Inspection on 04/09/08 for Oak Manor Nursing Home

This inspection was carried out on 4th September 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 11/03/08

Oak Manor Nursing Home 20/03/07

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Oak Manor Nursing Home Scarning Dereham Norfolk NR19 2PG Lead Inspector Lella Hudson Unannounced Inspection 4th September 2008 10:00 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 Manor Nursing Home DS0000066644.V371337.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.V371337.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 shaun.morrissy67@btinternet.com www.concensusupport.com Caring Homes Healthcare Group Ltd Mr Shaun Peter Morrissy Care Home 64 Category(ies) of Dementia - over 65 years of age (64) registration, with number of places Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th March 2008 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. Fees are currently between £536.00 - £900.00 per week. Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is ONE STAR. This means that the people who use this service experience ADEQUATE quality outcomes. This report contains information gathered about the Home since the last Key Inspection, which includes the Random Inspection (May 08) and an unannounced visit to the Home on the 4th September 2008. The Responsible Individual and Manager of the Home were invited to meet with the Commission following the Random Inspection to discuss the findings of that visit and that of the Key Inspection which took place in March 2008. This report also includes information provided by the Home in the form of notifications, information provided by a range of health/social care professionals, information about concerns/complaints and also information provided within eight surveys that were returned to us from relatives. The surveys were returned to us in June and July 2008 and therefore may not reflect all of the improvements that have taken place at the Home as many of these have been very recent. During the visit to the Home we spoke to the Manager, staff, residents and relatives. We observed staff supporting residents. We looked around the accommodation and looked at a variety of records relating to the care of the residents. The Home has been managed by one of the organisations peripatetic managers for the majority of this year. However, a permanent Manager, Sandy Watson, has been appointed and took up her role in June 2008. What the service does well: What has improved since the last inspection? The organisation has now taken action to address the problems that the Home had and this has led to many improvements being made. This includes the recruitment of a permanent Manager who is providing clear leadership and management of the Home in a way which puts the needs of the residents first. Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 6 A lot of attention has been given to the way in which the staff team work together and improvements have been made to ensure that this is more effective. Staff morale has improved and residents, staff and relatives all said that the care provided to the residents has improved. One of the relatives said that there has been “100 improvement”. Residents receive care in a more individual, personalised way. A new activities co-ordinator has been employed as well as a part time staff to work with her in the provision of activities. The activities co-ordinator is very enthusiastic and has plans for further improvements. The organisation has brought in one of their catering managers to review the catering arrangements and to provide training for the staff. Residents, staff and relatives all said that there have been improvements to the quality of the meals provided and in the support provided by staff to residents who need assistance at mealtimes. Improvements have been made to the accommodation with lots of areas having new flooring fitted. The lounges and dining areas have been decorated with new pictures and ornaments purchased to make it more homely. New seating, bedding and some bedroom furniture has been purchased. Additional training is now being provided to staff in subjects that will enable them to meet individual residents needs more effectively. Some staff have already attended this training and others have dates planned. What they could do better: The majority of improvements have been made very recently and the organisation needs to ensure that they maintain these and continue to make further improvements. The quality assurance system needs to be more effective so that any problems are identified more quickly by the organisation itself rather than waiting for Inspections to take place. Some of the bedroom carpets need to be replaced and further pictorial signs need to be placed around the Home to assist residents to find their way around. Some of the care plans and risk assessments need to be more detailed so as to provide clear guidance to staff about how to meet individual residents needs. The work about Person Centred Care that has been started needs to be continued and further developed. Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 7 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.V371337.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 Manor Nursing Home DS0000066644.V371337.