Inspection on 24/09/08 for Oak Tree House

This inspection was carried out on 24th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 13/06/05

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 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oak Tree House Lark Rise Brimsham Park Yate South Glos BS37 7PJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Grace Agu     Date: 2 4 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Oak Tree House Brimsham Park Lark Rise Yate South Glos BS37 7PJ 01454324141 01454324151 oaktree@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) care home 80 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Manager must be a RN on parts 1 or 12 of the NMC register. 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. The staffing notice dated 19/8/1999 applies. Date of last inspection Brief description of the care home Oak Tree House is a purpose built home, operated by Four Seasons Health Care. Mrs Janet Miller is the registered Home manager. 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 Care Homes for Older People Page 4 of 34 Over 65 80 0 Brief description of the care home 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. The fees range from £380-£575 per week depending on individual needs. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit conducted as a part of a key inspection ten hours to review the requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. In addition we also followed up concerns we received from relatives about general care of residents at the home. As a part of this inspection survey forms had been sent to the home for residents or relatives to complete giving their views of what the home do well and areas they could improve upon. These were also surveys for visiting health care professionals. We used Care Homes for Older People Page 6 of 34 the information on these to determine how the home is meeting the needs of the people living at the home. I met with Angela Tanner, the deputy manager and the administrator. Whilst touring the building we spoke with nineteen residents, seven staff and four relatives and a number of records were viewed. What the care home does well: What has improved since the last inspection? What they could do better: To ensure that service users, need are adequately met, care plans must be developed after assessment and in agreement with the individual concerned in a way that the individual feels that they are being listened to and confident that the home is able to meet their needs. Whilst staff have received training on dementia and related areas it would be better if the training were updated to ensure that they have the skills and knowledge to provide care for service users with behaviour that challenges. Furthermore it was concerning to note that seven residents have different grades of pressure sores and we are led to believe from discussing with staff and reviewing the records that staff have not received training on tissue viability to enable the to recognise the causes of pressure sore and to prevent its onset. Staff members would be enabled to perform the duties effectively if regular formal documented supervision is provided. The home must ensure that the Commission for Social Care is be informed of any serious injury to any resident in accordance with the regulation. To enable us to determine how the people living in the home are being treated and how staff felt about their roles and responsibilities we spoke to residents staff and relatives. Comments we received from these sources led us to believe that the home must review the staffing mix in line with the dependency to ensure that residents needs are appropriately met. Care Homes for Older People Page 8 of 34 The home must review the activities programme with the residents to ensure that activities are tailored to meet individual capabilities and choices and in particular for residents who choose to stay in their rooms. It could be better if risk assessments are reviewed after accidents to residents to prevent/minimise further falls. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission assessment of prospective residents are undertaken to ensure that the home is able to meet the needs before moving into the home. Evidence: We looked at five care files at this visit including a recently admitted resident. Each care file contained pre-assessment information in relation to activities of daily living, social activities, likes and dislikes, medical history and medication. In some cases the home obtained information from other professionals to enable the home to make a decision about its suitability to meet the residents need. The above information is evaluated and care plans are provided on how the assessed needs are to be met. The care file reviewed contained information detailing the terms and conditions of stay at the Home. Care Homes for Older People Page 11 of 34 Evidence: The home stated in the Annual Quality Assurance Assessment (AQAA) that the information on its website is regularly updated to promote informed choice, welcoming and inviting reception, detailed tour of the home with no appointment needed. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers support to residents throughout their lives and towards the end, it also protects residents by reviewing their health needs, however it fails to protect the identified residents through lack of documented involvement in their care planning and appropriate risk assessment following a fall. Drug administration practice is satisfactory. Evidence: Five care records were reviewed at this visit and each care file contained detailed admission assessment of the needs of the resident. All care files contained care plan information on how staff are to meet the physical and psychological needs of the resident and are regularly evaluated and reviewed on a monthly basis. Whilst we acknowledge that people living in the home are provided with care plans in relation to their assessed needs, we noted from the records and direct observation on the day that the home was finding it difficult to manage one individual with challenging Care Homes for Older People Page 13 of 34 Evidence: behaviour and various medical conditions. This person had various episodes of agitation and discomfort recorded and had been referred to a specialist health professional in November 2007 in order to assist the person and offer appropriate strategies to support staff in meeting this persons needs. The