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Inspection on 23/09/05 for Oak Lodge Nursing Home

Also see our care home review for Oak Lodge Nursing Home for more information

This inspection was carried out on 23rd September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users benefit from good quality, homely surroundings with attractive gardens.The home has thorough pre-admission arrangements that also provide good opportunities for the service user/representative to make a decision about moving in. The home offers a varied activity programme, including regular trips. The home has clear induction arrangements that support new staff effectively. The Acorns provides a good quality, accessible and suitably secure environment for people with dementia care needs. Service users benefit from the relaxed and domestic style surroundings and care offered.

What has improved since the last inspection?

At the last programmed inspection 7 requirements and 3 recommendations were made. At this inspection 5 of the requirements had been fully complied with and 1 partly complied with. None of the recommendations had been implemented. The home`s Statement of Purpose has been reviewed and now accurately reflects the services offered in the home. Service user plans are now in place in The Acorns, reflecting the personcentred approach to care. Medication management has improved and was found to be satisfactory during this inspection. The Acorns garden is finished and provides a safe, secure and accessible area for people living in this unit. Hot water outlets have been made safe with the fitting of thermostatic valves to baths and wash hand basins in The Acorns. Chemicals are all stored securely and the wardrobes in The Acorns have been secured to ensure the health and safety of service users. The identified radiator has been covered to minimise any risk of scalding. Further requirements were made following the 2 additional inspections made following the recent complaints. 4 requirements and 6 recommendations were made. A skills audit has been carried out and training needs identified for nursing staff. Efforts are being made to ensure that communication with families is more effective.

What the care home could do better:

Some care plans need to have greater detail and clearer instructions for staff to enable them to provide consistent and appropriate care. Food/fluid charts need to be fully completed to enable staff to accurately monitor a person`s needs. Use of creams needs reviewing to ensure that they are only used for the person for whom they are prescribed and are disposed of when they have reached their expiry date. Some care practices need reviewing to ensure that those who need help with feeding receive this support in an appropriate manner and that sufficient drinks are always provided. One carpet needed cleaning and some bed tables are in need of maintenance attention. The manager needs to ensure that all bedrails are safe and that staff are able to recognise any potential risks when they are in use. The manager needs to ensure that sufficient care staff are on duty at all times to meet service user needs. All recruitment practices need to follow the home`s recruitment procedure to ensure that all relevant checks are received before any employee starts work. The staff team needs to review their communications systems throughout the home to ensure that staff views can be made known and acted upon. Not all staff have been updated recently in moving and handling practices, which is required to ensure that staff and service users are not placed at risk.

CARE HOMES FOR OLDER PEOPLE Oak Lodge Nursing Home Lordsleaze Lane Chard Somerset TA20 2HN Lead Inspector Sue Burn Unannounced Inspection 23rd September 2005 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.V250415.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 Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 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 Ms Mutsa Mashingaidze 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.V250415.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 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. 14 March 2005 Date of last inspection 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. Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out as part of the planned annual programme of inspections. 2 inspectors carried out this unannounced inspection over one day. The last inspection was unannounced and took place on 14 March 2005. The Registered Manager, Grace Mashingaidze, was present throughout the inspection and the inspectors were also assisted and welcomed by the home’s staff. 41 people were living in the home. 36 people in the main house, where nursing care is provided, and 5 in the Acorns, where personal care is provided. Of the 36 people accommodated in the main house 4 people were receiving personal care only. All service users spoken to, and who were able, told inspectors that they found the staff kind and caring and enjoyed the food. Since the last inspection a visit has been made to the home to review the requirements made at the last report regarding The Acorns. This visit was made at the company’s request to obtain feedback on the progress that they had made. There have been 2 complaint investigations investigated by CSCI, one of which has recently been reopened and is still ongoing. The manager has also carried out an investigation into care provision at the request of the CSCI. Since this inspection a meeting has been held with directors of Majesticare who have agreed clear management arrangements with CSCI to address areas of concern raised in this report and in the investigation reports. A tour of the premises was made, care in the home observed and a range of records was inspected, including care records. Twenty-one service users, seven staff and three visitors were spoken to. What the service does well: Service users benefit from good quality, homely surroundings with attractive gardens. Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 6 The home has thorough pre-admission arrangements that also provide good opportunities for the service user/representative to make a decision about moving in. The home offers a varied activity programme, including regular trips. The home has clear induction arrangements that support new staff effectively. The Acorns provides a good quality, accessible and suitably secure environment for people with dementia care needs. Service users benefit from the relaxed and domestic style surroundings and care offered. What has improved since the last inspection? At the last programmed inspection 7 requirements and 3 recommendations were made. At this inspection 5 of the requirements had been fully complied with and 1 partly complied with. None of the recommendations had been implemented. The home’s Statement of Purpose has been reviewed and now accurately reflects the services offered in the home. Service user plans are now in place in The Acorns, reflecting the personcentred approach to care. Medication management has improved and was found to be satisfactory during this inspection. The Acorns garden is finished and provides a safe, secure and accessible area for people living in this unit. Hot water outlets have been made safe with the fitting of thermostatic valves to baths and wash hand basins in The Acorns. Chemicals are all stored securely and the wardrobes in The Acorns have been secured to ensure the health and safety of service users. The identified radiator has been covered to minimise any risk of scalding. Further requirements were made following the 2 additional inspections made following the recent complaints. 4 requirements and 6 recommendations were made. A skills audit has been carried out and training needs identified for nursing staff. Efforts are being made to ensure that communication with families is more effective. Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 7 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 Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 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.V250415.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 (standard 6 does not apply) The home has thorough pre-admission arrangements that also provide good opportunities for the service user to make a decision about moving in. EVIDENCE: The Statement of Purpose was examined at the previous visit arranged by The company. This now includes details of the care provision in The Acorns. The home has a thorough pre-admission process and documentation. The Manager and/or deputy will visit the prospective service user, liaises with professionals and obtains a copy of the Single Assessment. These assessments were examined during the inspection and were found to be satisfactory and sufficiently detailed. The manager is clear about needs that cannot be met at Oak Lodge. Visitors spoken to confirmed their experience of the admission process, that it included an assessment and opportunity to visit the home on behalf of their Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 10 relative. The recent survey results also confirmed that the pre-admission arrangements are followed. The main home is staffed by at least one suitably qualified nurse 24 hours a day. The Acorns has a nominated Care Co-ordinator, experienced in dementia care, and separate team who have undertaken dementia care training. The home is able to meet the needs of current service users. Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The care planning system is in need of further development to ensure that all service user needs are addressed. Food and fluid intake monitoring is not systematic and places service users at risk of inadequate intake. The home has good systems and links with other health professionals to enable service user health needs to be met. Personal support is offered in such a way as to maintain the privacy and dignity of service users. The management of medicines is satisfactory; the use of creams is not consistent with best practice. EVIDENCE: The home has an adequate documentation system, which includes a range of assessments to be carried out. Care plans from The Acorns were not examined at this inspection as they were reviewed at a previous visit to confirm their implementation, where they were found to be satisfactory. Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 12 8 care plans from the main home were examined during the inspection. All of these plans evidenced that a range of assessments had been completed and care plans were in place for individuals. Each of the plans examined also had an aspect of service user need that had not been addressed although generally the care plans detailed clear actions for staff to follow in most areas. The manager needs to ensure that plans are put in place where weight loss, pain, wounds, falls and psychological needs have been identified. Some of the planned review dates were overdue and visitor feedback indicated that needs identified in reviews are not always followed up. This was confirmed in the individual’s care plan. The care observed for one person was not consistent with the care plan and placed the service user at potential risk from falls, this was drawn to the attention of the nurse and the manager during the inspection. The care plan examined was ambiguous in this respect with different instructions in different sections of the record. The manager must ensure that all care plans accurately reflect the assessed needs of the service users, that instructions for staff are clear and detailed. The assessments and plans must be reviewed as determined in the plan and in consultation with the service user/representative. Plans and feedback obtained confirmed regular contact and support with other health professionals, including GP, district nurse, tissue viability nurse, CPN, podiatrist and physiotherapist. Concerns have been raised by the home that they are not always notified in advance about community care reviews and the manager is endeavouring to work with community teams to ensure that the home and families have enough notice to attend. 