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): 3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Detailed assessments are carried out prior to residents moving into the Home to ensure that the residents needs can be met EVIDENCE: During the random Inspection in May 2008 evidence was seen which showed that at least one resident had been admitted whose needs could not be met at the Home. A pre admission assessment had clearly identified the residents complex needs and the decision was made to admit them to the Home despite the fact that the staff had not received appropriate training. The resident no longer lives at the Home. We looked at pre admission assessments for residents who have since been admitted to the Home. These are detailed and include information from the resident and their family as well as information gathered from health/social Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 10 care professionals. There is written evidence to show that the Manager considers the information prior to making a decision about whether a residents needs can be met a the Home. Written records show that the Manager has made decisions not to admit a resident when she feels that the residents needs can not be met at the Home. Oak Manor Nursing Home DS0000066644.V371337.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 & 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The basic health and personal care needs of the residents are met. The care plans and risk assessments provide guidance for staff about how to do this. Medication is managed in a safe way which ensures that residents receive their medication appropriately. EVIDENCE: At the last Key Inspection requirements (March 2008) requirements were made with regard to improving the care plans and risk assessments, improving the residents experience of having their privacy and dignity respected as well as requirements about staff training. The random Inspection in May 2008 took place as a result of a complaint made to the Commission. This related to the lack of care provided to one of the residents. It was found during this visit that the requirements mentioned above had not been met and that the needs of the residents were not being met. Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 12 In the AQAA which was returned to us the Manager listed the action that had been taken to make improvements and to meet the requirements. This includes the review of care plans, the provision of net curtains for those bedrooms which overlook the car park and also the resiting of the staff smoking area. During the visit to the Home in September we looked at four of the care plans. These have been much improved but are still in need of further detail to ensure that the staff are able to provide consistent care. For example, one of the care plans states that the resident should be assisted to use the toilet but it does not make clear how this should be done considering that the resident concerned is not able to sit safely on a toilet. The care plans now contain evidence of regular reviews and of being updated. The care plans relate to basic health and personal care. They contain nursing care plans with regard to, for example, pressure care and wound care and whilst these are clear about the nursing intervention they are not always clearly translated into a care plan for the care staff about how to meet these needs on a daily basis. For example, one of the residents has a very clear nursing care plan about leg ulcers but there is not such a clear plan for the care staff to follow with regard to day to day care and prevention. The risk assessments have been improved and these are now present within the care plans. However, there is still a need for further improvement through the consideration of all risks. For example, one of the risk assessments written for the use of bedrails considers the risks to the resident of not using bedrails but does not consider the risks that may be present through the use of bedrails. The Manager has started to work with staff to ensure that the residents care is provided in an individualised way and that residents choices are sought and respected. A new format is being used to find out individual residents choices about a range of issues such as preferred name, preferred form of communication, whether the resident wishes to attend residents meetings, whether they would like to have an advocate. Minutes of the recent nurses meetings show that person centred care and the completion of Life Stories with the residents has been discussed and actions agreed to move towards this happening. Some care plans contain very detailed information about the residents specific needs and wishes. For example, one of the residents care plans with regard to nutrition states that the resident likes ‘sponge cakes with soft icing’ and likes ‘porridge without lumps’. This level of detail is particularly important for those residents who do not find it easy to communicate. The staff who spoke to us said that their views are incorporated into the care plans following discussions with the nurses. The staff are responsible for Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 13 completing the daily notes. The quality of these is varied with some being quite detailed and others being very basic and just stating ‘no issues’ or ‘no change’. Not all of the staff who spoke to us had a good understanding of the care plans and we were told that this is due to a lack of time to look at them. The way in which staff are allocated work has changed and staff who spoke to us said that the focus is now on ensuring that the needs of the residents are met in a more individualised way. They said that the residents have more choice now about basic things such as what they would like to eat/drink and where they would like to spend their time. The staff said that the way in which their work is allocated means that they have more time to spend with a small group of residents. One of the changes that has taken place is that the staff are allocated to work in different areas and that they all understand that there must always be a member of staff in each of the lounges. Also, the nurses spend more time in the lounges and carry out some of their paperwork here and this frees up the care staff to provide care to individual residents. In May 2008 we were notified of concerns from the continence service about the staffs lack of understanding of continence care and that residents needs were not being met with regard to continence. These