manager stated that she would contact the health professionals involve to visit and review this persons progress. We noted that the care plan in place regarding this condition had not explore the reasons for agitation and discomfort and there is no recorded evidence to suggest that the individual had been involved in the development of the care plans viewed or their relatives. There are caring staff that try to make the people who live in the homes life as comfortable as possible. The documentation did not reflect this attitude and the care plans focused on physical disabilities and problems. Some staff members spoken with confirmed informally that they found it difficult sometimes to communicate with the individual and that it could be frustrating. We discussed this with the deputy manager and it was agreed that the care plan must be put in place that reflects the feeling and frustrations of the individual for adequate protection and comfort. Other care files had care plans, which were satisfactory however not person centred. For example we received information from one relative who commented that attention to detail in their relatives care is missing such as making sure fingernails are kept short and clean. It is important and commendable to note that the home has an active Infection Control Policy and staff were noted disposing of aprons and gloves after attending to residents and washing their hands after attending to every resident. Residents spoken with confirmed that staff treated them with respect and knocked at the door and waited for an answer before entering to attend to their personal hygiene needs. One service user spoken with said the staff have treated me very well and I am happy. It is as if I was one of their relatives. We noted on the care file that there were risk assessments, pressure sore risk assessment manual handling risk assessments, nutritional risk assessment and weight monitoring records. These were regularly reviewed. Appropriate equipments were in Care Homes for Older People Page 14 of 34 Evidence: place for example pressure relieving equipment were needed. There was evidence that wound care plans were in place along with treatment required for managing wounds. However it was concerning to note that seven residents have different grades of pressure sores. The deputy Manager Angela Tanner stated that some of the pressure sores were noted on admission to the home. The home is reviewing the care plans and looking into ways of reducing the incidents. We also noted that one individual had a fall on 21/09/08 and sustained bruises to the face cheek and neck. Whilst there was risk assessment to prevent this person from falls, this risk assessment had not been reviewed to include other measures in order to prevent further falls. This was discussed this with the deputy manager and it was agreed that this must be put in place to protect the resident. A reviewed copy of this document was received at the Commission on 29/09/08 and was found satisfactory. Medication administration was reviewed on the first floor and was noted satisfactory. All medication seen was stored securely. Medicines trolleys are used to transport medication around the unit. Each unit has a medicine fridge and temperatures are recorded daily. There was medicine a policy in place. Evidence of receipt and disposal of medication was seen. The controlled drugs were properly recorded and signed by two registered nurses and balances tallied. The home has a policy and procedure in the event of death of a resident. Terminally ill residents are cared for in a dignified manner. Residents, representatives are able to stay with the individual if required. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables residents to maintain contact with family and friends and ensures choice in respect of meals. However it fails to provide the residents with meaningful activities and appropriate stimulation based on individual preferences and capabilities. Evidence: Discussions with residents and staff and entries in the visitors book showed that the home actively supports the residents to maintain contact with families and representatives. Visitors consulted during the inspection confirmed that they were always made welcome. During the visit relatives and friends were noted visiting the home. One relative spoken with stated stated that the staff are welcoming and that they are satisfied with the care provided for their person. One comment card from a relative stated, My relative is very happy in the home and staff communicate with us both well about every aspect of her medical and general care Staff are friendly and quite welcoming. Another relative stated On behalf of my relative may I say that since the stroke in may when my relative was admitted to Oak Care Homes for Older People Page 16 of 34 Evidence: Tree Care Home I have all their need are met. My relative has dementia as well and at times can be hard work a. I visit the home three times a week and think they are doing fantastic job. Staff are excellent and the carers are great. I cannot speak highly enough. On admission residents and their families are asked to complete a detailed social profile. This provides staff with information about the individuals likes and dislikes. The care records reviewed contained completed copies of this profile. Residents spoken during the inspection confirmed that they were able to choose how to organise their day. For example one of the thirteen residents met in the dining room on the upper floor states, I sometimes go out with the activities lady but I would like to go out on trips. On another occasion the inspector met and sat with one resident in one of the lounges on the ground floor. This person was in a distressing mood sitting on their own with no activities to stimulate them. The resident told the inspector that this is how they spent their time sometimes. The home employs two activities organisers one on each floor whose responsibilities are to provide appropriate activities based on individual capabilities. There was no evidence to suggest that this is the case. One of the activities people told the inspector that several of the current residents enjoy regular visits to the nearby public house. However the home is unable to take residents out on trips due to lack of funds The individual told us that several residents participate in group activities and that these were recorded in individual care files. Evidence from the care files seen suggest