Inspection on 11/03/08 for Oak Manor Nursing Home

This inspection was carried out on 11th March 2008.

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

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

Other inspections for this house

Oak Manor Nursing Home 04/09/08

Oak Manor Nursing Home 20/03/07

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

CARE HOMES FOR OLDER PEOPLE Oak Manor Nursing Home Scarning Dereham Norfolk NR19 2PG Lead Inspector Lella Hudson Unannounced Inspection 11th March 2008 09:40 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 Manor Nursing Home DS0000066644.V360786.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 Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak Manor Nursing Home Address Scarning Dereham Norfolk NR19 2PG 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) 01362 694978 oakmanor@caringhomes.org www.caringhomes.org Caring Homes Healthcare Group Ltd Care Home 64 Category(ies) of Dementia - over 65 years of age (64) registration, with number of places Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th March 2007 Brief Description of the Service: Oak Manor is a care home with nursing, providing care and accommodation for up to 63 older people who have dementia. Caring Homes Healthcare Group Ltd., whose head office is located in Essex, owns the home. Personal accommodation in 55 single bedrooms and 4 shared occupancy bedrooms. All bedrooms have their own en-suite facilities apart from 2 single bedrooms. The home is single storey, and level access, with some corridors with gentle gradients where a small change in level occurs. The home is located in the village of Scarning, which is close to the market town of East Dereham and all local amenities. Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information gathered about the Home since the last Inspection in March 2007. It includes information provided by the Home, such as the completed Annual Quality Assurance Assessment and through notifications. It also includes information gathered during an unannounced visit to the Home which was carried out by two Inspectors on 11th March 2008 between 9.40am and 5.10pm. During the visit the Inspectors looked around the accommodation, inspected records, spoke to staff, residents and relatives, observed staff supporting residents and spoke to the area manager and the new Manager of the Home. In addition to this one of the Inspectors carried out focused observations that looked at the experiences of three residents and the kind of interaction they had with staff. The outcome of this observation can be found within the report. The Commission had asked the Home for details so that surveys could be sent to relatives and residents but this information was not provided so individual surveys were not able to be sent. However, the report does include information provided by relatives who have raised concerns/complaints about the Home. At the last Key Inspection the Commission considered that outcomes for the residents were good and therefore an Annual Service Review was planned for February 2008 with a Key Inspection planned for 2009. However, the Inspector carried out an Annual Service Review on 22nd February 2008 which is a review of the information gathered about the Home since the last key Inspection. The results of this meant that the Key Inspection was brought forward due to the level of concerns/complaints notified to the Commission and the fact that there have been several changes of Manager recently. There have been recent changes to the management of the Home. A new Manager started work at the Home in January 2008 but left soon after. There is currently one of the organisations peripatetic managers in post but this is not a permanent position. The manager said that she intends to stay in post for at least a year to provide some consistency. The organisation are aware of the difficulties caused by changes in management of the Home. The quality rating for this service is NO stars. This means that the people who use this service experience POOR quality outcomes Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? 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 Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 7 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 Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 8 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): 3&6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents needs are assessed effectively prior to them moving into the Home EVIDENCE: The assessments seen in two of the residents care plans were both detailed and contained information about the residents needs. These are mainly concerned with the residents physical health and the format has not been updated despite a recommendation made at the last Inspection for these to contain more information about residents social and emotional needs. Staff said that prospective residents and their relatives are encouraged to visit the Home prior to moving in. The Home does not provide Intermediate Care. Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The care plans need to be improved so that they contain detailed guidance for staff about how to meet the residents needs The health care needs of the residents are not all met and the privacy and dignity of residents is regularly compromised Medication is managed in a safe way which ensures that residents receive their medication appropriately EVIDENCE: Two of the care plans were looked at in detail. These contain a lot of information about the residents, including individual care plans and risk Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 10 assessments. The nurses are responsible for initially completing the care plan and for monthly reviews and updating the records. At the last key Inspection a recommendation was made for the care plans to include more information about the social and emotional health needs of the residents and also to include a biography so that staff have a better understanding of the residents history and of significant events that are important to them. We were told that this process has started