of the National Minimum Standards. To ensure that people who use the service have access to up to date and accurate information. Individual plans of care must be 30/09/08 reviewed to ensure that they provide detailed instruction to staff about all of the resident’s health, personal and social care needs. Detailed risk assessments for 30/09/08 falls must be conducted for all residents, based on the guidance issued by the Health and Safety Executive and current best practice to ensure that the risks are reduced or managed. Detailed risk assessments for 30/09/08 falls from the bed must be conducted for all residents, based on the guidance issued by the Health and Safety Executive and current best practice to DS0000012875.V368750.R01.S.doc Version 5.2 Oak Lodge Page 30 5. OP7 15. 6. OP8 13. 7. OP8 13. 8. OP8 13. 9. OP19 13. 10 OP19 13. 11 OP19 OP38 13 & 16 12 OP38 37 ensure that the risks are reduced or managed. Individual plans of care must be reviewed on a monthly basis to ensure that staff have up to date and accurate information about how the residents needs and wishes to be cared for. Appropriate risk assessments must be conducted for the use of dental cleansing agents, including the arrangements for safe storage; to ensure the Health and Safety of residents. Appropriate assessments must be conducted for the risks of pressure and that these must be kept under monthly review to ensure that the resident’s health and well being is protected. Appropriate assessments must be conducted for the risks associated with poor nutrition and these must be kept under monthly review to ensure that the resident’s health and well being is protected. Individual risk assessments must be conducted to reduce and manage the risks of exposed radiator surfaces. To ensure the Health and Safety of residents. The management must ensure that only appropriate privacy locks, with an internal override facility are fitted to resident’s bedroom doors. To ensure the Health, Safety and protection of residents. The fire officer must be consulted about the use of items used to keep fire doors open. To ensure the Health and Safety of residents. The management must ensure that notifications are consistently sent to the Commission regarding circumstances that DS0000012875.V368750.R01.S.doc 30/09/08 30/09/08 30/09/08 30/09/08 30/09/08 30/09/08 30/09/08 30/09/08 Oak Lodge Version 5.2 Page 31 13 OP38 13, 17 & 37 adversely affect the well being of the residents. Accident records must be consistently completed and arrangements put in place to ensure that the right checks are conducted at regular intervals after an accident. 30/09/08 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 2 3 4. 5. Refer to Standard OP2 OP7 OP7 OP7 OP7 Good Practice Recommendations Residents contacts should be reviewed an reissued to ensure that they have up to date information about the charges and what is included in the cost. Individual plans of care should be reviewed to ensure that they are person centred. Senior staff should receive training in the development of person centred individual plans of care. Guidance should be sought from the local falls co-ordinator about the current best practice in the reduction and management of falls. Daily records should be reviewed to ensure that they demonstrate how the people who use the service are able to exercise choice in their daily lives and to provide an accurate record of the care that is provided. The care planning and review process should be accessible to residents or their representatives, so that they have opportunities to contribute and influence the way that they are cared for. Residents should be further assessed for their ability and wish to manage their own medication Formal written consent should be obtained for the staff to administer medication on the residents behalf when they are assessed as unable or do not wish to manage their own medication. 6. OP7 7. 8. OP9 OP9 Oak Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Lodge DS0000012875.V368750.R01.S.doc Version 5.2 Page 33 - 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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