that the activities undertaken by residents include Ludo, Bingo, Dominos Scrabble, Sing Along Skittles and Mobile shop. Whilst the activities organisers encourage the residents to participate in activities and record the names of those that participated it was not clear how some of the residents with challenging behaviour were being engaged. For example the response from the activities person about providing individualised activities especially for challenging residents on the ground floor was dismissive (the resident is always shouting) and this led the inspector to believe that more needs to be done to promote active participation in order to relieve boredom. Using the information gathered about peoples lives before they came into the care home may enhance the programme offered, particularly for those residents who Care Homes for Older People Page 17 of 34 Evidence: cannot communicate verbally. The home stated in the Annual Quality Assurance Assessment that each resident has a social activity form indicating previous hobbies/ activities in order to continue maintaining their quality of life. This form was seen some of the care files reviewed. However it was unclear if care staff and the Activities Organisers have the necessary skills to put this into practice as the activities person state we have do not know how to work with people with this condition. We have not received any training. Several entries noticed on one residents progress note states on 25/07/08 Shouting and calling out to change his/her pad, 3/08/08 shouting till 2am 6/08/08 shouting till 3am 21/08/08 shouting until midnight. This entry clearly shows that care has not been taken to find out the reason for this behaviour and develop strategies on how staff might engage the individual to relieve possible boredom and make the individual more comfortable. The home must review the activities provided to encourage active participation of all residents based on individual assessment. A requirement notice has been issued to address this short fall. The home operates a 4 weekly menu, devised by Four Seasons Health Care. The meals provided are varied and nutritionally balanced. This menu is displayed in the home on the ground floor The menu on the day contained a choice of two nutritional meals at lunchtime. Residents interviewed stated that they enjoyed the food. The inspector observed part of the lunchtime meal upstairs. It was seen that residents were brought to the dining room for some time before the meal arrived. No menu was displayed. However some of the residents knew what was on the menu and what they were having for lunch. Residents are able to choose to take their meals in their own room, or in one of the two communal dining rooms. The tables were laid with tablecloths and fresh cold drinks were offered to all residents. Those residents who needed to be helped with their meal had one to one assistance at their pace. Teaspoons were being used with a pureed meal making it a more dignified experience The residents consulted during the inspection said that the food was good and tasty. They felt that the standard of food provided had improved since the appointment of a new cook. The chef stated that there is a risk assessment for the kitchen kept in the folder for Care Homes for Older People Page 18 of 34 Evidence: kitchen staff to access when necessary. The fridge and freezer temperatures were up to date and the foods in the fridge were labelled. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are enabled to complain and are confident that their complaint will be listened to. Practices at the Home ensure protection of residents from harm and abuse. Evidence: The Home has appropriate procedures in place for management of complaints. The complaints procedure was noted displayed at the entrance of the home. This document contains information about the Commission for Social Care Inspection to enable individuals to contact the Commission if they were not satisfied with the outcome of their complaint to the organisation. There were five recorded complaints since the last inspection. These complaints were in relation to care provided to individuals living at the home. For example one complaint was in relation to a recent scalding accident on a residents skin. The organisation is investigating the complaint/incident and would forward the out come of the investigation to the Commission for Social Care inspection. Another complaint was made directly to the Commission in relation to general care of an individual by their relative this was referred to the Four Seasons Health Care and the response received indicate that the home had made changes to the persons care Care Homes for Older People Page 20 of 34 Evidence: plans and care of the individual was observed to be satisfactory on the day of the visit. This complaint was not recorded at the home, however the deputy manager assured the inspector that it would be recorded as soon as possible. Records indicate that the appropriate procedure was followed for the rest of the complaints and were satisfactorily responded to. The home is waiting to receive confirmation that the complainants are satisfied with the outcome of their complaints after investigation. Staff are aware of the Whistle Blowing policy and would report any bad practices to the Manager without fear of reprisal. There is evidence of staff training in relation to Protection of Vulnerable Adults from Abuse. Records of recently employed staff members were viewed and contained personal information and record of identity. There was evidence of statutory information to include two satisfactory references, record of previous employment, and satisfactory Criminal Record Bureau disclosures to ensure that service users are adequately protected. The home checks the personal identification numbers of all qualified nurses with the Nursing and Midwifery Council (NMC) before employment and periodically. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a safe and well -maintainedenvironment, comfortable bedrooms and specialist equipment suitable for residents needs, however cleanliness of the home need to be given a priority. Evidence: Oak Tree House is a purpose built home, operated by Four Seasons Health Care. 