concerns were passed on to the temporary manager. In August 2008 we were notified of continuing concerns with regard to residents receiving poor continence care. However, during the visit to the Home we were told by staff, residents and relatives that this is an area that has greatly improved. There were no unpleasant odours in the Home and relatives and staff told us that this is the usual situation now. Staff described the continence care that is provided for individual residents and said that new paperwork has been introduced to provide evidence of care being provided. The concerns were passed to the Manager who said that she would contact the continence nurse. Following the Inspection we were notified by the continence nurse that the situation has improved. Improvements have been made to maintaining privacy and dignity for the residents. Staff were seen to speak respectfully to the residents and to support them in a sensitive way. Staff said that they are now able to spend more time with individual residents and so are getting to know them better and therefore understanding their needs and preferences. Privacy screens have been provided for staff to put around the toilet doors as these are located close to the lounges. The Manager said that some of the toilet areas will be changed as they currently have walls that do not reach to the floor or the ceiling, therefore not providing much privacy. During our look Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 14 around the Home it was noted that incontinence pads are piled up in one of the toilet areas. These should be stored more hygienically and discreetly. Also the records relating to continence needs are on the bathroom walls. These too, should be kept somewhere more discreet. Net curtains have been provided in those bedrooms which overlook the car park and the staff smoking area has been moved so that it is not outside residents bedrooms. The views within the relatives surveys are mixed with regard to the care that is provided with some feeling that the care is good and others that is not. The surveys were returned to us in June and July 2008 and there have been further improvements made since that time. The responses are equally mixed with regard to whether the staff have the right skills and experience to meet the needs of the residents. Additional comments were made such as: “Its important to have more staff with the right skills” ”the care is second to none” “Im very impressed with the care” One of the nurses was observed administering medication. This was done in a safe way with attention being given to security of the medication trolley when the nurse was away from it. It can take considerable time to administer the medication, particularly in the mornings and so each of the two nurses on duty are responsible for the administration of medication to different groups of residents. Medication was offered with a drink, or food depending on the residents preference. The nurse took time to ensure that the resident had taken the medication before signing the administration record. This often involved a lot of explanation due to the communication difficulties that some of the residents have. One of the care plans that we saw contains written confirmation from the GP agreeing to the covert administration of medication for that resident if necessary. There was also evidence that the relatives had been involved in these discussions. Staff said that they actually do not have to do this on a regular basis. There was no evidence that Mental Capacity Act assessments had been carried out with regard to the use of covert administration of medication. The majority of residents living at the Home have some form of dementia and as a result have difficulties with communication. The staff who spoke to us said that they have learnt more about communication and its different forms through the training about dementia that they have received. The staff team and qualified nurses have received dementia training in the last six months. Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 15 The Manager is aware of the need to further develop the communication skills of staff with regard to different functions and styles of communication. The care plans have started to become more explicit about the forms of communication that the residents prefer, or find easier. Work has been started to provide information in alternative formats to the written word. For example, the staff have taken photographs of the meals prepared so that they can put together a photographic menu which some residents will find easier to choose from. Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A range of activities has started to be provided for the residents to take part in. Residents now have more choice about their meals and are supported effectively and sensitively at mealtimes. Relatives are mixed in their views about whether the staff communicate with them effectively. EVIDENCE: A requirement was made at the last Key Inspection for meaningful activities to be provided for the residents. Since that time there have been changes to the arrangements in place for the provision of activities. The previous activity coordinators have left, although are still involved in a voluntary capacity. A new full time activities co-ordinator has been appointed as well as a part time member of staff to assist with this and so that activities can be supported at weekends as well as during the week. The activities co-ordinator is enthusiastic and has already put in place additional activities with lots of plans for further improvements. The focus is on finding out what each resident Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 17 enjoys or may wish to be involved with so that this information can provide the basis for future planning of activities. The activities co-ordinator is keen to involve all of the residents, including those who have communication