but this had not been done for the care plans that we saw during the visit. This area is of particular importance for those residents who have communication difficulties associated with dementia and are unable to effectively communicate easily with staff. The care plans need to contain more detailed information in some cases so that staff have clear guidance about how to meet residents individual needs. For example, one of the residents care plans includes a wound assessment relating to pressure sores and a pressure care risk assessment highlighting a high risk but there is no care plan in place for the daily care that the resident needs to treat these and to prevent future sores from developing. There is little evidence that the care plans have been developed with the involvement of residents or their relatives. They need to contain more information about residents preferences about the way in which they like to receive their care and evidence of their involvement in the process. Another care plan states that the resident is losing weight and needs supplements but there is no care plan in place for dealing with this situation. Staff described the action to be taken to encourage the resident at mealtimes but this is not within the care plan. The daily notes within the care plans are varied in their quality with some being quite detailed and others containing very minimal information. For example, in one residents daily notes there is a brief mention of an incident involving another resident but there are no details of the situation, the outcome of this or of any plans to prevent it happening in the future. The Home is a nursing Home and therefore there are nurses on duty at all times who are responsible for dealing with nursing tasks and for delegating work to the care staff. As the Home is a large building the staff team are divided into different teams at the start of each shift and each are responsible for providing care to the residents in a particular area of the Home although they can assist in other areas as needed. Since February 2008 the Commission has received seven expressions of concern/complaint about the level of care provided at the Home. A review of the Homes complaints record shows that since February 2007 there have been five complaints made to the Home about the level of care provided. During the visit to the Home further concerns were raised with both Inspectors. All of the Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 11 concerns/complaints relate to the poor care being provided with regard to areas within the group of outcomes covered in this section of the report ie. Continence, staffing, personal care, privacy and dignity. Areas of the Home, including communal rooms, bathrooms and individual bedrooms had a strong smell of urine on the day of the visit. Staff said that they do not have time to support all residents to use the toilet on a regular basis and that they often have to leave residents without being changed for longer than they should be. There is a problem with some of the hoists at the moment and the Home does not have enough hoists for staff to be able to have easy access to these to assist all of the residents who require this assistance. Not all residents have their own slings and so slings are being shared and the care plans do not contain detailed information about what size sling each resident needs. The Inspector was also told that, despite staff requests, there are still no suitable weighing scales to weigh residents who are unable to stand/sit still. It is required that the necessary equipment is provided to meet the needs of the residents. During the tour of the building in the morning it is was noted that continence pads, aprons, handwash and gloves were not all present in all of the bathrooms. Another tour of the bathrooms during the afternoon showed that although continence pads were present there were still no aprons or gloves in some of the bathrooms. This means that staff sometimes have to leave residents alone in the bathroom whilst they go looking for these items. It also means that the infection control is compromised. Staff said that only the qualified nurses have access to the locked cupboard where gloves and aprons are kept and that the organisation have limited the number of gloves that can be used each shift. It is required that aprons, gloves and incontinence pads are provided in sufficient number and are readily available. Discussions with staff and relatives provide evidence that staffing numbers have been reduced. On some occasions this is the number of direct care staff whilst there have also been reductions in the hours that the domestic staff are working also which is clearly having an impact on the cleanliness and hygiene levels in the Home. There are several vacancies for all levels of staff within the Home and so a lot of agency staff are being used at present. This means that staff do not all know the residents and that it is difficult for the permanent staff who are constantly providing induction and orientation for new members of agency staff. Discussions with staff and relatives show that staff are very busy during each shift and that they do not have time to spend much time individually with residents. This was confirmed through observations of staff providing care to Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 12 the residents throughout the visit to the Home and through concerns/complaints passed to the Commission. One of the nurses showed the Inspector the systems in place for the storage, administration and recording of medication within the Home. The nurses are responsible for tasks relating to medication. Medication is stored safely and appropriate records are kept. The concerns/complaints received at the Commission relate to the compromising of individual residents privacy and dignity. This was confirmed through discussions with staff and relatives and also through observations throughout the Inspectors visit to the Home. For example, residents were seen to have food on their clothes after meals and were not assisted to change for long periods of time. Some residents were seen