Inspection on 23/01/07 for Oak Lodge Rest Home

This inspection was carried out on 23rd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Rest Home 07/01/09

Oak Lodge Rest Home 25/10/05

Oak Lodge Rest Home 12/05/05

Oak Lodge Rest Home 07/01/05

Oak Lodge Rest Home 31/08/04

Oak Lodge Rest Home 17/04/03

Oak Lodge Rest Home 17/04/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Oak Lodge Rest Home 1a Adams Road Shire Oak Brownhills West Midlands WS8 7AL Lead Inspector Lesley Webb Key Unannounced Inspection 23rd January 2007 08:00 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 Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak Lodge Rest Home Address 1a Adams Road Shire Oak Brownhills West Midlands WS8 7AL 01543 372078 01543 372078 pam@davidwilson6.wanadoo.co.uk 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) Mr David Alan Wilson Mrs Pamela Mary Wilson Mrs Pamela Mary Wilson Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That ramps be installed at the fire exits in the lounge and dining room and that the ground is made safe in the garden leading to designated fire evacuation points, within 3 weeks of certificate being issues. 25th October 2005. Date of last inspection Brief Description of the Service: Oak Lodge is a two storey detached property located in a quiet residential area of Brownhills. The building comprises of seventeen single bedrooms, many with en-suite facilities, a lounge, separate dining room, kitchen and laundry. There are parking facilities to the front of the property and a small, enclosed garden, with patio to the rear. The home is approximately one mile from the centre of Brownhills, close to bus routes to other towns, shops and other amenities. Oak Lodge is registered to provide care for up to seventeen older people of both sexes for the reason of old age. Over the past two years a number of improvements to the building have been made, including the installation of a passenger lift, improving facilities offered to service users. Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken by one inspector with the home being given no prior notice. During the visit time was spent talking to staff and residents, examining records and observing care practices. feedback about the inspection was given to the Registered Manager the next day over the telephone. The people who live at this home have a variety of needs. This was taken into consideration by the inspector when case tracking two individuals care provided at the home. For example the people chosen have differing communication and care needs, consist of male and female and have various cultural heritage. No relatives of residents were present during the inspection, however nine relatives comment cards were received, all praised the service, paying particular attention to staff and management. Fees charged for living at the home range from £329.15 to £380.00 per week. What the service does well: Prospective residents have their needs assessed and are able to visit the home prior to deciding if it will meet their needs. Comments regarding this include ‘spent a day at the home and moved in on a months trial before deciding to make it my home’ and ‘mum was invited to spend half a day here to see if she liked it. Everyone was most welcoming and extremely understanding of her situation. We feel we were very lucky to be able to have a place here when we needed somewhere’. Generally the systems for managing the health needs are good and medication practices protect residents. Detailed health records are in place that demonstrate appropriate intervention by the home in order that resident’s health needs are met. At the time of this inspection no resident has pressure sores, with equipment in place that promotes tissue viability. As in previous inspections staff demonstrated good understanding of promoting the privacy and dignity of residents. For example residents personal care was undertaken in their own bedrooms and staff were observed asking a resident if they would like to take a telephone call in private. Staff received an abundance of compliments from residents and relatives (relatives compliments were expressed in all of the nine comment cards sent to CSCI) regarding the care they give. These include ‘we know that … is happy with all aspects of her care at Oak Lodge. She tells us so every week. We are just so grateful that she is being so ably cared for’ and ‘staff/owners are always approachable and caring. The welfare of their residents appears important and my uncle sees Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 6 the premises and staff as his home and family. Nothing but praise for the care and attention from myself for my uncles care from the staff/owners of the home’. The atmosphere within the home is friendly and welcoming towards visitors, creating an inclusive place for residents to live. As in previous inspections all residents that the inspector spoke to confirmed that their visitors are made welcome in the home. Staff and records also confirmed that residents are able to receive their guests in the privacy of their own bedroom if they so wish and that the only restriction on visiting times are when meals are being served due to the disruption this can cause to others. The inspector sat and ate lunch in dining room with many of the residents. The meal was well presented and tasty, with residents confirming they are happy with meals provided. One person stated “foods great, plenty of it”. Praise was also given by a relative in a completed comment card who stated ‘my relative has special dietary needs through illness and the home from the first stages of this have always catered for his special diet which gives him the confidence to enjoy his food’. As in previous inspections the home has a satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. Nine residents comment cards were received by CSCI. All state they have been made aware of the complaints procedure and know who to talk to if unhappy. One comments ‘this has never been necessary but we are aware of the procedure, if we needed to use it’. Residents are supported by competent and qualified staff, which are dedicated to providing and quality service. Numbers of staff that hold or are in the process of completing a National Vocational Qualification are very good. Of the twelve care staff and three ancillary staff eight hold this qualification, with two others in the process of completion. What has improved since the last inspection? All requirements identified in the previous inspection have been met. These include providing bereavement training for staff, improving recruitment documentation and increasing the frequency of residents and staff meetings. Also medication system have been improved with the home implementing all recommendations made by the pharmacy inspector, disposing of out of date medication and obtaining copies of the supplying pharmacists reports. In relation to records individual training and development assessments have been completed for all staff, an annual audit of the quality assurance system has taken place, new policies and procedures have been introduced and improvements to financial records have occurred. Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Oak Lodge Rest Home DS0000020823.V326526.R01.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 Rest Home DS0000020823.V326526.R01.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 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although information is supplied to prospective residents the home must be confident that this is reviewed to reflect changes in legislation. Prospective residents have their needs assessed and are able to visit the home prior to deciding if it will meet their needs. EVIDENCE: Pre-inspection documentation supplied by the home to the Commission for Social Care Inspection (CSCI) states that there have been no changes to the statement of purpose since the last inspection. This was discussed with the Deputy, who was advised this and other documentation should be reviewed due to amendments to the Care Home Regulations 2001 that have occurred over the last twelve months. It is recommended that internet access be available within the home in order that staff have access to guidance at all times. Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 10 Two residents records were viewed and found to contain assessments of needs completed by the relevant placing authorities. The home is currently not registered to offer places to people who have dementia. However when observing care practices, looking at records and talking to staff it is apparent that some people who have moved to the home have this condition. For example pre-inspection documentation supplied by the home to CSCI states that four people living at the home have dementia requiring CPN intervention. This was discussed with the Registered Manager/Proprietor who confirmed the home is going to apply for registration in order that it can provide this service. She also informed the inspector that the majority of staff are currently undertaking dementia care training in order that they have the appropriate knowledge in this area. It is recommended that the home seek advice from a relevant agency such as the Alzheimer’s Society with regards to the environment and orientation objects for people with dementia. Nine residents surveys and nine relatives comment cards were also completed. All state contracts of residency have been given along with information about the home and services it provides. They also confirm that prospective residents and their families are invited to view the home in order to ascertain its suitability. Additional comments regarding this information include ‘spent a day at the home and moved in on a months trial before deciding to make it my home’ and ‘mum was invited to spend half a day here to see if she liked it. Everyone was most welcoming and extremely understanding of her situation. We feel we were very lucky to be able to have a place here when we needed somewhere’. Oak Lodge Rest Home DS0000020823.V326526.R01.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally the systems for managing the health needs are good and medication practices protect residents. Staff have a very good understanding of the residents support needs, this is evident from the positive relationships that have been formed between staff and residents. EVIDENCE: All residents files that were sampled contained care plans completed by various placing authorities and care needs/plans for areas including communication, mobilising, eat and drinking, hygiene, breathing, emotion, spiritual, activities and likes and dislikes. In addition to these all files contained risk assessments for falls, pressure areas and mobility. Although all plans have been reviewed monthly the inspector recommends that the contents of all of these documents be reviewed again as they appear to contain contradicting information. For example one persons dependency assessment states ‘low dependency’ but their falls and nutritional risk assessment states they are ‘high risk’. It was also noted on both files sampled Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 12 that the falls risk assessments have given residents scores above 30 when the format in use should only allow scores in for high risk to be between 15-18. It is recommended that staff that complete risk assessments receive further guidance and support to understand the process. It is also recommended that if a person is assessed as being at high risk a