difficulties. The care staff who spoke to us said that they also have more time to spend with residents on an individual basis during the afternoons and are encouraged to assist the residents to take part in activities. The activities coordinator understands that some residents will find it difficult to take part in group activities and that there is a need to provide 1:1 activities. Life Histories, including information about residents previous interests and hobbies are being completed by the activities co-ordinator and care staff. Although the provision of activities staff has increased there is still not enough hours to provide meaningful activities on a regular basis for the number of residents living at the Home. The activities co-ordinator is actively recruiting volunteers and contacting local community groups to encourage volunteers to be involved in the provision of activities within the Home. There are now ‘rummage boxes’ placed around the Home for the residents to explore. These contain a range of items which residents may find interesting. Around the corridors there are also items hanging down or fixed to the walls which residents are encouraged to touch and explore. These have interesting different textures and sounds. Residents have also recently started some indoor gardening with potting of plants. The Home recently had their first Summer Fete. During our visit to the Home some games were taken place, such as skittles. An external entertainer visited the Home to provide music and songs which some of the residents really seemed to enjoy. The relatives and staff who spoke to us were all very positive about the improvements that have been made with regard to activities. Two of the residents told us about the new shop that has opened in the Home. One of the empty rooms has been turned into a small shop with an old fashioned counter and shelves. It currently sells toiletries, sweets and other small items. Two of the residents have been assisting with pricing and selling items and said that they are really enjoying this. More thought has gone into where residents spend their time since the last Key Inspection. The seating arrangements in the larger lounge has been altered so that smaller groups of residents can sit together. Staff are now allocated to different lounge areas in the Home and there is the expectation that there will always be at least one member of staff in each lounge to provide support to the residents. The relatives surveys are mixed in their views about whether the staff at the Home keep in touch with them in an effective way. An additional comment was made about the lack of information provided about forthcoming relatives Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 18 meetings. The Manager was aware that this had been an issue in the past and has taken steps to ensure that all relatives were informed of the last relatives meeting which took place prior to our visit. An additional comment states that the staff ‘treat visitors well’. The Manager has also instigated the use of communication books which are kept in the residents rooms and can be used for relatives/staff to put messages in if it is relating to something that does not need an urgent response. During our visit to the Home we spoke to two relatives and they both said that communication between staff and themselves has improved in the short time that the new Manager has been at the Home. In June 2008 we had received two complaints about the meals provided and at the poor support that residents received at mealtimes. These were investigated by the organisation but improvements were slow to take place. However, the organisation has now addressed the situation and many improvements were seen at the time of our visit. Relatives and staff confirmed that the changes have made improvements to the quality of the meals and to the support provided at mealtimes. The organisation arranged for one of their peripatetic chef managers to spend time at the Home reviewing the arrangements for mealtimes and to provide training for the staff. The Homes own internal audit has recently shown that lots of improvements have taken place. Staff and residents said that the meals are now served hot and that residents are not sitting at the tables waiting for a long time for their meals to be served to them. We observed part of the lunchtime and teatime meals during our visit. Two additional staff have been employed to provide assistance to residents during breakfast and lunchtime. This is not currently happening for seven days a week. Staff supported residents in a sensitive and caring manner. Residents did not wait long for their meals and were offered a choice at the time that their meals were brought to them even though they had already chosen from the menu earlier in the day. The meals which need to be liquidised are done so with each part of the meal liquidised separately. New cutlery and crockery has been purchased and the Manager said that this was done after researching the most appropriate for people with dementia with regards to style, colour and shape. Drinks and snacks are provided during the day. One of the residents told us that he is very pleased with the snacks provided at supper time. The care plans contain nutritional assessments with guidance about the additional support that some residents need with regard to mealtimes and their dietary needs. Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 19 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. Relatives are not confident in the organisations ability to investigate and respond to complaints appropriately. Residents are not fully protected from abuse due to the shortfalls in staff training EVIDENCE: Following a complaint about poor care that a resident received a Random Inspection was carried out and found that a resident with complex needs including challenging behaviours had been admitted. Staff had not received appropriate training and this led to the poor care experienced by the resident, including the use of physical restraint. The organisation are now providing appropriate training for staff about working with residents with challenging behaviour but not all staff have yet received this training. The staff who spoke to us who have attended it said how useful and interesting it was. They were also clear about the importance of understanding the communication behind challenging behaviours. At the time of the last Key Inspection and the Random Inspection it was found that complaints had not been properly investigated or recorded. Relatives had Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 20 told us that they did not have confidence in the organisation to deal with complaints effectively. This includes complaints passed to us in June 2008. Again, the relatives surveys are mixed with regard to whether they feel that complaints are investigated appropriately. However, two relatives told us during this visit to the Home that the new Manager is approachable and that they have confidence in her ability to investigate complaints and to take appropriate action. The Manager keeps a record of complaints. Staff who spoke to us said that they have received training with regard to Safeguarding. This is provided during the induction for staff through the use of DVD training. Some staff, but not all, have also received more in depth training about Safeguarding which includes the arrangements in place in Norfolk for notifying relevant statutory authorities about any allegations of abuse. Staff who spoke to us were aware of the whistle blowing policy and this has recently been put into practice as an allegation of abuse was made. The Manager dealt with this situation appropriately and informed the correct statutory authorities. Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The quality of the accommodation is varied with some areas providing more homely and comfortable accommodation than others. EVIDENCE: At the time of the last Key Inspection many aspects of the accommodation were identified as needing improvements. At the time of the Random Inspection two months later it was noted that some of these improvements had been made, such as the provision of new flooring in the corridors and some of the bathrooms and the provision of new lounge chairs. However, at the time of the Random Inspection it was noted that some of the bedrooms still had poor quality bedding, including one duvet which was ripped and thin. Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 22 During this visit to the Home further improvements have been noted. New bedding has been bought and the housekeepers are now aware of the need to throw away any bedding which is not suitable for use. Further bedrooms have had replacement flooring fitted and net curtains have been fitted to some windows. However, some of the bedrooms still have carpets which need replacing but the Manager said that there are no plans to replace these in the near future. Some of the bedrooms have evidence of the residents personalising them but others are bare and functional looking. Some improvements have also been made to the bathrooms to prevent them from being bare and institutionalised looking. Many areas of the Home, including lounge areas, have been redecorated and new pictures have been put up. The communal lounges and dining room are much more homely and comfortable. The dining area near to the kitchen has also had some improvements and is a much more pleasant area to spend time in but it does remain functional and not as homely as the dining room. The Manager said that there are plans to make improvements to the small enclosed garden area. The generator is now being checked regularly to ensure that it works if the power fails. Oak Manor Nursing Home DS0000066644.V371337.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 adequate This judgement has been made using available evidence including a visit to this service. The residents basic needs are met by the staff team who are now working more effectively as a team. Staff have started to receive additional training which is assisting them to carry out their roles effectively. Appropriate recruitment procedures are carried out. EVIDENCE: There have been improvements in the way in which the staff team are working together. Attention has been given to how work is allocated, how and when staff take their breaks and where staff, including the nurses, spend their time. There is also better monitoring and support provided to staff. This means that the staff team are working more effectively despite not having any increase in the number of staff on duty. Ongoing recruitment means that there has been a decrease in the number of agency staff used although the Manager said that this has increased at night recently due to staff taking holidays. Staff told us that there are still times when they are very busy and the residents would benefit from additional staff at those times. The relatives surveys are mixed again with regard to whether the staff have the right skills and experience to meet the needs of the residents. Additional comments were made such as: Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 24 ‘important to have more staff with the right skills’ ‘the carers work hard’ ‘Im very impressed with the care’ ‘When morale is good the staff are cheerful and supportive’ The staff who spoke to us were all very positive about the improvements that have been made at the Home and of the new management arrangements. They all said that they feel that they are able to provide a better standard of care now than in the past and that they feel supported to do so. Staff said the training is improving with some staff having had additional training and others aware of the dates on which they will receive this. We observed the atmosphere within the Home to be a much more positive