in stages of undress and due to the fact that some of the lounges have long periods of time with no staff support available they remained this way for some time. Midway through the afternoon one of the residents still had on their apron which they had worn at lunchtime. Residents were heard calling out for assistance and having to wait long periods of time before staff were able to provide help to them. Residents were still having breakfast when domestic staff were starting to wash the dining room floor. Staff said that there are not enough staff to assist all of those residents who need help with eating and so they often have to assist two residents at once. This compromises residents dignity. There is little privacy for the residents. The Manager said that not all of the bedroom doors are locked but all of the bedrooms that the Inspector asked to see had locked doors. Many of the residents are unable to ask for their key and therefore are unable to access their rooms during the day. Some of the bedroom windows overlook the gardens or the car park and not all have net curtains or other suitable window coverings to provide privacy to the residents. One of the residents bedrooms overlooks the area which the staff use to smoke in and so this severely compromises the residents privacy and would also mean that the smell of smoke goes into their room if they had their window open. Discussions with staff show that they are unhappy about the changes that have led to the reduced standard of care being provided. They are well aware of the improvements that need to be made and are keen to provide a good service that respects the individuals privacy and dignity. Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. There are very few opportunities for residents to take part in meaningful activities Residents have little opportunity to exercise choice and control over their lives Improvements need to be made to ensure that the residents receive a wholesome, appealing balanced diet in pleasing surroundings EVIDENCE: The majority of the concerns/complaints raised with the Commission mentioned the lack of activities and stimulation available to the residents. This was confirmed through discussions with staff and relatives as well as observations throughout the visit. At the time of the last Key Inspection this group of outcomes was assessed as being of good quality but there has been a Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 14 real change in this area leading to a greatly reduced quality of service. All of the staff who spoke to us are frustrated by the lack of time that they have to spend with individual residents, particularly those with dementia. There are currently two staff employed to provide activities. They both work approximately the same hours which is mainly Monday to Friday. They are enthusiastic about providing meaningful activities but aware of the limitations to this currently. They are also responsible for accompanying residents to hospital appointments and so one of them may be away from the Home for several hours. They said that they used to be able to take residents out in small groups to local places in the community eg. Garden centres or shopping but that this rarely happens now. The activity staff are currently concentrating on providing activities to the more able residents as they said that activities can be provided to a larger number of people in this way and that these are the residents who actually ask for things to do. However, this means that the majority of residents, who have dementia, have very little stimulation or meaningful interaction with staff. The care staff do not have time to spend with residents to do any more than basic care for them. On the day of the visit to the Home one of the activity staff accompanied two residents to hospital appointments and so was away from the Home for considerable time. The other member of staff ran a craft group who were enthusiastically and happily making Easter Bonnets. Residents taking part in these activities said that they really enjoy them and wished that there was more available. The activity staff also assist at mealtimes and encourage small groups of residents to have lunch in the conservatory which is also used as the activity room. As part of this inspection, observations were made in a communal part of the home. The purpose was to look closely at the activity and occupation of people using the service and the kind of interaction they experienced with staff. The observations took place over a period of two hours and overall the findings were poor. One resident experienced only two interactions with staff during this time and these were good and generated a positive response form the resident. However, the interactions were very brief and lasted at most for four minutes. For another resident, the only engagement was when a member of staff fed her a cup of tea. This interaction was poor as the carer ignored her and talked to another person over her head. The third resident to be observed was alert to what was going on around her and always offered a positive response when spoken to, regardless how briefly. She sang along alone to music and without encouragement from staff. She experienced several engagements with staff that generated good responses. Unfortunately, these engagements were mainly based on staff calling her name as they walked past. She was looking Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 15 to have social engagement but was largely ignored. At one time, she held out her hand to a member of staff as they walked past but she was again ignored. Overall, the residents observed had a total of eleven engagements with a member of staff. These were of variable quality, were very brief and did not enhance the residents’ sense of personhood. The engagements did not reflect the interests or past experiences of the person but were based on physical care or distraction. There were several visitors to the Home during the day of the visit. Relatives said that access to the Home is easier now that they are able to have the codes to the keypad locks. The Commission received a