Inspection on 13/06/05 for Oak Tree House

This inspection was carried out on 13th June 2005.

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

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

Other inspections for this house

Oak Tree House 24/09/08

Oak Tree House 09/10/07

Oak Tree House 27/04/07

Oak Tree House 27/04/06

Oak Tree House 24/11/05

Oak Tree House 04/01/05

Oak Tree House 14/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Oak Tree House Lark Rise Brimsham Park Yate South Glos BS37 7PG Lead Inspector Grace Agu Announced 13 & 14 June 2005 09:30 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 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 Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Oak Tree House Address Lark Rise Brimsham Park Yate South Glos BS37 7PG 01454 324141 01454 324151 Laudcare Ltd (subsidiary of Four Seasons Healthcare Ltd Mrs Daisy Jean Finlay Matthews Care Home with Nursing for Older People 80 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of OP Old age for 80 registration, with number of places Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 80 persons aged 50 years and over who are receiving nursing care Of the total 80 persons, up to 10 persons (who must be 65 years or over) may be accommodated and provided with personal care. Manager must be a RN on parts 1 or 12 of the NMC register. The staffing notice dated 19/8/1999 applies. Date of last inspection 4th January 2005 Unannounced Brief Description of the Service: Oaktree House is a purpose built home, operated by Four Seasons Health Care . Mrs Janet Brown is the new Home manager awaiting registration. The home is situated in a residential location, within a quiet cul-de-sac and is accessible to local shops, amenities and bus routes. The property provides bedroom and communal accommodation over two floors for 80 residents. Bedroom accommodation is provided in good-sized single rooms with en-suite facilities. There is level access throughout the home and all areas of the home are accessible via the passenger lift.There are nine communal areas throughout the home, including an activities room. There are a suitable number of bathrooms and toilets with adaptations to meet the care needs of residents in the home. Appropriate equipment is provided for individual use based on assessed identified needs. All rooms have a call alarm system.The home is set in its own grounds with a garden and patio area to the back of the house. Car parking is available for several cars. Visitors are welcome to the home at any time. The home employs two activities organisers who make efforts to provide activities during the week. Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over sixteen hours and was undertaken to review the requirements made at the last inspection, to review the care practice to ensure it is in line with the legislation and that best practice is followed at the home, also in response to the issues raised on the comments card. This inspection was also undertaken in relation to a phone call received from a concerned relative about his/her mother’s care and an incident that occurred in the home which she felt was not reported. Before this inspection two complaints were received by the Commission with regard to poor care given to a resident before being transferred to hospital where he died, and another resident who suffered dehydration and pressure sores and was also transferred to hospital. The first complaint was fully investigated by the commission and all the issues raised except one were upheld. The second complaint may be investigated by the Commission if the complainant is not satisfied with the outcome of the investigation by the provider. The inspectors undertook a tour of the building and viewed a number of records. Eight residents, four staff members and four visitors were spoken with on both days of the inspection. What the service does well: Residents spoken with made positive comments about the staff. One resident felt that the staff are good, “they treat me well”. Another resident stated that “staff are very good and kind”. The environment is well maintained, tidy and with good décor giving the residents a sense of homeliness and security. All trained nurses working at the home had their Personal Identification Numbers (PIN) checked by the Nursing and Midwifery Council before commencement of employment to ensure residents are protected. Two satisfactory references and Criminal Records Bureau clearance are obtained before a new staff member commences employment to ensure Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 6 residents are adequately protected. Aids and equipment are provided in sufficient quantity to assist care staff in meeting the needs of service users. What has improved since the last inspection? What they could do better: At the last inspection, the home was given eighteen requirements and one recommendation. Five of those requirements have been met, one of the requirements had been made at the last three inspections and have not been met. The present Manager is one month in post and has completed an application form to be the Registered Manager. The Manager is required to ensure that the concerns set out below are addressed. These concerns include: To ensure that fire doors are shut at all times in order to protect the residents in event of fire out-break; to ensure that all accidents are recorded and investigated and actions taken to protect residents from abuse and to ensure that all staff are made aware of their responsibility in relation to residents’ dignity and privacy. The home would be a better environment for residents to live in and staff who support them to work in if all areas of the house are kept clean and free from offensive odours. In addition to the above all staff must be trained in relation to confidentiality of information about residents and to attend fire drills for adequate protection of residents. Residents would be better protected if medication is dispensed from named residents packets and if all unwanted medications are returned to the pharmacy. Also to include that staff and resident’s would be better protected if the fire safety instruction to staff was provided at the frequency recommended by the fire authority. Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 7 In order to ensure resident’s view/wishes are listened to and acted upon, it is required that an effective method of Quality Assurance is developed. The inspector suggested an initial step may be initiating residents meetings The residents would be better protected if the have access to their call bells in order that staff can respond promptly to residents needs. Residents dietary requirements would be met if fruits and vegetables are included in their diet and that appropriate supplies of food are available for residents. Residents would be better protected if risks are identified and minimised. Residents would benefit if the home provide an in-depth activities programme is provided and a record kept of individual resident participation Residents and families would benefit if the home’s complaints procedure is reviewed to include evidence of satisfaction. Visits must be carried out at the home in relation to monitoring of the quality of the services provided at the home. Residents would benefit from a cleaner environment if carpets are kept clean. Residents would be better protected if the Commission for Social Care Inspection is notified of all serious accidents at the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 and 5. The process of admissions of prospective residents is well planned to enable the resident to make a choice of moving to the home with the assurance that their needs will be met. However, the home fails to provide them with the Terms and Conditions of their stay. EVIDENCE: Two newly admitted residents’ files were viewed and both contained an admissions assessment which is completed by the Manager on a preassessment visit either in hospital or at the prospective service user’s home. One of the resident’s relatives spoken with stated that the Manager visited the resident at the hospital before admission. The staff nurse spoken with stated that no resident is admitted to the home without assessment to ensure that his/her needs would be met. The two care files had care plans in place informing staff of how the assessed needs were to be met. No Statement of Terms and Conditions were noted on both the care files, however, the Manager produced a standard letter from Four Seasons which is sent to the prospective service user or representative before admission. The letter contained information about the fees to be paid, what it covers and information about the Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 10 nursing care. This letter has no information in relation to meeting the needs of the residents. The Manager is required to confirm in writing that the home is able to meet the needs of the residents before admission to the home. The home has a Statement of Purpose and a Service Users Guide. One service user’s relative spoken with stated that she/he was aware of the one month trial period to enable the resident to make a choice regarding staying at the home. Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 The home offers support to service users throughout their lives and towards the end, however, it fails to protect service users from injuries through its care practices. EVIDENCE: Seven care records were reviewed. Each care file had detailed admission assessments of the needs of the residents. Specific care plans were completed for each area of identified need. The care plan contained holistic information about the residents and were regularly reviewed. One care file of a resident with leg ulcers contained a record of on-going wound assessment and visit by the Tissue Viability Nurse for advice and plan to be followed including the type of wound dressing to be used. There was evidence of general risk assessments, pressure sore risk assessment, nutritional risk assessment and moving and handling risk assessment. All these were regularly reviewed. Records relating to one service user with Dementia who sustained injury on the abdomen and thigh was viewed. The file record on the daily sheet stated that Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 12 a large red area was noted on the abdomen on 4th June 2005 but was not hot to touch. It was observed on the 5th June 2005 that a large blister had formed on the abdomen and right thigh. There was no evidence of recording how the resident sustained the injuries. The Manager was unsure of how the injury was sustained. The information on the care file stated that the resident is to be supervised at meal times. The Manager stated that it may have been caused by a hot cup of tea being given to the resident unsupervised. There was evidence of Doctors visits and subsequent antibiotic Interventions. The Manager was advised to report the incident to the South Gloucestershire Adult Protection team for full investigation. A strategy meeting was held at Oak Tree Nursing Home on 22nd June 2005 after full investigation by the South Gloucestershire Social Services Adult Protection Team. Present at the meeting were the Commission for Social Care Inspection, the Home Manager of Oak Tree