detailed assessment and care plan be introduced that gives comprehensive information and a breakdown of tasks staff are required to do in order that the risk is managed. For example a bedroom has bedrails, bumpers and a pressure-relieving mattress. The person living in this room requires a hoist and the bed is located against a wall. The risk assessments for this person were viewed and found not to reflect in detail where the bed is located or the use of a mattress and the implications this can have with bedrails. In addition to the care plans the home has introduced ‘This is my life’ documentation for residents that details resident’s family, past life experiences, favourite things and family life. The inspector found the information contained within these documents very informative, allowing for insight of residents life’s before they required residential care. Staff at the home complete daily records, again that are informative detailing all events that have occurred during the day. It is recommended that details from the daily records be incorporated into the care plan reviews in order that the home can be confident that the content of care plans is still applicable, as currently most reviews state ‘no change’ when examination of daily records indicate this may not be so. Both files sampled contained very detailed health records that demonstrate appropriate intervention by the home in order that resident’s health needs are met. At the time of this inspection no resident has pressure sores, with equipment in place that promotes tissue viability. Weight charts were also in place, however both of these have not been completed on a monthly basis, as the residents ‘are unable to stand/weight bear’. It is strongly recommended that the home look at alternative ways to measure weight such as the BMI system in order that this area of health care can be appropriately managed. It was also noted that currently records do not evidence appropriate exercise interventions for residents identified as at risk of falling, again it is recommended the home explore opportunities for residents to undertake this activity. All previous requirements relating to medication are now met in full. These include implementing all recommendations made by the pharmacy inspector, recording the date when nasal sprays are open and obtaining copies of reports completed by the supplying pharmacist. Generally medication practices and systems protect those living at the home. Records are maintained for all medication entering, leaving and being administered (it was noted on two persons medication administration records that there were some gaps in signatures). The inspector also instructed the home that they must clarify any ‘as directed’ instructions with the general practitioner, obtaining clear and precise instructions. Staff were observed administering medication, with no issues identified. Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 13 As in previous inspections staff demonstrated good understanding of promoting the privacy and dignity of residents. For example residents personal care was undertaken in their own bedrooms and staff were observed asking a resident if they would like to take a telephone call in private. Staff received an abundance of compliments from residents and relatives (relatives compliments were expressed in all of the nine comment cards sent to CSCI) regarding the care they give. These include ‘we know that … is happy with all aspects of her care at Oak Lodge. She tells us so every week. We are just so grateful that she is being so ably cared for’ and ‘staff/owners are always approachable and caring. The welfare of their residents appears important and my uncle sees the premises and staff as his home and family. Nothing but praise for the care and attention from myself for my uncles care from the staff/owners of the home’. Oak Lodge Rest Home DS0000020823.V326526.R01.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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The atmosphere within the home is friendly and welcoming towards visitors, creating an inclusive place for residents to live. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. Some routines of daily living are not based on residents preferences, expectations and capacities but for the ease of managing the home. EVIDENCE: Practices observed confirm that in the main routines of daily living are flexible and varied to suit resident’s preferences. For example residents were seen choosing to take their meals in various locations around the home, one resident informed the inspector that they attend a church of their choosing and two residents confirmed they prefer to spend their time in their bedrooms, which staff respect. The inspector was however concerned with the contents of a staff meeting which states ‘Generally though, night staff felt it was working for them Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 15 to get up all but three of the residents by 7.50am’. When investigating the inspector was informed that in order to do this residents have to be woke at 5am (and sometimes a little before this). This is not acceptable, as the inspector explained, if a resident chooses to rise this early in the morning then it is appropriate that they receive support, but under no circumstances should staff be waking residents this early unless the home can demonstrate it is in that persons best interests. Residents must not be woken and assisted to bath and dress purely for the smooth running of the home. In order that this situation can be closely monitored the home must obtain residents preferences in relation to times of rising and retiring (with the involvement of families and other professionals where needed) and staff must record the actual time a