letter from a relative who comment positively about the care provided at the Home but the other relatives who the Commission have had contact with have not been happy about many aspects of care provided at the Home. They have all said that the care has recently deteriorated and that they find it very difficult to obtain responses to their concerns due to the changes in management of the Home. Relative meetings used to take place at the Home on a regular basis and the new Manager has restarted these with a meeting due to take place the week following the visit to the Home. The Manager also said that the Operations Director for the organisation and the Area Manager will attend a relatives meeting so that some of the relatives concerns can be aired at that time. Relatives made positive comments about individual members of staff and said that often verbal communication is good but commented negatively about the lack of staff available and the lack of written communication within the Home. It was difficult to see any examples of residents being encouraged to exercise control and choice over their lives. Communication is difficult for a lot of the residents with dementia and staff have not received suitable training or ongoing support with regard to this issue. The care plans are not detailed enough about individual residents preferences and choices or their previous life history for staff to be able to gain information about how they may wish their care to be provided. Staff were heard and seen to offer very limited choices, for example, about where residents wished to spend their time and about which biscuit or drink they may wish to have. The staff are aware of the constraints which do not enable them to encourage residents to make their own choices. Some of the concerns/complaints received at the Commission have been related to the quality of meals and of the support residents receive at mealtimes. These were also raised as issues through discussions with staff Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 16 and relatives. However, we did also hear positive comments about the meals provided. The dining room next to the kitchen is not a pleasant room for residents to spend time in. It is bare, institutional and not at all homely. During our walk around the Home in the late morning there were still three residents having breakfast. There are large ‘hatch’ type windows in this dining room and therefore residents can see into the kitchen. On one of the hatches there was a large bowl of left over food which was presumably the remains of the breakfast meal and one of the kitchen staff was using machinery which was noisy. There were no care staff assisting the residents and one of the residents was having great trouble with eating their breakfast with the majority of it ending up on the floor. The domestic staff had started to wash the floor despite the residents still eating. There were two large overflowing bins without lids in the dining room. As previously stated in this report some residents eat in the conservatory which is a much more pleasant room. There is also another dining room which is also quite institutionalised and impersonal. Despite the activity staff assisting at lunchtimes there are not enough staff to assist each of the residents who require assistance and staff said that they often assist two residents at once to ensure that residents get their food when it is hot. This is not a dignified way to support residents. Relatives said that food which needs to be liquidised is all put together so that the meal does not look appetising. This was not seen during the visit to the Home. Some of the care plans contain MUST nutritional assessments which then provides guidance to staff about individual residents nutritional needs. The care plans also contain information about residents food allergies and likes and dislikes. In the kitchen there is a large board which includes some of the information mentioned above. However, there was no mention of one of the residents being allergic to eggs despite other dietary information relating to that resident being listed. There was also no guidance about most residents likes and dislikes. As previously mentioned one of the residents has specific arrangements in place to encourage them to eat but this is not recorded in their care plan and not all staff are aware of the arrangements which reduces the opportunities for it being used consistently. Comments about the quality of the meals were mixed with several negative comments about the lack of fresh fruit and vegetables and the lack of choice about puddings. During the visit we spoke to the kitchen staff and looked Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 17 around the kitchen as well as looking at menus. There seems to be some discrepancies between the menus seen and what is actually provided. We saw the recent delivery of fresh fruit and vegetables which consisted of salad vegetables, potatos, oranges, apples and bananas. The cook was positive about the need to provide good quality meals and for the residents to have a choice. Homemade soup for the next day was being prepared at the time we were in the kitchen. The care staff ask each resident daily for their choice of meal for the next day. This system is not suitable for all residents due to the fact that many have dementia and are unable to remember what they have ordered. It is recommended that the menus are provided in a pictorial/photographic format to aid residents understanding. Staff said that if a resident asks for something different to what is on the menu then it is not always possible to provide it. For example, a resident requested to have an omelette one lunchtime and was told that it was not possible. This is particular poor as the resident is someone who has an identified need for additional support to maintain a healthy diet. The kitchen is very small considering the size of the Home and this may limit the amount of choice that can be accommodated at short notice. Residents were seen to be taken to the dining rooms during the late afternoon and then sat there having to wait for their meal for over half an hour. This is particularly difficult for residents with dementia who may not understand why they are waiting. It is required that the residents are provided with wholesome, appealing meals and receive appropriate support at mealtimes. Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Some relatives and staff do not have complete confidence in the organisation to deal effectively with concerns/complaints The residents are at increased risk of possible harm due to lack of consistent staff and lack of training EVIDENCE: The Home has the complaints procedure on display. Relatives and staff told us that they have raised concerns/complaints with the Manager and the previous manager and that these have not been dealt with appropriately. The record of complaints seen at the Home included very brief written responses to complainants which did not fully cover the issues raised initially. Due to the communication difficulties that the majority of the residents have it would be difficult for them to raise concerns. Improved training for staff with regard to communication and working with people with dementia should improve this situation. Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 19 Due to the poor staffing levels and the fact that there are often long periods of time when there are no staff in some communal areas of the Home the residents are at increased risk of harm. Some of the residents are at a very high risk of falling and others are at risk from the behaviour of other residents. The training record provided by the Home shows that under half of the staff team have attended training with regard to Safeguarding Adults (protection of vulnerable adults). The matrix for future planned training includes seventeen staff names to attend this training in June/ July 2008. This still leaves a lot of staff who have not received this training. It is required that all staff receive Safeguarding training. Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 26 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The decoration and furnishings in a lot of the areas of the Home is poor and does not provide homely, comfortable accommodation for the residents EVIDENCE: We were shown around the Home during the morning and then looked again at the bathrooms during the afternoon. During the tour of the building all of the communal areas were seen and some of the bedrooms were seen. We were provided with a list of furniture that has been ordered for some of the bedrooms and lounges following a visit and audit by the Operations Director. Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 21 However, we were told that any further upgrading of the accommodation was not planned in the near future. The majority of the rooms in the Home, communal and bedrooms would benefit from redecoration, recarpeting and new furniture. The rooms are not homely and there is an unpleasant odour in some of the bathrooms, lounges and bedrooms. One of the bedrooms has been redecorated and is very personalised with the residents own ornaments, pictures etc. This room is attractive and homely but when the bed spread was removed there was only a thin duvet on the bed with no cover or covering sheet. The duvet was ripped in several places. The bathrooms are institutionalised and bare, some have no natural light. The larger bathrooms are used as storage areas for laundry baskets, wheelchairs and hoists and this further detracts from the homeliness or comfort of these rooms. The beds that were seen do not have mattress covers and so some of the residents are sleeping on plastic mattresses with only a sheet covering the mattress. It is recommended that mattress covers are provided to increase comfort for the residents. The majority of the bedrooms have photographs or other personal items displayed on the door to aid residents in finding their own rooms which is good practice. As previously mentioned in this report all of the bedrooms seen by the Inspector were locked. The majority of the bedrooms were cold as the windows were open. Work has been carried out to the gardens and a path has been provided, as well as raised flower beds and areas for seating in warmer weather. A new call bell system has been fitted. The laundry room was not seen during the visit but we were told that improvements have been made. It is required that the Home provides comfortable accommodation for the residents with a planned programme of redecoration and refurbishment. As previously mentioned, the Home does not have scales that are suitable to weigh all of the residents. Staff also said that there are not enough hoists currently as some are broken and have not been returned. It is required that the appropriate equipment is provided to meet the residents needs Prior to the Inspection the Commission was notified by an anonymous caller that the generator had failed during a recent power cut and therefore there Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 22 was no power to the Home which means that in addition to the usual effects the keypad locks and the call bells do not work. The organisation have known that the generator needs attention but this has not been effectively addressed. A requirement is made about this. Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 23 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 & 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The staffing levels are not adequate to meet the needs of the residents Staff would benefit from additional training about the specific needs of the residents EVIDENCE: There are always qualified nurses on duty who are responsible for allocating work to the care staff. As previously mentioned, the care staff work in ‘teams’ and are allocated to provide care for groups of residents but may be called to assist another team if needed. Concerns about the current staffing levels have been raised to the Commission by staff and relatives. Observation of the staffing rota confirmed that there are times when the organisations own minimum staffing levels are not met. In addition to this there are several vacancies within the staff team, both nursing, care staff and ancillary staff. Often agency staff are used to cover these shifts. As some staff work a ‘long day’ shift system there are periods of time during Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 24 the middle of the day when there is not actually the number of staff available as stated on the rota as staff are entitled to have a break. This report contains many examples of poor outcomes for the residents which can be linked to staffing levels and a requirement is made about this. The majority of training is provided in–house and the Home provides induction and ongoing training as per Skills for Care. Due to the staffing difficulties it can be difficult for the qualified staff to have time to provide training and to release the care staff to attend. The organisation has plans to introduce etraining which is a computer based form of training. There is a need for staff to receive additional training about specific needs of the residents. This includes dementia, communication, managing difficult behaviours, epilepsy, learning disability, pressure care. A requirement is made about training. The Manager confirmed that recruitment is ongoing and that they have recently appointed new care staff who will start once all recruitment records have arrived. Two of the personnel files were seen. One contained the necessary information relating to recruitment but the other was missing some documents. The Manager confirmed later that the information had been filed separately. No training records were seen although the Manager provided an overall training matrix. Very few supervision records were available. Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The recent changes to management mean that there has not been consistent management provided to the Home recently The Home is not run in the best interests of the residents The health and safety of residents is not fully protected EVIDENCE: There have been recent changes to the management of the Home. A new Manager started work at the Home in January 2008 but left soon after. There is currently one of the organisations peripatetic managers in post but this is Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 26 not a permanent position. The manager said that she intends to stay in post for at least a year to provide some consistency. The organisation are aware of the difficulties caused by changes in management of the Home. The Home does not currently have an effective quality assurance system in place that takes into account the views of the relatives and residents. A requirement is made about this. As previously mentioned in this report very little written evidence of supervision could be found. This confirmed the staff views that this does not take place on a regular basis. Throughout this report there have been examples of how the health and safety of the residents and staff have been compromised. For example, the lack of detail within the care plans means that there is no clear guidance for staff about how to effectively reduce the risks associated with pressure area care, falls, weight loss or aggressive behaviours. The lack of equipment also compromises the health and safety of residents and staff. The staff should have easy access to gloves, aprons and hand washing supplies at all times without having to go looking for them or having to ask for them. The Home should have adequate numbers of hoists which are well maintained. The residents should be able to use a sling that has been assessed as suitable for them. There should be scales that are suitable for weighing residents, including those who are unable to sit or stand easily. The generator must be well maintained as when this failed during a recent power cut it meant that the fire detection system, the lights and the keypad system also failed. It is required that steps are taken to address these issues so as to provide better protection for residents and staff. Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 27 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 2 X 1 2 2 X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 1 X 3 1 X 1 Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 28 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 Requirement It is required that the care plans are more detailed and that they contain information about the residents emotional and social care needs It is required that equipment such as gloves, aprons and incontinence pads are provided in sufficient amounts It is required that the privacy and dignity of the residents is respected It is required that meaningful activities are provided for residents It is required that wholesome and nutritious food is provided and that the individual dietary needs of the residents are met It is required that the Home provides comfortable and homely accommodation which meets the needs of the residents It is required that suitable equipment is provided to meet the needs of the residents and that this is kept in good working order It is required that at all times DS0000066644.V360786.R01.S.doc Timescale for action 31/05/08 2 OP10 12 11/03/08 3 4 5 OP10 OP12 OP15 12 16 16 11/03/08 31/05/08 11/03/08 6 OP25 23 30/06/08 7 OP22 23 31/05/08 8 OP22 18 30/04/08 Page 29 Oak Manor Nursing Home Version 5.2 9 OP26 16(2)(k) suitable qualified, competent and experienced persons are working in the Home so as to meet the needs of the residents The registered person must 30/04/08 ensure that unpleasant odours are eradicated and effective odour control is in place. This requirement is repeated It is required that the health and safety of the residents and staff is protected It is required that an effective system of quality assurance is in place which takes into account the views of the residents 11/03/08 31/05/08 10 11 OP38 OP33 13 24 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 OP15 OP23 Good Practice Recommendations It is recommended that menus are provided in a pictorial format It is recommended that mattress covers are provided Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oak Manor Nursing Home DS0000066644.V360786.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!