CARE HOMES FOR OLDER PEOPLE
Oak Lodge Nursing Home Lordsleaze Lane Chard Somerset TA20 2HN Lead Inspector
Shelagh Laver Unannounced Inspection 28th February 2006 09:55 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.V284992.R01.S.doc Version 5.1 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.V284992.R01.S.doc Version 5.1 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.V284992.R01.S.doc Version 5.1 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. 23rd September 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.V284992.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over one day, and was conducted by 3 inspectors. The Registered Manager Caroline Orrell was present throughout the inspection. 44 people are living at the home; this includes the 7 residents of The Acorns. The inspectors toured the home and spoke to several service users, staff members and one visitor. All service users spoken to, and who were able, told inspectors that the staff were kind and helpful. 7 care plans and 4 staff files were viewed. A range of maintenance certificates was seen and the complaints book and menus were viewed. What the service does well: What has improved since the last inspection? Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 6 A new registered manager has been appointed and has been in position for four weeks. The home and staff appears settled and responding well to the changes that the new manager is implementing. A care plan audit has been instigated by the manager and a review of care practices within the home, with teaching sessions are planned. Staff communications has been addressed and a communications book started. A review of monitoring food and fluid intake has been implemented and a recording system within the rooms has started. A safer system has been implemented for the dating and labelling of creams in service users rooms, however attention to detail is required for the dates of creams opened. Staff recruitment has increased staff levels and no agency staff have been used. The manager has addressed the issue of staff working excess hours and the off duty has been revised to prevent this occurring. All prospective employees now undergo a thorough recruitment process. All staff have now completed moving and handling update training. Care staff now sit down with clients to assist them with eating. A handyman has commenced employment and a start on repairs and maintenance has begun. Rusty bed tables have been removed. What they could do better:
Staff allocation to all eating areas requires reorganising to enable all service users to be supported at mealtimes. Cold drinks should be offered to all eating areas at mealtimes. More clothing protection aprons for service users should be purchased to enable all service users to access to them at mealtimes. Now that new scales have been purchased, weights of all service users should be recorded monthly.
Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 7 Staff supervision needs to undertaken by all staff for a minimum of six times each year. It was considered by the inspectors that further work is needed to make sure that care plans show clear direction for all staff to ensure service users receive the care they need. All staff must be aware of the dangers of wedging fire doors open with equipment. Further improvement is required on the monitoring of diet and fluid intake. Further improvement is required on the systems for monitoring the dates of prescribed creams opened. An alternative arrangement for attracting the attention of staff when the buzzers are under repair is required. All staff should be aware of the use and storage of data sheets for any chemicals used. An audit of all bedrails is required to establish that all service users who use bedrails have been risk assessed for their use and they are correctly installed as per the manufacturers instructions. The manager is required to ensure that references are returned before staff commence employment on every occasion. 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.V284992.R01.S.doc Version 5.1 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.V284992.R01.S.doc Version 5.1 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. The home is able to meet the needs of the current service users. The home has a thorough pre-admission procedure and provides good opportunities for the service user to make a decision about moving in. EVIDENCE: The home has a thorough pre admissions process and documentation. Quality Assurance documents read confirm relatives positive experience of the admissions process. Service Users and relatives had the opportunity to visit the home prior to admission to establish that the home can meet their needs. Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 10 The main home is staffed by two qualified nurses, between 8am and 8pm each 24 hours. The Acorns has a nominated Care Co-ordinator, experienced in dementia care. Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 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. Service users needs are met The care plans require further refinement to ensure that staff are able to use them easily to ensure service users needs are met. The management of medicines is satisfactory. EVIDENCE: The care plans use a documentation index provided by Majesticare. All care plans evidenced that a range of assessments had been completed for each service user. Wound care plans were evident in two care plans. The care plans seen in the Acorns had considerable information but often assessments were incomplete and duplicated.
Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 12 Each service user has a chart in their bedroom, which staff record changes of position if required and fluid intake/output. At 11am on the day of inspection several charts indicated that service users had not had a drink or breakfast. Drinks were evident in all rooms. Staff had not filled in these forms since 10pm the previous evening. This was discussed with the manager on the day of inspection. There was also documented an incident of a pressure relieving mattress being deflated for 24 hours without repair. This was also discussed with the manager. The registered manager is currently undertaking a care plan audit and will address the updating of care plans. Care plans evidenced nutritional assessments and wound care assessments. There were records within the care plans of other professional staff involvement. Monthly weights were not routinely recorded for all service users. The new manager reported that she had found the ‘sit on’ weighing scales to be out of order and had requested and recently purchased a new set of ‘sit on’ scales, these were seen at this inspection. Personal care is offered in such away as to maintain the privacy and dignity of service users. The management of medicines is satisfactory. The Registered Manager is investigate an incidence of unclear medicine charting noted by the inspectors. However, some creams in service users rooms were poorly labelled and is was unclear when they were opened. Medicine room fridge temperature was satisfactory. Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Service users are supported to lead the lifestyle they wish and have opportunities to participate in leisure activities. Visitors are made welcome. Service users bedrooms are furnished to reflect each resident’s own lifestyle. The meals in the home are offering a good choice and variety of meals taking into account personal tastes. Assistance for service users requires review and reorganisation. EVIDENCE: On the day of inspection three service users and two activities organisers were preparing decorations for a planned Easter party. There had been entertainment two days previously. The Activities co-ordinators hours total 35 hour per week. Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 14 There are many photographs around the home showing activities and trips out. Some service users bedrooms contained a photo album of events held by the home. Service users spoken to, who were able, all confirmed that they could spend the day as they chose and were happy with the activities in Oak Lodge. An activities programme was available in each service users bedroom with the planned activities for the week. This was clear and easy to follow. The Acorns was calm and relaxed with a pleasant atmosphere. People were free to move around in a domestic style environment. The Acorns had its planned activities posted on a notice board in that area. At the time of inspection service users in The Acorns were watching a cookery programme and staff were talking to them about cooking. A visitor spoken with, was always made welcome, and their relative well looked after. Lunch was seen as part of the inspection. A choice was offered and the food appeared plentiful and appetising. The main dining room is very attractive and the tables were laid with tablecloths and napkins. Sherry, soft drinks and fresh fruit were available. Five service users were having lunch in the lounge. Two in arm chairs and three at a table. One staff member was designated to assist in this area. The service users did not have a drink, one service user had to ask for condiments, plastic aprons were used to protect clothes. A staff member told the inspector, that another staff would help in this area once all the room trays had been delivered. The three service users at the dining table needed more supervision over lunch to ensure that they all received a hot meal and a drink. Some meals were served upstairs for those who wished to stay in their rooms. The staff assisting service users to eat, were sat with the service users and were helping them in a discreet and pleasant manner. The Acorns have a small separate dining area in keeping with the domestic arrangement of the unit. Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be 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 homes recruitment policy protects service users from the potential risk of harm or abuse. EVIDENCE: The home has a complaints procedure, which is displayed. There is a complaints book in the home and one complaint had been registered. The registered manager was dealing with this matter in a positive and constructive manner. Four recruitment files were seen. The home has clear procedures for obtaining POVA/CRB checks for new staff and this is adhered to. Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23 & 24. Service users benefit from a comfortable, homely, well maintained environment. The garden areas offer accessible outdoor communal space. Bedrooms are personalised according to service users preferences. All areas of the home are clean and tidy. EVIDENCE: The inspectors had a tour of the building and found it to be a good quality, safe environment for those living at the home. A new handy man has been employed and on the day of inspection was seen working around the home.
Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 17 The design of the Acorns supports service users to find their way around and be able to identify their own room easily. The Acorns garden was seen and has a level access and is easily accessible for Acorns service users. A green house has now been constructed. All the bedrooms seen were comfortable and service users had been supported to personalise their own rooms. New carpets were due to be fitted in two bedrooms. Sufficient toilet facilities are provided. The standard of hygiene was good. It was noted by the inspectors that the first floor radiators were very dusty behind the metal protective covers. Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 18 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 numbers are sufficient to meet service users needs. Staff receive induction training. The recruitment process supports and protects Service Users. Staff receive further training to enable them to ensure service users needs are met. EVIDENCE: 27, 28, 29 & 30. On the day of inspection there were two staff on duty in The Acorns. Staffing levels in the main house appear adequate to meet service users need and no agency staff have been used recently. A service user commented that there appeared to be not many staff around after 6pm. Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 19 There are thorough recruitment procedures, however, one of the records examined showed that only one reference had been returned before the member of staff commenced work. The manager is required to ensure that these checks are received prior to an employee starting work. Staff members spoken to, all seemed settled and happy. One staff member confirmed that staffing levels for service users needs in her area of work were sufficient to provide the care required. Staff records confirm that staff receive induction training and all staff have now completed moving and handling training. Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 20 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, 34, 36, 37 & 38. The home is registering a new manager. The service users are safeguarded by the financial procedures of the home. The staff are not receiving formal supervision 6 times each year. The health and safety arrangements do not fully protect the service user from potential risks. EVIDENCE: Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 21 Caroline Orrell is an experienced nurse and manager. She has been employed at Oak Lodge for 4 weeks and appears to have a grasp of her responsibilities. Mrs Orrell received induction training for her new position. She has a positive leadership and management style. The manager informed the inspectors that a system of supervision for all staff has now been developed and will soon be fully implemented. Mrs Orrell has implemented several changes with regard to communication and auditing of care and a full staff meeting was taking place on the day of inspection. Staff seemed settled and no problems were voiced to the inspectors. The company has a range of quality audits. The most recent quality assurance audit questionnaires were sent out on 09/05 and further questionnaires were being prepared to be sent out. The inspector viewed twelve returns, which were generally positive about the care in the home. The registered manager explained that she intends to adjust the style and format of these questionnaires to improve the auditing process. Records required for inspection were held appropriately, well managed and made available. Most health and safety arrangements were satisfactory. The manager is required to make arrangements to rectify the following hazards. *A full audit of the bedrails used in the home. All bedrails must be risk assessed, consent given for their use and fitting compliant with the manufacturers instructions. This must all be fully documented in the service users care plan. *The safe disposal of sharps, and the ensuring that visiting health professionals adhere to the homes sharps policy. Risk assessment for the storage of all sharps disposal arrangements. *A suitable alternative of call bells made available to service users for the purpose of attracting attention. *The reorganisation of arrangements for the storage of net pants for individual service users.
Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 22 *Staff must be aware of data sheets for information regarding the use of cleaning and other chemicals. *The staff are required to not wedge open the laundry fire door with equipment. A range of records was examined and were well maintained and ordered and demonstrated satisfactory checks are carried out. These included: *Fire system, lighting and extinguishers *Weekly fire alarm test *Nurse call system *Hoists *Environmental Health *Waste Disposal Contract Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 23 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 3 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 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 X 2 3 2 Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 24 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 OP8 Regulation 12(1)(a) Requirement Monitoring of food and fluid intake must be reviewed to ensure that it is systematic and accurate and action is taken where necessary. Timescale for action 10/04/06 2. OP8 13(2)(a) 3. OP15 12(1) 4. OP29 19(1)(4) (Previous Timescale not met 30/11/05) The registered manager has 10/04/06 purchased new scales and is required to ensure that all service users are weighed every month. Sufficient staff must be available 10/04/06 to ensure all service users receive the help they need at mealtimes to ensure they eat hot meal and have a full drink. One employee file was seen with 10/04/06 a start date before one reference was returned. The company recruitment policy must be followed on all occasions All staff must receive formal 10/09/06 supervision at least 6 times per year. All Staff must be made aware of 10/04/06 the risks of holding open fire
DS0000003274.V284992.R01.S.doc Version 5.1 Page 25 5. 6. OP36 OP38 (18)(2) 23 (4)(d) Oak Lodge Nursing Home 7. OP38 13(4)(a)( b)(c) doors with equipment and the manager is required to ensure that this does not happen. All staff must be clear about the potential risks when using bedrails and what action they must take to minimise these risks. A full audit of bedrails is required. All bedrails must be risk assessed and consent signed. (Previous Timescale not met 30/11/05) 10/04/06 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 OP9 OP15 OP38 OP38 OP38 Good Practice Recommendations It is recommended that all creams are labelled clearly with the services users name and date the cream was opened. It is recommended that more suitable clothing protection is purchased for service users to ensure adequate supplies for all service users. In the event of call bell failure, the Registered Manager must provide an alternative for alerting attention for use by the service user. The Registered Manager is recommended to ensure that visiting Health Professionals conform to the Homes Health and Safety Policy. All staff must be aware of data sheets for chemicals used and it is recommended that all staff are aware of where they are kept and their use. Oak Lodge Nursing Home DS0000003274.V284992.R01.S.doc Version 5.1 Page 26 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
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