resident has woke/retired to bed, what assistance they have given and also if they woke the resident up in order to offer this support. The home offers a range of in-house activities that include vocalists, bingo, board games and music. During the visit the inspector indirectly observed music being played (Max Bygraves), with residents appearing to enjoy this. A member of staff was also observed playing cards and board games with residents. People appeared to enjoy these activities, laughing and talking in a friendly way. As mentioned earlier in this report the home should now seek advice regarding exercise activities and it is also recommended that further efforts be made to arrange regular external activities. As in previous inspections all residents that the inspector spoke to confirmed that their visitors are made welcome in the home. Staff and records also confirmed that residents are able to receive their guests in the privacy of their own bedroom if they so wish and that the only restriction on visiting times are when meals are being served due to the disruption this can cause to others. An abundance of compliments were also made by relatives that completed comment cards regarding staff at the home and how they welcome visitors. For example one person states ‘we are very happy with the care given at oak Lodge. The staff are always polite, friendly and very caring. Mum is content and well cared for. We are very pleased we chose Oak Lodge and have recommended the home to a friend seeking care for their mother’ and another ‘Christmas party and Carol Service were excellent and relatives were welcomed to take part’. The inspector sat and ate lunch in dining room with many of the residents, one of who was being assisted to eat by a member of staff. As in previous inspections the menu was seen and found to offers choice of starter, main meal (hot) and desert of lunchtime, with choices of sandwiches and snacks of an evening. The meal was well presented and tasty, with residents confirming they are happy with meals provided. One person stated “foods great, plenty of it”. Praise was also given by a relative in a completed comment card who stated ‘my relative has special dietary needs through illness and the home from the first stages of this have always catered for his special diet which gives him the confidence to enjoy his food’. Oak Lodge Rest Home DS0000020823.V326526.R01.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good complaints system with evidence that residents feel that their views are listened to and acted upon. Staff have a good understanding of adult abuse, ensuring residents are protected from harm. EVIDENCE: As in previous inspections the home has a satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. Nine residents comment cards were received by CSCI. All state they have been made aware of the complaints procedure and know who to talk to if unhappy. One comments ‘this has never been necessary but we are aware of the procedure, if we needed to use it’. Pre-inspection documentation states that there have been no complaints since the last inspection and this was confirmed as true when examining complaint records and talking to the Deputy. As one resident explained, “you don’t need to make complaints, you just have to talk to the staff and they sort things out for you”. It was also pleasing to find that regular residents meeting take place where issues and standards of care are regularly discussed, allowing residents to give their views and raise concerns. Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 17 The majority of staff have received training in adult protection and demonstrated understanding of their responsibilities in this area. In addition to this the home has written policies and procedures for adult protection including whistle blowing and management of residents financial affairs. Oak Lodge Rest Home DS0000020823.V326526.R01.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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally the standard of the environment within this home is good, providing residents with an attractive and homely place to live. Minor improvements to some infection control practices will enhance systems already in place. EVIDENCE: Since the last inspection building work has been completed with three additional bedrooms having been registered, increasing numbers to seventeen. In addition to this six additional en-suite facilities have been created and both the lounge and dining room areas have been extended. Also a manual sluice has been provided separately from resident’s toilets. This is now located in the laundry, which has, been extended to accommodate this. It is recommended the home seek advice from an Infection Control advisor regarding this to ensure infection control practices are appropriate. A tour of the building was Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 19 undertaken with no major concerns identified. There is a homely atmosphere, which was confirmed by many of the residents. For example one person stated, “its lovely and its clean”. All bedrooms that were viewed were found to be individually decorated and personalised with resident’s items. Infection control systems were examined and generally found to be acceptable. Staff were observed using appropriate protective equipment and a random selection of policies were viewed, appearing appropriate for the home. Attention must however be given to replacing a bin in the downstairs bathroom that is used for putting soiled continence pads in as this did not have a lid and to introduce a system and procedure for appropriate storage and sanitizing of mop heads as currently there is none in place. Oak Lodge Rest Home DS0000020823.V326526.R01.