one than during our last two visits. Staff were seen to spend time with individual residents and supported them in a relaxed and friendly style. There was lots of positive communication between staff and residents. The relatives who spoke to us confirmed that there have been improvements within the staff team and that staff morale is a lot higher than in the past. They said that staff seem more positive about working at the Home and that they are able to spend more time with residents. They also said that communication between staff and relatives has improved. Regular staff meetings have started to take place. These are mostly divided in to the different groups of staff but the Manager said that there will also be joint team meetings. The minutes that we saw for the different meetings show that the same issues and plans for improvement are being discussed with all staff groups. A selection of recruitment files were seen during our visit and these all contained the necessary checks that were undertaken prior to staff starting to work at the Home. One of the staff told us that they are receiving an effective induction period which includes shadowing more experienced staff. The training matrix provided by the organisation shows that staff receive mandatory training and that additional training is now being provided with regard to specific needs of residents. In the last six months the staff team have received training about working with people with dementia. This includes working with people with challenging behaviours, epilepsy, and mental capacity act. The nurses are encouraged to attend relevant workshops and training sessions with regard to their nursing knowledge and skills. Not all staff have received all of the necessary training yet but further dates are planned. Oak Manor Nursing Home DS0000066644.V371337.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, 36 & 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There has been little effective, consistent management at the Home this year but recent changes to the management team has made improvements. The residents are now benefiting from the leadership and management at the Home. The health and safety of the residents and staff is taken seriously and action is taken to ensure they are kept safe. Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Home has had four managers since the beginning of this year. At the time of the last Key Inspection and Random Inspection there was a temporary manager who works as a peripatetic manager for the organisation. The current Manager was appointed as a permanent manager in June 2008. The organisation has also employed a consultant, with experience in working with people with dementia, to work as part of the Homes management team to ensure the necessary improvements were made. The consultant is due to leave the Home the week after our visit. The current Manager has appropriate skills and experience to manage the Home and has previously been registered with the Commission as a Manager. She said that she will start the application process to become the Registered Manager at this Home as soon as she has received her Criminal Records Bureau disclosure application form. At the Random Inspection it was found that that the requirements from the Key Inspection had not been met and that little action had been taken by the organisation to address the problems. The Responsible Individual of the organisation, the Manager and other staff from the organisation were invited to meet with the Inspector and the Regulatory Manager in July 2008 to discuss this. This report contains many examples of the improvements that have been made within the last two months. Relatives meetings take place and the Manager plans to have residents meetings. The staff try to obtain the residents views about a range of issues affecting their lives. Further work with regard to communication will assist with this process. The organisation has a system in place for reviewing the quality of the service provided but in the past this has not identified the issues that have been highlighted through Inspections of the service. New weighing scales have been purchased so that the residents weight can be monitored. Staff said that there are enough hoists to meet the needs of the residents. A look at a selection of records show that regular servicing takes place for the hoists and other moving and handling equipment as well as the fire safety equipment. We saw the gas safety check certificate and this included a list of action that needed to be taken. The maintenance staff member said that this work has been done. Staff said that they now receive good support and formal supervisions, either from one of the nurses or from the new Manager. Records of supervision are kept. Staff and relatives said that the new Manager is approachable and that she has good communication skills. Oak Manor Nursing Home DS0000066644.V371337.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 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 2 X 3 Oak Manor Nursing Home DS0000066644.V371337.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 to ensure that staff have accurate guidance about how to meet individuals needs It is required that the bedroom carpets which are marked and stained are replaced It is required that all staff receive appropriate training to carry out their roles effectively. It is required that an effective system of quality assurance is in place which takes into account the views of the residents Timescale for action 31/10/08 2. 3. 4. OP26 OP30 OP33 23 18 (c) 24 30/11/08 31/12/08 31/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Oak Manor Nursing Home DS0000066644.V371337.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection 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.V371337.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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