Inspection on 16/07/07 for Oak Lodge Nursing Home

This inspection was carried out on 16th July 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 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 Nursing Home 20/07/06

Oak Lodge Nursing Home 28/02/06

Oak Lodge Nursing Home 23/09/05

Oak Lodge Nursing Home 14/03/05

Oak Lodge Nursing Home 03/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Oak Lodge Nursing Home Lordsleaze Lane Chard Somerset TA20 2HN Lead Inspector Gail Richardson Unannounced Inspection 16th July 2007 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 Nursing Home DS0000003274.V345328.R02.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 Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak Lodge Nursing Home Address Lordsleaze Lane Chard Somerset TA20 2HN 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) 01460 67258 01460 68068 oaklodge@majesticare.co.uk Majestic Number One Limited Caroline Orrell Care Home 47 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (39) of places Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Elderly persons of either sex, not less than 60 years, who require general nursing care No more than 39 persons requiring nursing care may be accommodated. Up to 10 places for elderly persons, of either sex, in the category OP, who require personal care only. Eight places exclusively in The Acorns for elderly persons of either sex, in the category DE(E) who require personal care only. There will be a named Care Co-ordinator and designated staff team for The Acorns. To provide care for one named person under the age of 60. Date of last inspection 20th July 2006 Brief Description of the Service: Oak Lodge was first registered in 1989 and is now owned by a growing care company. The home is situated in a private lane a short distance from the rural town of Chard. The home is partly converted house with a purpose built extension with accommodation provided on two floors. The home offers general nursing care for up to 39 older people. The home also has 8 beds registered to provide personal care for people with dementia care needs using a person-centred model of care. This provision is in a separate area of the home called The Acorns that is reached through the main reception area of the home and has a keypad secured entrance. The main area of the home has a pleasant outlook onto private gardens from two large downstairs communal rooms and a conservatory. The Acorns has been fully refurbished to provide domestic style accommodation including a kitchen/diner and lounge. The separate Acorns garden has been designed to be safe and secure with separate access for those people living there. Both these areas of the home have identified staff teams. Activities are provided during the week and include a weekly mini-bus trip. The fee range for personal care residents is £500.00 to £550.00 and the Nursing fee range is £650.00 to £750.00. These fees do not include items such as hairdressing and chiropody. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place over 7 hours (14 inspection hours) on the 16th July 2007 by inspectors Gail Richardson and Shelagh Laver. A tour of the home took place of a selection of the bedrooms and all communal areas were seen. There were 43 people using the service currently residing at the home, this includes 31 nursing patients, 4 residential patients and 8 people residing in the Acorns Unit. The inspectors spoke to 10 people using the service and 6 members of staff and 1 visitor, the Registered Manager was available throughout the inspection. As part of this inspection the inspectors surveyed the opinions of a random selection of service users and their representatives, GP’s, District Nurses and Care Workers. A 3 responses were received from relatives, no responses were received from people using the service, 1 response was received from a visiting health professional and 6 responses were received from staff. Records relating to care, staff, finances and health and safety were examined The people using the service looked well cared and those able to express their opinion were complimentary about the care they received. Staff spoken to were happy about working in the home and were happy with the care being provided. Inspectors observed staff working and noted that people were treated with dignity and respect at all times. The inspectors would like to thank the people using the service and staff for their time and hospitality through out the inspection. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. What the service does well: Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 6 The inspectors observed that the atmosphere within the Acorns unit was homely and cheerful. Staff appeared knowledgeable and competent about the people in their care and confirmed they feel supported by the Dementia Unit Manager Carol Parker. People using the service appeared settled and were observed moving freely around the unit, interacting with staff and other service users. People using the service were happy wit the care they received and were complementary about the staff. Comments included “They are wonderful” and “I am well looked after”. People using the service spoken with, all confirmed that the quality, quantity and variety of food is always good, there was evidence that individual preferences are catered for. Relatives confirmed that they are made welcome and kept informed of changes in their relative’s condition as necessary. The home appeared clean and free from malodour. What has improved since the last inspection? What they could do better: The registered manager is required to ensure that plan of care is in place for each person using the service which is fully completed, regularly updated and contains all the relevant detail for each identified need. This is to ensure that staff have all the details required to ensure that all needs identified are met. The registered manager is required to ensure that all oxygen cylinders are stored securely in an upright position and that oxygen signage is available on all doors to rooms containing oxygen cylinders and the signage contains the correct details. This is required to ensure that there are no risks of accident, injury or explosion. The manager is required to ensure systems are in place for the recording of administration details for all prescribed creams and dietary supplements. This is required to ensure that all prescribed items are administered as prescribed. The manager must ensure that all hand transcribed entries on the Medication Administration Records are signed by 2 suitably qualified staff members to ensure that there is no risk of transcribing error. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 7 The registered manager must ensure that the policies relating to complaints and whistle blowing contain the direct contact details of CSCI. This is required to ensure that all staff and people using the service have direct contact with out external agencies. The registered manager is required to ensure that all Health and Safety issues outlined in the body of the report are addressed to maintain the health and wellbeing of people using the service. The manager is recommended to reorganise the dressings stored in the home to ensure that each dressing remains in the labelled box which contains the prescribing name and directions for use to ensure that all people using the service receive the correct medication prescribed for them. The manager is recommended to ensure to ensure that all activities undertaken are recorded in the persons file, this is recommended to include all one to one activities undertaken to ensure an accurate and updated record. 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 Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 8 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 Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 9 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 4 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home continues to be able to provide prospective residents and relatives with sufficient information in the format of brochures, the Service User Guide and Statement of Purpose for them to make an informed decision about the home. All prospective people who will use the service receive a pre admission assessment by the registered manager to ensure the home can meet the assessed needs identified. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide which is made available to prospective people using the service and their representatives. This is unchanged since the last inspection. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 10 Prior to admission the people using the service and their representatives have the opportunity to visit the home to view prospective rooms and communal areas. Two surveys were returned to the inspector and both of these confirmed that they received enough information prior to admission. Five people who use the service, records were examined. Each person had received a pre-admission visit by the manager from the home. Their needs were assessed and documented and this forms the basis of the care plan. This assessment ensures that the home can meet the needs of the person assessed and will identify any equipment requirements prior to admission. However, it was noted that on one occasion a person’s pre admission assessment identified the need for a pressure-relieving mattress, which was not available for several days after admission. It was discussed with the registered manager that identified equipment needs must be provided for prior to admission. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 11 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. Each person who uses the service has a care plan, the assessed areas of need were not all reflected in the plans of care examined and the detail recorded did not ensure that staff could provide a good standard of care. The management of medications systems does not meet the required standard in all areas. Staff were observed to treat the people using the service with dignity and respect at all times and residents fell well cared for. EVIDENCE: Five care plans examined and were found to have varying degrees of information. One care plan examined of a person using the service, who was observed to have complex and high dependency needs did not have sufficient care planned detail to support staff to give the care required. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 12 Another care plan was noted to not have care needs identified at pre admission suitably addressed in the care plan to support that persons needs and choices . Another care plan did not provide suitable detail for the treatment of an acquired infection. In the records examined, wound care plans were not regularly updated. It was noted that in one instance a person who required a high amount of staff input did not have a care plan to support staff to be aware of the required plan of action and the records of staff input for change of position and fluid intake had significant gaps. It was noted by inspectors that one person using the service who was being cared for in bed did not have a recorded change of position for a period of over 4 hours. Social care plans in both units were not fully completed and lacked documentation of social choices and preferences. Some dependancy levels and screening tools had not been completed and therefore staff would not be supported with the information required to provide the care needed for the pesron using the service. Inspectors observed that the people using the service appeared comfortable and cared for and all the people using the service who were asked were complementary about the care they were receiving. When asked does the care home support the people using the service as expected, both surveys said usually. One person using the service stated that “If I press my buzzer, they come like lightening “. A comment was received and a further concern raised about the level of staff available to assist people using the service to get up within a reasonable time and access to staff during the day. This issue was forwarded to the manager to be investigated, the manager later confirmed that these issues were not raised/reported directly with the home. All residents are registered with G.P. Regular appointments are upheld for visual, dental, chiropody, speech and specialist care requirements. One comment received from a visiting health professional felt that on some occasions communication between staff may not take place and advice is not always followed, there was a further