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 ensuite 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 Care Homes for Older People Page 22 of 34 Evidence: parking is available for several cars. Residents were found to be relaxed in the lounges and some in their bedrooms. It was pleasing to note that several rooms have been redecorated and some parts of the building have been refurbished. For example the dining room flooring on the ground floor has been replaced as well as upstairs carpets and corridors. Whilst touring the building, we found the home generally clean, warm, well lit and free from unpleasant odours and suitable for its stated purpose. However the domestics expressed their concern about the general cleanliness of the home due to the number of domestics at the home. Staff told us that on several occasions and especially on weekends the home had only one cleaner. One individual states, on one occasion I worked for eight day in a row and out of the eight I was on my own for four days and I know I was unable to do the job properly and it worries me. Furthermore, one of the surveys returned to the Commission that was completed by a relative on behalf of a person living at Oak Tree states I dust the room but my relative pays enough for all aspects of care. Housekeeping is not up to standard I am not fussy but clean floors and dust free surfaces are essential. Smelly rooms and corridors are not acceptable. A requirement notice has been issued to the home to review the numbers of housekeeping staff in line with the size of the home to maintain acceptable cleanliness of the home. The Deputy manager stated that the home had interviewed two people to work as domestics and is awaiting statutory clearance in relation to Criminal Record Bureau disclosure and references before commencement of employment. The laundry area was found clean with good flooring and hand washing facilities. Staff aware of infection control measures and would ensure that soiled linen are separated from normal laundry before washing to prevent cross infection. The washing machines also have sluicing and disinfection programmes. The home has Control of substances Hazardous to Health (COSHH) policy. The staff member met in the laundry stated that she had received COSHH training and infection control to enable them to carry out their duties effectively and to protect the residents. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst residents are supported and protected by the homes recruitment policy and procedures, staffing levels were not meeting the levels of dependency in the home. Staff training is not meeting specific needs of individual residents. Evidence: We looked at the staffing notice put in place by Four Seasons Health Care the provider for Oaktree Nursing Home based on 65 residents at the home on the day of the visit. The staffing notice indicates that there should be 17 staff including the trained nurses between 8am and 2pm and 13 staff including trained nurses between 2pm and 8pm, 7 staff at night including trained nurses between 8pm and 8am. The number of residents on the day of visit was 65 and the staffing levels were cotrrect. However a random review of the rota on saturday 23/08/08 and Sunday 24/08/08 showed that the home had one care staff less between 8am and 2pm and 2pm and 8pm and 8pm and 8am on both days based on 65 residents and their dependency level. The deputy manager told the inspector that this was due to sickness and that the Care Homes for Older People Page 24 of 34 Evidence: home was unable to replace staff on those two days and that working with one staff less during the day was putting pressure on the care staff and that the needs of the residents are not satisfactorly met due to high dependency level of current residents. Another example was observation made during lunch time. A very dependent individual on a recliner chair was left unattended in the lounge on the ground floor in a distressing mood. The inspector sat with the individual for a few minutes before going to look for staff to attend to this person. Staff stated that the resident responds to one to one attention but they havent enough staff to give the person individual attention all the time. In addition record show that there were high incidents of accident to residents and high level of pressure sore at the home. Furthermore we received a complaint from two relative regarding the level of care provided to their relatives at the home. We believe that urgent review of the staffing level is required to ensure that the needs of the residents. We had discussion with the staff, residents and relatives and the general comment was mostly of inadequate numbers of staffing on duty especially on weekends. For example staff told us that they find it difficult to meet the residents needs and they are unable to spend quality time with the residents due to heavy workload and less staff. The deputy manager stated that she is aware that the home has high dependency residents and would be discussing staffing levels with the Regional manager with the view to increasing the numbers to ensure that residents needs are met. We have issued a requirement for urgent review of the staffing level at the home to meet the needs of the present category of the residents at the home. Residents spoken with told that staff were very kind and caring but some times are busy and it cold take up 10 minutes to answer the bells. We spoke with one relative at the home who told us that they were satisfied with their relatives care and that staff were always polite and welcoming any time they visited. In relation to staff training evidence from staff training record indicate that staff have attended training courses to include, Manual Handling, Fire Safety, Protection of Vulnerable Adults from Abuse, Nutrition, Dementia. In addition the home stated in the Annual Quality Assurance Assessment that 15 Care Homes for Older People Page 25 of 34 Evidence: carers have either completed or are near completion of National Vocational Qualification (NVQ) at level 2 and that one carer had successfully completed NVQ level 3 since the last inspection. This was not reviewed at this inspection. The AQAA also told us that the home plans to send two staff members to attend Tissue Viability Training courses and update training for all staff on maintaining residents dignity and respect. We have previously discussed the importance of ensuring that staff attend training on challenging behaviour to enable staff to support the residents at the home with challenging needs. We have issued a requirement and this would be followed up to ensure compliance in order to protect the individuals living in the home. Staff recruitment had been discussed under Standard 18. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home lacks leadership and direction to ensure residents receive quality consistent care. Some health and safety practices fail to protect the residents. Evidence: Four Seasons Health Care notified the Commission on 21/08/08 that the home had no manager due to sickness however, in the mean time that the deputy manager would be covering the home with support from the regional manager and the manager from a nearby sister home also owned by Four Seasons. On the day of this visit we met with Angela Tanner the deputy manager who assisted with this inspection in a professional manner. Angela confirmed that she is the acting Manager and had received support from the organisation to enable her to run the home effectively. Angela contacted the regional manager on two occasions during the inspection for matters that needed clarification. Care Homes for Older People Page 27 of 34 Evidence: Whilst staff told us that there is low morale amongst staff at the home due to lack of communication from the organisation in relation to employment matters and staffing levels staff were seen interacting with the residents in a friendly and respectful manner. Staff were seen carrying out their job with enthusiasm without any reflection to the general mood at the home. Staff told us that they were not being listened to and that no staff meeting had taken place for quite a while to enable them to put their views across about matters of concern in relation to residents wellbeing. Staff stated that the deputy manager is good however the home lacks leadership and direction at this present time. The regional manager had recently contacted the Commission to confirm that the manager had resigned and that one of the experienced managers from another home had accepted the appointment to manage Oak Tree Care Home. 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 administrator keeps small amounts of money at the Home. Secure facilities are provided in the office for the safekeeping of money and valuables. 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 regional manager contacted the Commission few days after the visit to confirm that the visits were undertaken but the home manager had not forwarded it to the Commission. The fire logbook was found to be up to date and well maintained and there was evidence that staff have attended regular fire drills. The home has a fire risk assessment to ensure that residents are adequately protected from fire accidents. Accidents were recorded and however we noted that risk assessments and care plans for one identified individual had not been reviewed to minimise further occurrence. We have received the reviewed risk assessment for this individual before this report was completed. We found it satisfactory. Statutory Notifications (Regulation 37) in relation to one serious incident had not been Care Homes for Older People Page 28 of 34 Evidence: received from the home at the Commission for Social Care Inspection at the time of occurrence. This individual had a fall out of bed on 21/09/08 and sustained bruises on the face neck and cheek. The deputy manager stated that the home would normally notify the Commission of any serious incidents/accidents but had not done so on this occasion. We have issued a requirement to ensure that this is not repeated. This document was received before this report was completed. In relation to health and safety measures, there was lift maintenance in June 08. Portable Appliance Testing was in May 08. The home has policies and procedures to include recruitment of staff, complaints, monies and valuables and Protection of Vulnerable Adults from Abuse. There was evidence, documentary that staff at the home receiving supervision however not regularly for example evidence from the records show that one staff had last supervision on 7/07/07. We believe that regular staff supervision plays a key role in ensuring that staff perform their duties effectively. The AQAA states that the home undertakes annual staff appraisal however the inspector was unable to verify this on this visit. Individual service users records were securely locked at the Home along with other service users information. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 7 15(1) Ensure that detailed and specific care plans are in place for residents. This requirement confirms the immediate requirements that were made at the time of the visit to the home. 30/11/2007 2 9 13 (2) Medicines must be safely 01/12/2007 administered this refers to: a) Making sure residents are always given medicines from their own labelled supply, and b) Making sure that staff follow the home?s selfmedication policy. All medicines must be stored 01/12/2007 securely at a safe temperature. This refers to the downstairs storage area. 3 9 13 (2) 4 27 18 (1) (1) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users? Ensure that at all times suitably qualified, competent 30/10/2007 Care Homes for Older People Page 30 of 34 and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. This requirement confirms the letter sent relating to staffing levels in the home. Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 15A Ensure that detailed care plan is in place for identified residents 24/11/2008 2 8 13 13 The home must ensure that risk assessments are reveiwed after accidents to residents to prevent /minimise falls 24/11/2008 3 12 16 16(2)(n) Develope a programme of activities in consultation with the residents to meet individual needs based on their capabilities 24/11/2008 4 26 23 23 The registetered manager must ensure that the home is clean at all times. 24/11/2008 5 27 18 18(1) The registered person shall, having regard to the size of 24/11/2008 Care Homes for Older People Page 32 of 34 the care home, the statement of purpose and the number and needs of service users. Ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users.This requirement relates to staffing levels in the home. 6 30 18 18 Ensure that staff receive training that meets specific needs of the residents. 7 36 18 18(2) The home must ensure that staff receive regular supervision to enable then to perform their duties effectively. 8 38 37 37 The registered person must ensure that the Commission for Social care is informed of serious injuries to residents. 24/11/2008 24/11/2008 24/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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