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): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by competent and qualified staff, who are dedicated to providing and quality service. The Registered Persons must take responsibility for ensuring staff are deployed throughout the home at all times in sufficient numbers to safeguard and protect residents. EVIDENCE: Since the last inspection an additional three rooms have been registered, with an additional waking night person on duty during the night (resulting in two staff on duty). Normally there are two care staff on duty during the day and early evening, with an additional member of staff on duty between the hours of 6pm and 9pm. In addition to this, there are separate kitchen and domestic staff on duty during the morning, seven days per week and members of the management team up till around 5pm approximately. Examination of records and discussions with staff and management confirm that the 6pm till 9pm shift has recently been stopped, with the inspector being informed that this is due to one resident moving from the home and another being admitted into hospital bringing the total residents currently residing there to fifteen. The inspector spent two hours (4.40pm to 6.40pm) sitting and observing routines and practices in order to assess if the removal of the additional member of staff from the shift was affecting care residents receive. Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 21 The inspector was concerned with some of the findings, which include observing residents being left unattended whilst the two staff on duty had to assist a resident who requires hoisting, residents requesting assistance but being informed that they would have to wait due to care staff having to administer medication and assist with meals and residents being asked if they would prepare for bed at 5.40pm. These concerns were discussed with the Registered Manager/Proprietor the next day who agreed to re-instate the additional member of staff for the early evening shift with immediate effect. Numbers of staff that hold or are in the process of completing a National Vocational Qualification are very good. Of the twelve care staff and three ancillary staff eight hold this qualification, with two others in the process of completion. Generally recruitment practices and procedures are good, ensuring residents are suitably protected. Both staff files that were sampled contained an enhanced CRB disclosure or povafirst clearance, two forms of identification, a recent photograph, two references and an application form (meeting a requirement identified in the previous inspection). It is recommended that the application form be reviewed as in its current format it does not ask for any gaps in employment to be explained and only asks for employment history for the last ten years and not a full history as guidance from the Department of Health recommends. The home must also ensure that if a person is employed and commences shifts prior to a full enhanced CRB disclosure is obtained that a risk assessment is completed along with allocated a named supervisor for that person who is on shift with them. It is also recommended that the home obtains the Department of Health’s guidance relating to employing people prior to receiving a full-enhanced CRB disclosure and implement any recommendations it makes. Generally records and discussions with staff indicate that staff are trained and competent to do their jobs. Training that staff have undertaken includes bereavement (meeting a previous requirement), incontinence and foot care. The inspector was also informed that the majority of staff are currently undertaking dementia training in order to extend their knowledge in this area. An abundance of praise was made by relatives of residents living at the home regarding the care given. These include ‘my sister and I feel that the staff do everything within their power to make this a ‘home from home’ situation. We both agree that mum could not be looked after better anywhere else’. The deputy also informed the inspector that since the last inspection individual training and development assessments have been completed for all staff working at the home. Oak Lodge Rest Home DS0000020823.V326526.R01.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): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of this home is good, with good quality monitoring systems in place that ensure the views of residents, staff and relatives are listened to and acted upon. Generally safety is well managed, creating a safe environment for residents to live. EVIDENCE: The Registered Manager is also the co-proprietor and has been in this position for several years. Discussions, observations and examination of records confirm that the Registered Manager discharges her responsibilities fully. Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 23 Quality assurance systems are in place that includes an annual audit (completed January 2007). In its current form the annual audit covering areas including medication, kitchen, care and cleaning. It is recommended that this be expanded to cover other aspects of the service such as staff, all of the environment, fittings and activities. Monthly monitoring of accidents, medication, health and safety and other aspects of the home takes place. There is a maintenance refurbishment and redecoration programme in place that would benefit with the inclusion of specific details and timescales. The views of residents and staff are obtained in regular meetings (meeting a previous requirement) and the use of questionnaires. In addition to this the views of relatives and professionals are also sought, again through the use of questionnaires. The inspector was pleased to find that the need for more exercise (as detailed earlier