2 of the plans examined detailed thorough wound care plans. During the inspection the manager confirmed to inspectors that they had identified 2 service users whose health needs could no longer be met in the main house. Suitable arrangements had been made for reassessment and accommodation that could better meet their needs. Fluid and food intake and positional change is recorded where a need has been identified. These charts were examined during the inspection. The positional change charts were well maintained. The intake/output charts were not always fully completed, some had significant gaps and most were not totalled at the end of the 24-hour period. This has been raised as a problem before and the manager has instructed staff to complete these and total to ensure adequate monitoring. This monitoring requires closer scrutiny to ensure that problems are identified and action taken where necessary. Staff and service users indicated that some drinks are missed when staff are under pressure. Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 13 The home has adequate supplies of pressure relieving equipment, including specialist chairs. The activities organiser provides flexercise as part of the activities programme. The management of medicines is satisfactory and storage and documentation was inspected. The supplying pharmacist carried out a satisfactory pharmacy inspection on 20.9.05. The inspectors found a number of creams in use that were not being used appropriately. The manager is required to ensure that creams are signed for on the MAR chart and only used by the individual for whom they are prescribed. They should also be dated when opened to ensure that they are used by the expiry date. All staff who administer medication on The Acorns received training in March 2005. Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15. Service users are supported to lead the lifestyle they wish and have opportunities to participate in leisure activities. Visitors are made welcome at any time. The meals in the home are good offering choice and variety and taking account of personal preference. Assistance for service users does not always take account of individual need. EVIDENCE: Service users spoken to, who were able, all confirmed that they could spend the day as they choose and were happy at Oak Lodge. They all appreciated the activities available. The Acorns was relaxed and calm when inspectors visited with people free to move around in a domestic style environment. Service users are encouraged and supported to help with household tasks such as washing up, dusting and tidying up. Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 15 There were no activities available during the inspection as the activities organisers were not on duty; one was on holiday and the other off sick. Records and feedback confirmed that activities are provided regularly, including a weekly bus trip. Records examined had at least a weekly entry of an activity. There is a newsletter and photo album of events available in the entrance hall. Visitors spoken to all found the staff welcoming and friendly and could visit at any time. Lunch was seen as part of the inspection, with a choice offered. The food looked plentiful and appetising. A menu is available and offers a choice of meals at lunch and teatime, made the day before. The main dining room is very attractive with laid tables with sherry and fresh fruit available. Some meals were served up stairs to those who chose to stay in their rooms. The Acorns have a small separate dining room in keeping with the domestic arrangement of the unit. Staff were available to assist people but inspectors noted that some practices needed review to ensure that those needing help receive the full attention of staff. The manager should ensure that staff are encouraged to sit with people who need all help with feeding and that soft foods presented separately are not mixed together as this detracts from the taste and appearance of the food. Drinks are provided morning and afternoon. Feedback indicated that the morning drinks are occasionally missed if the home is short staffed; the manager needs to address this. It was observed during the morning that not all service users were offered a choice of drink or a biscuit. The provisions set out in containers on the trolley were not covered or in clean containers. The manager should review this practice. Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. The home has a satisfactory complaints procedure that enables action to be taken. The home’s recruitment procedures do not fully protect service users from the potential risk of harm or abuse. EVIDENCE: The home has a complaints procedure, which is displayed. CSCI has received 2 complaints since the last inspection. Both of these have been investigated and most areas upheld. The manager and company provided action plans to address the shortfalls identified as a result of these investigations and have implemented these plans. One of these investigations has been reopened and the company are cooperating fully with this process to fully identify the problems and ensure that they are addressed satisfactorily. The home manager carried out another investigation at the request of CSCI. This investigation was carried out thoroughly and promptly. 