House Nursing Home and the South Gloucestershire Social Services. At the meeting it was concluded that there was no abuse involved but that the injuries were caused by an accidental spillage of hot tea on the resident. The Home Manager is required to ensure that staff are given clear guidance on how the service user’s needs are being met. Another service user’s care file reviewed showed evidence of wandering into other resident’s rooms and at risk of falling. One service users raised concern about this on the resident’s comment card. The Manager stated that she is aware and that the care plan had been regularly reviewed. There was entry in the care file of wandering upstairs on 26th May 2005, there was no risk assessment in place for a possible fall from the stairs. The Manager is required to ensure that the health and welfare of all service users are protected, furthermore, that there is a risk assessment in place to prevent serious injuries to a service user. One service user’s relative raised concerns about his/her mother’s care, she/he stated that the care plan drawn up by Social Services was not being followed and that his/her mother was not being encouraged to drink and that there were always cups of cold tea left on the table in front of his/her mum when she/he visited. There was evidence of this on the second day of inspection. The inspector advised the relative to discuss these concerns with the new Manager. Another person commented on the care of his/her relative. She/he stated that on two occasions the relative was soaking wet and the room had an offensive odour due to the catheter bag not being closed properly by staff. He/she stated that she would discuss this concern with the new Manager. Other comments made by other relatives were in regard to personal care. One service user’s relative stated that she/he was satisfied with the care of his/her relative. She/he stated that staff are very good and respect the privacy of his/her relative. Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 13 There was evidence in the care files that staff liaise with other health professionals to ensure that the health needs of the service users are being met. The home has a medication policy. Two service users on self-medication had self administrations form completed and signed. There was also a GP consent form and risk assessment, however, there was no evidence of recording the medication when the medication was brought into the home. The staff nurse spoken with stated that the resident manages him/her self. The home is required to ensure that all medication brought into the home is recorded. Medication on each floor was inspected. It was noted that unwanted medication was in the downstairs cupboard and had not been returned to the pharmacy. It was also noted that staff were dispensing a medication from one service user’s box to all other service users. The staff nurse stated that this was due to lack of space in the medicine trolley. It was also noted that staff dispensed Omeprazole from one resident’s pack to another resident. An immediate requirement notice was made to stop this practice. There was no clear explanation why this had occurred. An over stock of Omeprazole for one resident was noted on the downstairs stock cupboard and an over stock of liquid medications. It was agreed that new stock is not obtained until the present stock is exhausted. The controlled drugs were stored correctly and balance was noted to be correct. Staff spoken with demonstrated knowledge of confidentiality of information about residents, however, one service user’s relative contacted the Commission to raise concern about a service user who received an injury from a hot cup of tea. The service user’s relative stated on the day of inspection that she/he was given this information by her/his sister. The home Manager is required to ensure that all staff are trained to be aware of the importance of keeping all information about residents confidential. The Home has a Death and Dying Policy procedure. Two staff were noted going into a service users room without knocking at the door. One service user stated that staff gave her respect. Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The Home enables residents to maintain contact with family, friends and the Community, however, it fails to provide meaningful activities and choice in respect of meals and meal times. EVIDENCE: Service users spoken with stated that staff supported them to maintain contact with their friends and families. One service user stated that his/her sons visited regularly, another service user stated that her/his son visited daily. Staff spoken with stated that visitors are not restricted from coming into the Home. The home’s visitor’s book evidenced that there are a number of regular visitors to the home. Service users or their families are given a social profile to complete on admission to enable staff to provide activities to the residents according to their likes, dislikes and capabilities. The Home employs two Activities Organisers on a full time basis five days a week. The activities organiser stated that the residents don’t always participate in the activities because they prefer to stay in their rooms. A group of residents were noted playing skittles on the top floor on the day of inspection. There was evidence of weekly organised activities for all residents and details of monthly organised activities Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 15 for June were provided, however, it was not clear who had participated. It was agreed that the Home record should provide a more in-depth information at the activities programme and record