in this report) has been identified by the home through use of the quality assurance system. As in previous inspections the systems for managing residents finances on their behalf are appropriate and offer the required protection. In addition to individual personal allowance records the home has introduced a safe contents record, with the deputy stating checks relating to this are completed every week. Pre-inspection documentation supplied to CSCI states that fire equipment was last checked by manufacturers July 2006, the most recent fire drill took place December 2006, fire alarms are tested weekly, the Environmental Health Department inspected the premises June 2006, central heating was serviced November 2006, water was checked for Legionella January 2007, hoists and equipment checked December 2006 and the emergency call system serviced January 2007. Also that all staff have undertaken manual handling and fire training and three staff have received first aid training since last inspection. With regards to the Environmental Health Departments visit the inspector found that all but one requirement have been addressed. When looking at records relating to staff training the inspector instructed that greater numbers of staff are required to undertake infection control training, but that all other areas appear good. During the inspection a resident was observed in wheelchair being hoisted to a comfy chair by two staff. A good technique was used, with staff explaining the process whilst carrying out manoeuvre, to offer reassurance. It was also recommended that the records of fire drills be expanded to include time of drill, outcome, those involved and any issues. Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 24 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 2 3 3 2 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4,5,5a,5b, 6 Requirement The home must review the statement of purpose and other documentation and ensure it complies with amendments to the Care Homes Regulations 2001. The home must not admit anyone to the home that has dementia until it is registered to provide this service and can demonstrate it can meet the needs of people with dementia. Staff must sign for all medication administered. The home must clarify ‘as directed’ instructions with general practitioner, obtaining clear and precise instructions. 4 OP12 12(2)(3) 12(4)(a) 13(6) The home must obtain residents preferences in relation to times of rising and retiring (with the involvement of families and other professionals where needed). 01/02/07 Timescale for action 31/03/07 2 OP4 4, 10(1) 24/01/07 3 OP9 3(2) 01/02/07 Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 26 Staff must record the actual time each resident wakes and retires to bed. Staff must record what assistance they have given to each resident and if they woke the resident in order to give support. All of the above information must be submitted to CSCI Halesowen office until further notice. 5 OP26 13(3)(4) The home must introduce a 14/02/07 system and written procedure for the appropriate storage and sanitizing of mop heads. The bin in the downstairs bathroom must be replaced. 6 OP27 18(1)(a) The home must ensure staff are 24/01/07 deployed in sufficient numbers at all times to meet the needs of residents. All staff must undertake infection control training. All requirements detailed in the Environmental Health Departments report must be acted upon. 31/03/07 7 OP38 13(3)(4) Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 27 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 Refer to Standard OP1 OP4 Good Practice Recommendations That internet access is available within the home. That the home seeks advice from a relevant agency such as the Alzheimer’s Society with regards to the environment and orientation objects for people with dementia. That the home reviews the contents of care plans and risk assessments to ensure they do not contain contradicting information. That staff that complete risk assessments receive further guidance and support to understand the process. If a person is assessed as being at high risk a detailed assessment and care plan be introduced that gives comprehensive information and a breakdown of tasks staff are required to do in order that the risk is managed. That details from daily records be incorporated into the care plan reviews. That the home looks at alternative ways to measure weight such as the BMI system. That the home explore opportunities for residents to undertake appropriate exercise interventions for residents identified as at risk of falls. Further efforts should be made to arrange regular external activities. That the home seek advice from an Infection Control Advisor regarding the sluice being located in the laundry 3 OP7 4 5 OP7 OP7 6 7 8 OP7 OP8 OP8 9 10 OP13 OP26 Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 28 11 OP29 That the recruitment application form be reviewed to ask for explanations in gaps in employment and for a full employment history. That the home obtains the Department of Health’s guidance relating to employing people prior to receiving a full enhanced CRB disclosure and implements any recommendations it makes. That the annual quality assurance audit be expanded to include staff, all of the environment, fittings and activities. That the maintenance and redecoration programme includes specific details and timescales. That the fire drill records be expanded to include the time of the drill, outcome, those involved and any issues. 12 OP29 13 14 15 OP33 OP33 OP38 Oak Lodge Rest Home DS0000020823.V326526.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Rest Home DS0000020823.V326526.R01.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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