Inspection on 18/05/05 for Oak Tree House

This inspection was carried out on 18th May 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 01/05/07

Oak Tree House 31/05/06

Oak Tree House 30/11/05

Oak Tree House 19/10/04

Oak Tree House 17/06/04

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Ravensworth Lodge

Snydale Care Home

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Hawkhills

Beeches The - North Yorkshire County Council

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Carentan House

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

CARE HOMES FOR OLDER PEOPLE Oak Tree House Oak Tree Estate Station Road Preston, East Yorkshire HU12 8UX Lead Inspector Lynne Busby Unannounced 18 May 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 J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Oak Tree House Address Oak Tree Estate Station Road Preston East Yorkshire Hu12 8UX 01482 899169 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) Mrs Pamela Joy Cawkwell PWC Care Limited Mrs Pamela Joy Cawkwell Care Home 23 Category(ies) of OP Old Age (23) registration, with number of places Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 19/10/04 Brief Description of the Service: Oak Tree House is a private residential home. It is situated in the village of Preston within easy access of local facilities and being close to the city of Hull. It is located a short distance from the main road where public transport may be accessed. The home is registered for 23 people over the age of 65 years of either sex. The home presently has 17 permanent service users, one accommodated on a respite basis and two attend for day care. There are bedrooms on the ground and first floor with a stair lift for those service users who are less mobile. There are four shared rooms and fourteen single rooms, seven have ensuite facilities. The home has two lounges and a separate dining room all located on the ground floor. To the rear of the premises is a small car parking area and a garden area that is accessible to service users. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was completed as part of the programme of inspections for the year. It was an unannounced inspection undertaken by Lynne Busby. The inspection day lasted from 9.00 am to 5.30 pm with a previous 2 hours of preparation also being completed. The inspection process included a review of documentation kept by the home and a tour of the building. During the inspection a number of service users were spoken with, and approximately four of these were engaged in longer conversations. The inspector spoke to three staff members, the provider/manager and visiting relatives and a health professional. What the service does well: What has improved since the last inspection? What they could do better: The recruitment and selection of staff must improve to ensure the safety of the service users. The redecoration and programme of replacing furnishings should continue to provide service users with a safe, comfortable and well-maintained home. Water temperatures need to be tested to ensure that there is no risk of scalding, and bed rails should only be provided for service users following a risk assessment. All radiators must be guarded or have a low temperature surfaces. The doors must not be held open by unauthorised means. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 6 All records relating to service users should be signed and dated. Care plans should be drawn up with the involvement of the service users. 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 J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2 and 3 Although a statement of terms and conditions is provided and service users are fully assessed they cannot make a fully informed choice until the statement of purpose and service user guide is improved. EVIDENCE: There is a statement of purpose and service users guide available for service users and their representatives. There have been no improvements since the last inspection. The statement of purpose needs to include the number, relevant qualifications and experience of staff working in the care home, and the size of rooms. There is a service user guide this requires further development to meet the standard 1.2. The provider manager informed the inspector that the home has also developed a website, which will have any information for families and friends who cannot get to the home regularly. Service users are provided with a statement of terms and conditions when moving into the home. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 9 Service users are admitted to the home following a community care assessment or the home’s assessment of needs. A plan of care is generated from these. The home’s assessment covers all the areas identified in the standard and the provider/manager will visit service users in hospital or at home to complete the assessment were necessary. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 10 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 and 10 Service users health, personal and social care needs are fully met and they are treated with respect. EVIDENCE: The inspector tracked three service user files and plans of care had been generated from the community care assessment or the home’s assessment of needs. Keyworkers review the care plans on a monthly basis and in addition the keyworker meets with a senior staff member to discuss changes to the plan of care. Records are held on the strengths and needs of service users. All records were not consistently signed and dated. Service users are involved in the drawing up of the plan. However, the plan needs to be agreed and signed by the service user whenever capable and /or their representative (if any). Service users health care needs are monitored. Health professional visits are recorded and the district nurse visits regularly. Advice is given on the prevention of pressure sores and the promotion of continence. The home monitor the service users psychological health and community psychiatric nurses are involved when required. Service users have access to chiropody, dental and optical services. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 11 The home has updated policies and procedures on medication since the last inspection and these now includes a risk management framework for selfmedication service users. The home does not presently have anyone who self medicates. The medications are provided by a local pharmacist and the home use a NOMAD system. Controlled drugs are stored and recorded correctly. There is no dedicated fridge for storing medications. Staff are attending updated training on medications. Service users are able to open their own mail were this is not possible this is given to the family members. All service users have access to a telephone. It was noted that some service users have their own telephone. The staff were observed using the service users’ preferred form of address and this is recorded on individual service users files. Staff were observed knocking on service users doors and this was confirmed in discussion with service users. The provider /manager informed the community staff nurse and the inspector that the home had received a complaint about the storage of equipment used by health professionals which was stored in a shared room. This is now to be stored in individual service users rooms that require this service. In discussion with the provider/manager the inspector was informed that generally medical treatment and examination is completed in service users own rooms. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 12 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) 13 and 14 Service users can maintain contact with family and friends and can exercise choice and control over their lives. EVIDENCE: Service users can see family and friends in private. Relatives advised the inspector that there are no restrictions on visiting and they are always made to feel welcome. There is involvement by local community groups the staff informed the inspector that the Women’s Institute visit occasionally. The home enables staff as far as is practical, personal choice and autonomy. The provider manager informed the inspector that information on advocacy services is given to service users and their representative and this information will be included in the service user guide. The inspector noted that service users could bring in personal possessions into the home. Service users are encouraged to handle their financial affairs as long as possible. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 13 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 Service users and their relatives know how to complain and are listened to. Service users are protected from abuse. EVIDENCE: The home has a complaints procedure available for service users and their representatives. The home has had one recent complaint, which the provider/manager dealt with regarding a range of issues on personal care, health care and using the storage for other service users health equipment. There was evidence of investigation and outcome and this has now been resolved. In discussion with service users they knew how to complain. The visitors to the home were also aware of how to make a complaint and stated “ I would do so if I had any concerns”. The home has a Hull and East Riding Protection of Vulnerable Adults procedure. The provider/manager has developed in house procedures on protection of vulnerable adults and whistle blowing. Staff have not attended any training on protection of vulnerable adults but demonstrated an understanding of the policy on protecting service users. There are policies and procedures on service users’ money and financial affairs. This requires further development. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 14 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) 22,24,25 and 26 The home offers a ‘homely’ environment. Whilst improvements have been made there are still some outstanding concerns that may put service users at risk. EVIDENCE: The home has been assessed by a suitably qualified person and a report was completed. Service users have access to all parts of the building via a stair lift. The home has a range of aids and adaptations including grab rails, hoists assisted baths and toilets. The inspector noted that in a number of service users room’s bedsides were in use but these had not been risk assessed. There is a call system provided that was checked by the inspector and was answered promptly. The service users informed the inspector that if they use the call system it is answered quickly. Two service users rooms that are not presently occupied are being redecorated and furnished including new carpets. In the tour of the home the inspector Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 15 noted that two other rooms require new carpets. It was also noted that a number of wall lights that are positioned over the bed did not work. Service users are provided with a lockable storage for valuables, money and medication. The rooms are centrally heated and naturally ventilated. Not all windows on the first floor have window restrictors. Those that do not must be risk assessed. Since the previous inspection the radiators have been guarded with the exception of two, one is the dining room and the provider/manager advised that this is to be removed. The second is in a service users bedroom and is very close to the bed. This radiator needs to be guarded or have a low temperature surface. The water temperature was tested in two bedroom washbasins and found to be in excess of 50C. This was identified at the last inspection. The provider /manager had evidence that this will be completed in the near future. The home should record regular checks on water temperature to prevent risk of scalding. The main communal areas are clean and hygienic, however, one of the bedrooms had a malodour. The laundry includes equipment, which will wash at appropriate temperatures for infection control. The laundry is to be redecorated and have a new floor that will be impermeable. There are policies and procedures on infection control and staff are provided with protective clothing. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 16 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 homes recruitment practices do not fully protect service users. Staff undertake regular and appropriate training. EVIDENCE: The home has a staff rota available for inspection this indicated that there are four staff on duty in the morning, three in the evening and two waking night staff. The home also has a cook and a domestic. The provider/manager is hoping to employ a staff member to be responsible for the laundry. The deputy manager recently left and the inspector was informed that this post would be replaced. The home presently has one vacancy; interviews had been arranged for this post. The staff have had a variety of training since the previous inspection which includes basic food hygiene, moving and handling, infection control, fire awareness and have commenced on the safe handling of medicines course. There is induction training in place for new staff this needs to be to TOPSS specifications. Staff should receive foundation training within the first six months of appointment. Six staff have completed NVQ level 2 other staff will be starting when funding is available. The inspector checked three staff files and found that all had completed CRB checks. One staff file had no references, however, this staff member had been in post for a number of years. The most recent staff member had only one written reference and no health declaration on file. This was identified at the last inspection. All staff receive a statement of terms and conditions. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 17 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) 31,33,36.37,38 The health safety and welfare of service users and staff are not fully promoted and protected although staff are supervised and trained in safe working practices. EVIDENCE: The registered manager is also the provider and has 26 years experience as a nurse. She undertakes training with staff to update her skills and knowledge and is in the process of completing NVQ Level 4 in management. The staff have supervision and six monthly reviews and this was confirmed in discussions with the staff. The home has developed an in house quality assurance system and has been awarded Parts 1 and 2 of the East Riding social Services Department Quality Development Scheme. The development plan for the home and published results of the surveys is required to be sent to CSCI. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 18 The records for service users were not always signed and dated and some recording was completed in pencil. Individual records are held securely. Maintenance records were in place for portable appliance testing, electrical installations with the exception of an updated gas certificate. There are risk assessments for the safe working practices and fire. However, these all require reviewing. It was noted during the inspection that a number of doors were opened by unauthorised means. An immediate requirement was issued. The premises are secure, the front door is always locked the keys are held near the fire point. It is recommended that the fire officer be consulted regarding this practice. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 19 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 1 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION x x x 3 x 3 1 1 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 x 1 x x 3 1 1 Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 20 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. Standard 1 Regulation 4,5 Requirement The registered provider must ensure that the statement of purpose and service users guide includes all information required by the regulation.(Previous requirement- timescale 1/08/04)-not met). The registered provider must ensure that the plan is drawn up with the involvement of the service user; agreed and signed by the service user or their representative.(Previous requirement-timescale 1/08/04not met). The registered provider must ensure the homes policies and procedures and practices regarding service users money and financial affairs covers all areas identified in the standard. (Previous requirement -timescale 1/02/05 - not met). The registered provider must ensure that all radiators are guarded or have low temperature surfaces. The registered provider must ensure that risk assessments are in place to test water temperatures in washbasins. Timescale for action 31/07/05 2. 7 15 Schedule 3 30/06/05 3. 18 16,20 31/07/05 4. 25 16,23 18/06/05 5. 25 13(3)(4) (a)(c) 18/06/05 Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 21 6. 26 13,16 7. 29 18 8. 33 24(a)(b) (2)(3) 9. 37 17 10. 11. 12. 38 38 38 16 23 12,13,16 Where required, pre-set valves which have fail safe devices and are fitted locally are regularly maintained to provide water close to 43C. The registered provider must ensure laundry floor finishes are impermeable and these finishes are readily cleanable.(Previous requirementtimescale 1/03/05- not met). The registered provider must ensure the recruitment and employment policies and practice comply with the standard. All records in Schedule 2 of the Care Homes Regulations 2001 must be in place for staff. (Previous requirement -timescale 31/01/04- not met). The registered provider must ensure that an annual development plan for the home, based on systematic cycle of planning. The results of surveys must be punblished and made available to service users and representatives and the Commission for Social Care Inspection. The registered provider must ensure all records are dated. (Previous requirement timescale 1/01/05 - not met). A copy of the updated gas certificate to be forwarded to CSCI. The practice of holding doors open by unauthorised means must cease. Risk assessments must be updated. Risk assessments must be in place for any bedrails used by service users and these must be checked for safety on a regular basis. 30/09/05 30/06/05 30/09/05 30/09/05 30/06/05 Immediate Requireme nt issued 30/06/05 13. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 22 14. 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 28 31 Good Practice Recommendations 50 of the staff should be trained to NVQ level 2 or eqivalent by the end of 2005. The registered manager should be trained to NVQ level 4 in management or equivalent by the end of 2005. Oak Tree House J53_s47696_Oak Tree House_v226843_180505_Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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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