evidence of individual participation. Some service users spoken with stated that they would prefer to stay in their rooms. One service user’s relative stated “there is no mental stimulation here”. It was disappointing to note that the planned trip to Almondsbury Garden Centre was cancelled due to inspection and was rebooked for September. Weekly activities recorded included mobile shop, board games, hymn service nail manicure and Bingo. One of the residents told the inspector that they make decisions about areas that affect them; this enables them to have control over their life and make choices. Service users spoken with stated that they had a choice of when to get up and when to retire. One service user stated that he got up when he wanted and retired at 10.30pm. The Home’s menu was viewed and it contained nutritious meals and a choice of two cooked meals at Lunchtime and choice of sandwiches or warm savoury alternative at Teatime. Lunch was observed on the day of the inspection and a number of the residents were spoken with; comments made were that the food was good and that daily alternatives to the main menu are offered, one resident commented that they like to eat a healthy diet and the home has sought to accommodate this, however for four days consistently there were no yogurts for dessert, another resident told the inspector that one day there was no milk, three residents told the inspector that there is a lot of processed or frozen vegetables, this was the case on the day of the inspection. When the manager was questioned about this her answer was that the home is required to use one supplier for their provisions, it is recommended that the home seek to improve their food ordering in order that residents do not go without basic food. On the second day of inspection, some residents commented on the meal at Lunchtime. One resident stated that tinned vegetables or frozen vegetables were always on the menu. Service users spoken with stated that they enjoyed the meal. Often service users who were unable to feed themselves were supported and fed by staff in a sensitive manner. One service user stated that she/he does not like the food, “meat is too tough”. The service user stated the there was no choice of drinks at nighttime, however, the Chef stated that there was always a choice of hot drinks. The Manager stated that the menu was shown to the residents the day before in order to make a choice of meal for the following day. The kitchen was found to be clean, the fridge and freezer temperatures were regularly recorded and a cleaning schedule was in place. The freezer had a Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 16 good stock of frozen food to include vegetables. The Chef stated that the Home uses more frozen vegetables than fresh vegetables due to company budgeting. The Chef is currently undertaking NVQ in Catering and hospitality. He has attended food hygiene, First Aid and Manual Handling. The kitchen assistant had also attended a food hygiene course, however, the kitchen assistant had not attended COSHH training. There was no evidence of risk assessments in the kitchen. An Environmental Officer visited the Home on the day of inspection and would make his report available to CSCI when completed. The Home administrator acts as appointee to the residents. The administrator stated that residents monies are put together in one bank account and small amounts are kept at the home for residents’ use. Residents meetings are not held at the home and a quality assurance audit had not taken place at the home for some time, therefore there was little evidence to show that resident’s view are listened to or acted upon by the manager. Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Residents are enabled to complain but are not confident that their concerns will be listened to or that they would be protected from abuse. EVIDENCE: The Home has a complaints policy and procedure. The document contained information about the Commission for Social Care Inspection to enable residents’ families and friends to complain if unsatisfied with the outcome of their complaint. Information on how to make a complaint was seen on display in a communal area of the home. The home has in place an Adult Protection policy and also a copy of South Gloucestershire’s Protection of Vulnerable Adults Policy. Two complaints were received by CSCI. One in the past three months in relation to poor practice. One was fully investigated by the Commission and all except one concern was upheld. The second complaint is to be investigated after a response is received from the Provider. At the visit one complaint was noted in the Complaints Record, there was evidence of correspondence from the previous Manager to the complainant but there was no indication of whether the complainant was satisfied with the outcome of the investigation. One relative stated that he made a complaint to the previous Home Manager but was not satisfied with the way the complaint was dealt with. Another relative stated that she/he made a complaint to the previous Home Manager in relation to his/her mother’s care but was not Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 18 satisfied with the outcome of the complaint. She/he would make another representation to the new Manager in relation to poor practice. The Home has a Protection of Vulnerable Adults Policy in place including the South Gloucestershire Policy and Procedure to safeguard residents from abuse. However, there was a lack of documentary evidence of how a resident sustained an injury on her/his abdomen and thigh. Staff members spoken with demonstrated awareness of adult abuse issues. Two staff members spoken with stated that they had not attended abuse training. A number of residents were noted without easy access to their call bells to summon for help in an emergency. Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20,2122,23,24,25,26. The Home has a safe, well maintained environment, comfortable bedrooms and specialist equipment suitable for service users needs, however it fails to always provide a clean environment for residents. EVIDENCE: The Home is purpose built and provides good accommodation for the residents. The residents were found to be relaxed in their homely environment. There have been no changes in the services and facilities provided at the home since the previous inspection. The location and layout of the home is suitable for its intended purpose. The home is a large detached building with accommodation set over two floors with lift access to the first floor, The inspector did a tour of the home and viewed lounge and dining areas, bathrooms and activities room and fifteen bedrooms. The home is well maintained however and at the time of the inspection, not all areas were odour free. The tour of the premises found that all communal areas of the home were Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 20 clean, tidy and odour free, however one of the lounge carpets and a carpet in an individuals bedroom had staining to them which require cleaning, if these are unable to be removed the carpets must be replaced. At the visit, several bedrooms were noted to have unpleasant smells. A requirement was made to get rid of the unpleasant smell. The carpets in two residents rooms had stains and need to be replaced or deep cleaned. The home has an array of comfortable spaces for shared use, residents were seen relaxing and making use of these areas. All bedrooms viewed had en-suite facilities, were personalised and colour coordinated. Each bedroom had small items such as pictures, photographs and other personal items to remind them of past memories. The garden to the rear of the home is well laid out with a patio and plenty of seating. The toilets and bathrooms have hand and grab rails and manual handling equipment to assist with the mobility of service users. The communal areas were noted to be well furnished and attractively decorated and meet the needs of the current service users. Service users spoken with stated that they liked their rooms. One service user stated that she/he felt safe at the home. The laundry was noted to be clean with good flooring and ventilation. The washing machines at the Laundry has a sluicing programme to ensure that a good infection control is maintained. The Home has Control of Substances Hazardous to Health Policy. The laundry assistant met on the day stated she had attended first training, Manual Handling, achieved NVQ 1 in cleaning but had not attended abuse training and infection control. Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 21 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. The recruitment procedure of the Home is robust and offers protection to residents at the Home. There are adequate number of staff who are competent to meet the needs of residents. EVIDENCE: On the first day of inspection, there were three trained nurses 8am – 2pm; two trained nurses 2pm –8am and two trained nurses 8pm –8am. Also, there were twelve care assistants from 8am–2pm; ten care assistants from 2pm – 8pm and five care assistants from 8pm – 8am. This met the minimum requirement that had been set by the Health Authority staffing notice before the inception of the Commission for Social Care Inspection. The Home has a robust recruitment procedure to ensure that suitable staff are recruited to meet service users needs. The record of one recently recruited staff member contained required information to include personal details, previous employment details, two satisfactory references, Criminal Record Bureau (CRB) disclosure and relevant qualifications. Registered nurses working at the home had satisfactory checks from the Nursing and Midwifery Council (NMC). The Manager stated that induction takes up to six weeks to complete and ensures that staff are competent to work independently with residents. Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 22 All staff spoken with stated that they attended various training courses to include Basic Food Hygiene, Manual Handling, Fire Safety, Abuse Training and First Aid. Two staff members spoken with stated that they have not attended Abuse Training but have had information in relation to Abuse Training. The Home is required to ensure that all staff attend training in relation to their roles to protect the residents. Staff records viewed evidenced that some staff have attended training in relation to their roles to protect the residents. Staff records viewed evidenced that staff have attended these courses. Residents spoken with stated that staff are very “kind and caring” but some times are busy and sometimes it takes a long time to answer the bells. One relative stated that it took a long time to answer the bell on one occasion when he was at the home. The new home manager Janet Brown stated that she would address such concerns once she is settled in post. The Manager is to commence the Registered Managers Award course soon. Three care staff have completed NVQ 2, two commenced NVQ 2 in Autumn. It is not clear if the Home would achieve 50 NVQ 2 of its care staff by 2005. Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35,34 36, 37 and 38. Whilst it is intended that the home should be managed in the best interests of residents and that staff supervision is a part of this process, its practices fail to protect the health and safety of residents. EVIDENCE: Janet Brown is newly appointed as Manager. She had been in post for one month at the time of inspection. Janet Brown is to commence Registered Manager Award course soon. Service users spoken with stated that she is a “good person”. Two staff members spoken with stated that the “Manager is trying her best” and is “trying to improve the care”. One relative stated that he/she hopes that things will improve. Another relative stated that she/he would approach Janet with the concerns she/he has and hopes that the issues would be resolved. Staff spoken with stated that they receive regular supervision to enable them to perform their duties effectively and deal with any areas that need Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 24 improvement. Staff stated that supervision enables them to review their care practices to ensure that residents receive good care. An anonymous letter was received from the Home in relation to management of the home, complaining of the Manager and another senior member of staff. It is difficult to verify the issues raised in the letter because the Manager is new in the post. Some of the issues were shared with the Manager who stated that she would address them. The issues raised in this letter will be reviewed at the next inspection. Individual service users records were securely locked at the Home along with other service users information. The administrator of the Home acts as the appointee to service users. The Home administrator stated that the Home has one bank account for all the residents’ monies. Residents have individual accounts on the computer, also recorded. Money is provided for residents if they need to buy any items. The administration keeps small amounts of money at the Home. The balance of money at the Home corresponded with the record. The system of monitoring the quality of care in the home need to reflect the views of the residents are being listened and are being acted upon. There is evidence of regular care plan reviews, however, the regular monthly visit by the Provider to monitor its services had not been completed for the months of April and May. The Home’s maintenance book was in order. All fire alarm system checks including fire alarms, call bell systems, smoke detectors and emergency lighting were in date. However, several bedrooms doors were wedged open, a fire door on the ground floor linen room was propped open for two consecutive days despite discussions with the Home Manager on the first day of inspection. An immediate requirement was issued to close the door to protect residents in the event of fire outbreak. The fire logbook and staff training records evidenced that staff have not received sufficient training instruction. Strategies to overcome this were discussed with the management. Staff must receive appropriate instruction in order that they are competent to deal with fire emergencies and evacuation. Records examined showed that staff had not attended regular fire drills. The Manager is required to ensure that all staff attend fire drills in order to familiarise themselves of emergency procedures The accident record was viewed and resident’s accidents were recorded, however, one service user accident on 4th June 2005 in relation to spillage of hot cup of tea on the abdomen and thigh of a resident was not recorded. There are polices and procedures in place to include, Abuse, Complaints, Confidentiality Training and Medications. Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 3 3 2 3 3 3 3 2 Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 26 YES Are there any outstanding requirements from the last inspection? 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. 2. 3. 4. Standard 38 26 38 10 Regulation 23 16 17 4 Requirement Ensure Fire doors are kept shut keep home free from offensive odour Ensure accidents are recorded Ensure staff are aware of their responsibility and work in a way that respects the dignity of residents Residents to have access to call bells The home to ensure that all accidents are fully investigated Staff to be aware of confidentiality Carpets identified during inspection to be cleaned Ensure residents are protected from harm or abuse Ensure all unwanted medication are returned to the pharmarcy and that medication are not dispensed from one residents packet to another. Ensure all staff attend fire drills and fire safety instructions Ensure monthly visits are are carried out to minitor the quality of service provided Home must notify CSCI of all serious accidents to the service D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Timescale for action 14/6/05 14/6/05 15/7/05 15/7/05 5. 6. 7. 8. 9. 10. 18 18 18 26 18 9 12 12 12 16 13 23 14/6/05 14/6/05 15/7/05 22/6/05 14/6/05 24/6/05 11. 12. 13. 38 33 38 23 26 37 24/6/05 24/6/05 14/6/05 Oak Tree House Version 1.30 Page 27 user 14. 15. 16. 17. 18. 19. 20. 12 15 16 8 2 4 8 16 16 22 12 5 14 13 Ensure that suitable activities is organised for the residents. Ensure that appropriate supplies of food is available to the residents Ensure that complaints are thoroughly investigated and actioned Ensure that staff respect the privact of residents Ensure that Terms and Conditons of their stay are issued to residents. Confirm in to residents that the home is able to meet their needs Ensure that a resident is risk assessed to prevent falls. 15/7/05 14/6/05 22/7/05 22/8/05 22/8/05 22/8/05 22/7/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Oak Tree House D56 D05 S20252 Oak Tree House V223626 13140605 Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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