5 recruitment files were examined. The home has clear procedures for obtaining POVA/CRB checks for new staff and this is mostly adhered to. One of the records examined did not evidence that a POVA First or CRB check had been received prior to the nurse starting work. The manager is required to ensure that these checks are received prior to an employee starting work (see Staffing). Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 17 The manager and care co-ordinator have undertaken abuse awareness training since the last inspection. Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25, 26 Service users benefit from comfortable, homely, well maintained surroundings. Bedrooms are personalised according to service user preferences. All areas of the home are kept clean and tidy. EVIDENCE: The home has been refurbished over the last 2 years and provides a good quality, safe environment for those living at the home. The Acorns garden has been completed since the last inspection and is suitable for service users to use. The garden is fully accessible with raised beds, walkways, secure fencing and seating. A greenhouse was being erected during the inspection. All bedrooms seen were comfortable and service users have been supported to personalise their rooms. There are a number of assisted baths and showers Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 19 and sufficient toilet facilities are provided. The home now has 24 adjustable beds for those who require them. The design and size of The Acorns supports service users to find their way around, including finding their own rooms. Control of infection measures and hygiene standards were generally satisfactory. The lounge carpet in the Acorns requires cleaning. As at the last inspection a small number of rooms had bed tables with rusting legs. It is recommended that the rust is removed or the tables are replaced. Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Staff morale is variable which is affecting the consistency of care for some service users. Staff numbers on duty are not always sufficient to meet service user needs. Staff induction and training are planned to ensure that staff receive the training they require. EVIDENCE: During the inspection 1 member of staff was on duty in The Acorns and needed to leave the unit at times. This was reported to be due to short staffing and staff had been deployed to the main home. The expectation is that there will be 2 staff on duty in this area during the day and the unit will always have at least one person there at all times. The manager made arrangements with the operations manager to rectify this during the inspection and ensure that 2 staff would be on duty during the day. Rotas were examined for the main home for the period 29.8.05-23.9.05. The required numbers of nurses were on duty at all times, 2 during the day and 1 during the night. Over this period 7 day and 2 night shifts were 1 short of the expected numbers of care assistants on duty. Some agency staff had been employed to cover Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 21 shortfalls. Feedback from staff, service users and visitors confirmed that the home is short of staff at times and that the staff are always very busy and at times appear overstretched. The staffing levels are not always adequate to meet the needs of service users and fall far short of the previous requirements. It is required that these levels comply with at least the previous SHA staffing notice. The rotas indicated that at least 4 of the care staff have regularly been working hours in excess of 50 per week, with one person working 83 hours in one week. This is not good practice as staff can become overtired which may affect their well-being and the quality of the care provided. This should be reviewed to ensure that staff have adequate breaks and rest periods from work. Housekeeping, catering and maintenance staff support the nursing and care staff. The home has a vacancy for an administrator, a role that the manager is fulfilling at the moment supported by staff from another of the company’s homes. Staff feedback was variable and indicated that the team is not as cohesive as it was at the last inspection. The manager and company are aware of this and are taking steps to address this. Training was discussed with the manager and records were examined. A requirement made following one of the complaints investigations related to nurse skills and training needs. The company is in the process of implementing self-assessment and identifying the training needs of the nurses at the home. A training analysis has been submitted to CSCI. Recent training has been provided in continence management and palliative care. Staff are supported to undertake NVQ training and have trained assessors on the staff team. A number of staff are currently undertaking NVQ in Care training. 9 staff have NVQ 2 or 3 in Care, which is 41 . The training matrix examined indicated that 11 staff have not been updated in moving and handling in the past year and new staff are not always trained promptly on induction. The manager must ensure that all outstanding staff are updated in moving and handling practices. All staff complete a 6 week induction programme and have a number of ‘shadow shifts’ when they first start work and are allocated a mentor. New staff spoken to confirmed these arrangements. Not all records seen confirmed that the programme is completed in the 6 weeks as planned. 5 recruitment records were examined. The recruitment procedure is robust and was followed for 4 of the staff recruited. One of the files did not contain Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 22 evidence that a POVA First or enhanced CRB check was obtained prior to them starting work. References were not available from the last employer and were copies of references supplied to her previous employer. The manager must ensure that a POVA first or enhanced CRB check and 2 satisfactory references are received for all employees before they start work. Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 37, 38 The manager is suitably experienced and competent to manage the home. Health and safety arrangements do not fully protect the service user from potential risks. EVIDENCE: Mrs Mashingaidze is an experienced nurse and manager. She has recently completed the Registered Manager’s Award and enabled the home to achieve the Investors in People Award. Regular staff meetings are held and most staff felt well supported by the manager and able to take concerns to her. Some of the staff were less confident and inspectors were aware of some staff morale issues. The two complaint investigations identified significant problems with communication between both staff that impacted on care provision. The management team Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 24 are aware of this. Inspectors noted that the staff team still needs to address communications systems throughout the home to ensure that staff views can be made known and acted upon. Visitors and service users felt informed and able to ask questions. The company has a range of quality audits. These were not examined at this inspection. The manager conducted a survey of relatives in August 2005. The response rate was good and the comments were positive about a range of issues. Records required for inspection were held appropriately, well managed and made available. A number of staff have completed First Aid training since the last inspection. Fire safety training has recently been carried out for 21 staff; the manager must ensure that the outstanding staff receive update training. A tour of the premises was made. Most health and safety arrangements were satisfactory. The manager is required to make arrangements to rectify the following hazards. • A small number of bedrails were found to be a potential risk to service users and one risk assessment following an entrapment did not identify that suitable arrangements had been made. The manager must ensure that all staff are able to recognise these potential risks and clear about what action they should take to minimise them. The restrictor to an upstairs window was broken and requires fixing. 2 unsecured and unstable wardrobes were found in bedrooms. The manager is required to remove or secure these wardrobes to minimise risks to staff and service users. • • A range of records was examined and were well maintained and ordered and demonstrated satisfactory checks are carried out, these included: • Electrical testing • Fire system, emergency lighting and extinguishers • Weekly fire alarm test • Hot water temperature checks • Nurse call system • Hoists • Gas supply • Wheelchairs Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 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 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 4 3 X 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X X X 3 2 Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Care plans must be reviewed to accurately reflect the assessed needs of the service users. They must contain clear and detailed instructions for staff to follow. The assessments and plans must be reviewed as determined in the plan and in consultation with the service user/representative. Monitoring of food and fluid intake must be reviewed to ensure that it is systematic and accurate and action is taken where necessary. Safe systems for the use of creams must be implemented as detailed in this report. The Acorns lounge carpet must be thoroughly cleaned. The numbers of staff on duty must be maintaied at least at the levels previously agreed and must be sufficient to meet the assessed needs of the service users. New employees must not commence work until the home has received either a POVA First or Enhanced CRB check and 2 DS0000003274.V250415.R01.S.doc Timescale for action 30/11/05 2 OP8 12(1)(a) 30/11/05 3 4 5 OP9 OP26 OP27 13(2) 13(3) 18(1)(a) 31/10/05 31/10/05 17/10/05 6 OP29 19(1)(4) 17/10/05 Oak Lodge Nursing Home Version 5.0 Page 27 7 8 OP30OP38 OP38 18(1)(c) (i) 23(4)(d) 13(4)(a) (b)(c) satisfactory references. All outstanding staff must be updated in moving and handling practices and fire safety. All staff must be clear about the potential risks when using bedrails and what action they must take to minimise these risks. The identified window restrictor must be fixed. The 2 identified wardrobes must be removed or secured to the wall. 31/12/05 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP15 Good Practice Recommendations The care practices should be reviewed where people are assisted to eat, to promote their enjoyment of the meal. Care staff should sit down when assisting individuals and soft diets should be provided as served, that is in their constituent parts. The drinks provisions should meet accepted food hygiene standards. Bed tables that have rusting legs should be replaced or the rust removed to ensure that they are not harbouring infection. The hours of staff working in excess of 50 hours per week should be reviewed to ensure that they have adequate rest periods. Recruitment references should be taken up from the last employer. The management team should review the effectiveness of staff communications systems within the home. This should be done in consultation with the whole staff team. 2 3 4 5 OP26 OP27 OP29 OP32 Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oak Lodge Nursing Home DS0000003274.V250415.R01.S.doc Version 5.0 Page 29 - 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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