concern that on occasion some basic nursing care needs are not addressed, however the comment did state that matters do appear to have improved recently.These concerns have not been raised directly with the management of the home. 6 staff surveys received, confirmed that 4 of those staff were involved in care planning for residents. The management of the medication systems requires further attention; there were some gaps seen in the Medication Administration Records which would indicate that prescribed medications had not been given or that the registered Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 13 nurse has omitted to sign for administered medications. The registered manager is required to review these practices. It was also noted that some hand transcribed medications had not been signed by two staff, this is required to ensure that all entries are written correctly and reduce the risk of error. The storage of oxygen requires urgent attention to ensure that the cylinder stored in the treatment room and one persons room, which are not secured to the wall, are suitably secured to prevent the risk of the falling over, causing injury or explosion. The signage used to indicate oxygen is stored and in use in bedrooms is required to display the correct information, signage for oxygen stored in the treatment room is required to be put in place. The home has written protocols in place for the administration of all medications. The manager is recommended to implement a system to record the administration of all prescribed creams which is used by all staff as the practice of recording in the care plans is not specific enough to be able to identify which prescribed creams have been applied and at what time. Further recording of dietary supplements is also required to ensure that prescribed supplements are given and recorded at the prescribed intervals. A homely remedy policy is in place with signed consent on agreed protocols by the relevant GP’s. All medications were stored safely and securely with systems in place for ordering and disposal. The registered manager is recommended to reorganise the dressings stored at the home to ensure that each dressing is clearly identified for the person it is prescribed for as stocks were seen to be muddled. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 14 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. There is a range of opportunities for social stimulation and residents are supported to join in with organised activities or pursue their own interests. The meals in the home are of a good quality and a wide range of choice is available. EVIDENCE: The inspectors spent time talking with people using the service and observed people reading newspapers and chatting to staff and visitors. The planned activities are advertised on a board in the lounge and there are photographs of activities recently undertaken. One person commented that “The activity lady is very good”. The Acorns unit has access to an enclosed garden and on the day of inspection people using the service were enjoying a comedy DVD with staff sat with them. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 15 The home is required to develop social care histories and ensure that the record of activities undertaken is accurately maintained. It was noted during case tracking that some people using the service did not have these records complete or there were significant gaps of time with nothing recorded. It was discussed with the manager that one to one sessions of activity/discussion should also be planned and recorded for the people using the service who remain in their bedrooms. No activities were seen at this inspection, however the inspector observed staff talking to residents in a social setting. One visitor to the home confirmed that they were always made welcome to the home and found staff to be helpful. They were supported to be active in the care of their relative. People using the service’s rooms were decorated in a manner, which reflected their tastes and lifestyles. Evidence was seen in some cases of people’s own furniture in their bedrooms. Those people who were able confirmed that they could get up and go to bed within a reasonable time of request. One visitor expressed concern that on occasions their relative did not get up until lunchtime and had been advised by staff that this was due to staff shortage. Lunch observed was appetising and plentiful and a choice related to personal preferences was seen. Care staff spoken to had a good understanding of service users dietary needs. The menu offers a choice and service users were satisfied with the meals provided. Special diets were seen for diabetic diets and pureed diets were served separately. Meals were served both in the dining room and in service users bedrooms if preferred. One relative confirmed that their resident always enjoyed the food, residents told the inspector that meals are plentiful and delicious. On the day of inspection lunch consisted of: Chicken and mushroom casserole Or Cauliflower cheese With potato, broccoli and cabbage. Desert was a choice of apricot crumble, orange jelly and mouse. Almost all service users spoke positively about the standard of the food and mealtimes appeared to be a pleasant dining experience. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 16 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 17 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff and residents are confident that the homes management team would appropriately deal with any complaints or concerns. Policies, procedures and training are available to staff to ensure they have the knowledge to prevent service users from the risk of abuse. The policies do not contain all information required to support the reporting processes. Recruitment procedures protect service users from the risk of abuse EVIDENCE: The complaints records of the home were examined and confirmed that all complaints were investigated and outcomes reached within an agreed timescale. CSCI has received one concern regarding Oak Lodge which was investigated by the home and appropriate action taken. Relatives surveys and people using the service surveys, confirmed that they knew how to make a complaint. One visitor explained that they had raised concerns with the management of the home which they had not received any feedback at this time. These concerns were not recorded in the complaints book. The registered manager will investigate this issue. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 17 All people using the service are registered to vote and have access to an advocacy service if requested. The home has policies and procedures in respect of challenging behaviour, making a complaint and whistle blowing, staff training in the protection of vulnerable adults. All 6 staff surveys confirmed that they were aware of policies about protecting vulnerable adults and how you report any concerns about poor care practice or allegations of abuse. Policies relating to whistle blowing did not contain the contact details for CSCI and are recommended to be amended. All 6 staff surveys received confirmed that they had received a Criminal Record Bureau Check and examination of recruitment files confirms that these check were undertaken before staff commenced employment. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 18 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 20 21 22 23 24 25 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is a large building with some parts of the building suffering from wear and tear that would be typical of a building of similar age and usage. Maintenance is seen to be ongoing and the standard of hygiene is good. The gardens are attractively laid out and suitable for people using the service use. EVIDENCE: A tour of the home was made by the inspectors and a selection bedrooms and all communal areas were seen in both the main body of the home and the Acorns Unit. All the bedrooms seen were comfortable and people using the service had been supported to personalise their own rooms. The inspectors found the home to be showing signs of wear and tear associated with its use. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 19 An ongoing maintenance plan is underway and worn carpets are planned to be replaced upstairs. Two sinks were noted to need repair to the surrounding areas and a broken window pane is required to be replaced. There are suitable and sufficient toilet and bathing facilities for all people using the service. The design of the Acorns supports people using the service to find their way around and be able to identify their own room easily. The unit was noted to be clean and comfortable. The unit has developed a comfortable homely atmosphere by creating a domestic style environment and people using the service appeared settled and happy. Access to specialised equipment was seen throughout the home and the manager confirmed that further pressure relieving mattresses and hi/lo and profiling beds have been received. The general standard of cleanliness was good. The cleaning staff confirmed that they received sufficient training and that they considered the domestic hours sufficient to maintain the hygiene of the home. One person commented “My room is cleaned every day” and another comment from a relatives survey stated that “ The room is always clean, the home never smells and is always clean”. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels at the home are adequate to meet the assessed needs of service users and staff training is promoted to support people using the service. The induction process for staff has been developed to meet the Skills for Care, Common Induction Standards. EVIDENCE: On the day of inspection there were 2 qualified staff on in the morning with 6 care staff in the main unit and 2 care staff in the Acorns . No activity staff were on duty. Also on duty were 4 domestic staff, 1 laundry staff and 2 kitchen staff. The maintenance man was also on duty. Recent staffing levels have required the use of agency staff to cover maternity and sick leave. The inspectors examined staff rotas for the week of the inspection and discussed with staff and people using the service their views on staffing levels. Both were confident that staffing levels were adequate to meet the needs of the people using the service. It was discussed with the registered manager that a concern was raised with the inspector about staff who’s first Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 21 language is not English, speaking in another language in front of people using the service, as this is confusing and may cause distress. The recruitment process within the home is adequate, the 3 staff files examined contained sufficient detail but did not yet contain a clear staff photograph, the registered manager will ensure this is done. 6 staff returned comment cards to CSCI, 5 staff confirmed that they felt they had received adequate induction and supervision when they commenced their job, 1 did not. All 6 staff confirmed that they were clear of what the service users needs were and also all 6 staff were aware of the duties they must not undertake. The registered manager has developed the induction process to include the Skills for Care Common Induction Standard, records were not available for this as they were in use at the time of inspection. The home actively promotes staff to undertake NVQ training, currently levels exceed 70 of staff have completed NVQ training. The home has a qualified staff member who is qualified to assess for Moving and Handling and NVQ training. Staff training is advertised on a staff notice board and records of training were supplied at inspection. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 22 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): 31 32 33 35 36 37 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. All staff, service users and visitors spoken to were positive about the management and felt able to raise concerns and felt that their ideas are listened to. The financial procedures require further development to protect people using the service. Staff are not currently adequately supervised. Further improvements are required to ensure the health and safety of service users, staff and visitors to the home. EVIDENCE: Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 23 The manager has settled in to her new position and is working hard to improve standards within the home. Staff and people using the service spoken with at the inspection were positive regarding the management style of the manager and most staff said they felt supported. One staff comment received stated “ The home is run quite well now and everyone works as a team when told what to do.” Minutes of regular staff meetings were viewed which confirmed that staff are able to discuss their concerns with the management of the home and review areas of practice causing concern. As required, the company in accordance with Regulation 26 of the Care Homes Regulations 2001, carries out monthly visits. It is noted that Regulation 26 records were not available in the home since January 2007. This issue will be investigated by the manager. Records seen at this inspection were appropriately and securely stored and staff have access as required. Quality assurance records were not seen at inspection. There are established systems in place for dealing with service users finances. The inspector evidenced that each service users personal monies were stored in individual envelopes with a running total of deposits and withdrawals. 3 random accounts were checked, 2 of which were incorrect. The manager and administrator are recommended to ensure robust record keeping when withdrawals and deposits are made. The manager confirmed that the previous system of one to one staff supervision had broken down and currently staff supervision is undertaken at staff meetings in a group setting. Whilst this is acceptable all staff must have the opportunity to speak privately to their supervisor up to 6 times per year and areas of discussion must include the topics outlined in the National minimum Standards. Accident records were viewed and it was discussed with the manager that the accidents must be audited monthly for trends and regular occurrences and action taken to reduce any risks of further accidents taking place. Maintenance records were well maintained and up to date, these included ; * * * * * * Fire Extinguishers Hoist Servicing Emergency lighting Boiler servicing COSHH Fire System DS0000003274.V345328.R02.S.doc Version 5.2 Page 24 Oak Lodge Nursing Home * Lift servicing * Gas certificate *Hard wiring *Environmental Health visits *Fire risk assessment. The manager agreed to forward details of the PAT testing certificate to CSCI. These have not yet been received. All 6 staff surveys received stated that they were provided with protective clothing and necessary equipment to do their work safely and cleaning staff confirmed that they had access to COSHH data sheets and had received training in the safe use of chemicals. One cleaning solution was noted to left on the unit of an unlocked sluice. This may cause a risk of accidental ingestion. Further Health and Safety Issues discussed at inspection : An upper floor window from a small staff kitchenette area accessible to people using the service was unrestricted. The registered manager confirmed that this would be restricted immediately. It was also noted that 1 wardrobe was not secured to the wall a bookshelf located on a corridor was at risk of being accidentally pulled over and is recommended to be secured to the wall. The bedrail checks are required to be recorded in more detail to ensure that a person who has received the appropriate training to do so has regularly checked all rails. The registered manager must ensure appropriate information/action is taken regarding the homes cat sleeping on the stairs used by visitors to the home to reduce the risk of falls and injury. Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 25 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 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 3 3 3 3 3 3 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 3 3 X X 2 2 3 1 Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 26 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 OP7 Regulation 15(1)(2) Requirement The registered manager is required to ensure that plan of care is in place for each person using the service which is fully completed, regularly updated and contains all the relevant detail for each identified need. The manager is required to ensure systems are in place for the recording of administration details for all prescribed creams and dietary supplements. The manager must ensure that all hand transcribed entries on the Medication Administration Records are signed by 2 suitably qualified staff members to ensure that there is no risk of transcribing error. Timescale for action 30/08/07 2. OP9 13(2) 30/08/07 3. OP9 13(2) 30/08/07 4. OP38 12(1)a&b The registered manager is 30/08/07 required to ensure that all Health and Safety issues outlined in the body of the report are addressed. The registered manager is DS0000003274.V345328.R02.S.doc 5. OP38 13(2) 30/08/07 Version 5.2 Page 27 Oak Lodge Nursing Home required to ensure that; • All oxygen cylinders are stored securely in an upright position. • Oxygen signage is available on all doors to rooms containing oxygen cylinders and the signage contain the correct details. 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 OP9 Good Practice Recommendations The manager is recommended to reorganise the dressings stored in the home to ensure that each dressing remains n the labelled box which contains the prescribing name and directions for use. The manager is recommended to ensure to ensure that all activities undertaken are recorded in the persons file, this is recommended to include all one to one activities undertaken. The registered manager is recommended to include the contact details of CSCI in the whistle blowing policy used by the home. The manager is recommended to continue the programme of maintenance to include the replacement carpets, broken window and damaged sink surrounds. The manager and administrator are recommended to ensure a robust recording systems for deposits and withdrawals of people using the service’s personal monies. The manager is recommended to ensure that staff supervision is offered to staff in both group and individual sessions and all topics are discussed outlined in the National Minimum Standards. 2. OP12 3. 3. OP18 OP19 4. OP35 5. OP36 Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 28 Oak Lodge Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Nursing Home DS0000003274.V345328.R02.S.doc Version 5.2 Page 30 - 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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