Inspection on 27/04/07 for Oak Tree House

This inspection was carried out on 27th April 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Oak Tree House 24/09/08

Oak Tree House 09/10/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Oak Tree House Lark Rise Brimsham Park Yate South Glos BS37 7PJ Lead Inspector Grace Agu Key Unannounced Inspection 27th April 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak Tree House Address Lark Rise Brimsham Park Yate South Glos BS37 7PJ 01454 324141 01454 324151 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.fshc.co.uk Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Janet Elizabeth Miller Care Home 80 Category(ies) of Old age, not falling within any other category registration, with number (80) of places Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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 27th April 2006 Brief Description of the Service: 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 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. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced site visit as part o a key inspection that was undertaken by two inspectors over nine 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. The inspection visit also followed up a Regulation 37 notification sent by the home following a lift break down. The inspectors reviewed the actions undertaken by the home and the provider to minimise the impact on the health and safety of the residents. Full report on this incident can be found in the body of the report under standard 19. At the last inspection seven requirements were made in regard to different areas of service provision to ensure that the residents are protected and that the quality of service provided is what they expect and deserve. It was pleasing to note that the home had made considerable effort to ensure that all but one requirement had been met. As a part of this inspection two immediate requirements were issued in relation to following up accidents/falls and ensuring that the care plans and risk assessments are reviewed in order minimise occurrences. In addition another requirement was issued for the kitchen to have a deep clean and that the cleanliness be maintained to promote infection control at the home. A satisfactory response on how the home addressed the immediate requirements and action plan on how to prevent it from happening again was received before this report was completed. A tour of the building was undertaken and a number of records were viewed. Fifteen residents, three staff members and three relatives were spoken with on the day. What the service does well: Generally the home was found clean, tidy and warm and free from unpleasant odour. Staff were working as a team and interacting with residents. The residents seen looked well cared for at the home. A comprehensive Service User’s Guide is given to the prospective resident to enable them to make an informed choice about moving to the home and Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 6 residents and relatives are informed on admission of a one month trial to enable the person to make a decision whether to stay at Oaktree Care home. A robust complaint procedure is in place and all complaints are investigated properly and action taken where required. To ensure that residents are adequately protected, ongoing training courses are provided for staff and appropriate recruitment procedures have been followed for recently employed individuals at the home. The home is adequately staffed to include care and domestic staff. Aids and equipment are provided in sufficient quantity to assist care staff in meeting the needs of residents. The home’s ability to manage the discomfort faced by the residents, the relatives and staff during a recent lift break down is commendable. Residents and relatives spoken with informed the inspectors that they were regularly updated on the action being taken to repair the lift. The manager throughout the process, regularly informed the Commission for Social Care Inspection in writing. What has improved since the last inspection? What they could do better: It was disappointing to find the kitchen very untidy and deeply unclean when the inspectors visited the area at different times of the day. An immediate requirement was made for the kitchen to be deep cleaned and cleanliness maintained to protect the residents, staff and visitors. Residents would be better protected if risk assessments and care plans are reviewed following residents’ accidents/falls. To ensure that residents are adequately protected, medication must be given as prescribed and any alteration made on the residents’ Medication Records Sheets must be signed and dated. 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. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 7 The people who use the service on the top floor have been living in an environment, which is of a lesser quality than those people who live downstairs. There are plans to redecorate and refurbish this floor but it was disappointing that this had taken so long to be organised. It was noted that there were no signs to aid orientation on that floor on bathroom and toilet doors, this would benefit those people who might be able to find those rooms independently if they could recognise the room. There are caring staff who try to make the people who live in the home’s life as comfortable as possible. The documentation did not reflect this attitude and the care plans focused on physical disabilities and problems. Focusing on each person’s abilities and preferences is crucial in the promotion of person centred care. Ensuring that a full biography is used with a social care assessment would help staff to try and keep people’s interests and hobbies. There was no evidence of the care plans being written in consultation with the residents themselves or if that was not possible with their relative. The activities organiser who works part time provides social activities. It was unclear if anything happens when they are not working and due to time constraints and the size of home there is the risk that some residents are not being offered sufficient things to do to interest them. During the inspection some staff were seen moving residents without telling them what they were going to do first, this practice is demeaning and should be checked by the senior staff in future. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are properly assessed before admission to the home are and assured that their needs would be fully met. EVIDENCE: All prospective residents and/or their families are encouraged to visit the home before admission and are informed of a one month trial to enable them to decide whether to stay. Two care files of recently admitted residents contained pre-admission assessments and care plans completed on how the assessed needs were to be met. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents needs are assessed before admission, and their right to privacy is respected. However, the home fails to protect the residents through lack of care plans and risk assessment reviews following accidents/falls and unsatisfactory drug administration practice. EVIDENCE: The inspector who was based on the top floor read five care plans as part of the case tracking process, this means that all records related to that person’s care are read and the inspector meets that person and will talk to staff about their care. The care plans were purely about the person’s physical needs and did not cover any aspects of personal or social care needs. (Nor any religious views). It was noticed that any remaining abilities the person may have were not mentioned to ensure staff continue to promote each person’s independence. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 11 There was no evidence of the plan being drawn up with the resident and/or their relatives. In some instances health problems read about in records such as Doctors notes were not recorded as a health problem, this included a diagnosis of depression with the prescribing of anti-depressants, and a condition requiring a hospital appointment. There are caring staff who try to make the people who live in the home’s life as comfortable as possible. The documentation did not reflect this attitude and the care plans focused on physical disabilities and problems. Information was received from one relative who commented that attention to detail in his/her relatives care is missing such as making sure fingernails are kept short and clean. The details to meet any needs were vague in some instances. Risk assessments were present and some gave useful information to reduce risks. Staff carry out very regular safety checks for those residents who are in bed and have bed rails. One resident who was at very high risk of falling had a member of staff with her/him to try and prevent this person falling. Despite these efforts this person had 5 falls in March 2007 which had not led to a review of the risk, and if the measures in place were working. The inspector spent some time with this resident, they were able to walk and the efforts of staff trying to prevent this person standing could have been better spent helping them to walk. Staff were seen to be physically holding this resident in the chair which could be viewed as restraining them. This is a difficult situation for staff as they try to balance their duty of care with that person’s human rights. This was discussed with the Manager and Deputy Manager. Efforts had been made to obtain a more suitable chair and to get advice from various professionals such as Physiotherapists. This so far had not been productive. An immediate requirement notice was issued by the inspector for the care plan and risk assessment for this resident’s safety to be reviewed to show evidence that the risks are reduced as much as possible. On the ground floor, care files viewed contained evidence of risk assessments manual handling assessments, nutritional risk assessments and weight monitoring records and care plans drawn up for individual physical and Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 12 personal care needs, to provide care staff with the information needed for supporting the residents. These were regularly reviewed The general view of this inspection is that there is a worrying difference in care provision between the two floors. This was discussed with the manager at feedback. The home must address this difference to ensure consistency in the care provided for all the residents. There was evidence of visits from other health professionals to include doctors, dentists, physiotherapists, and chiropodists. Out patient appointments are also organised. These visits are undertaken urgently or routinely in order to meet the residents needs. One comment card received from a relative states“ trained nurses are good at monitoring medical needs and will always contact General Practitioner (GP) surgery when necessary. The GP practices are excellent at responding.” Another comment card also states “from my point of view I feel safe in the knowledge that my mother, who is wheelchair bound is having her medical, personal care and hygiene and social care needs met in an atmosphere that is warm and friendly.” The home’s medication administration on the ground floor was reviewed, it was disappointing to note that a resident’s medication had had not been administered as instructed by the dispensing pharmacist and hand written changes made on the Medication Administration Record sheets (MARS) were not signed and dated. A requirement was made for the home to ensure that measures are in place to prevent further occurrence. Evidence of residents’ wishes in the event of death were noted in the care files viewed. There is a policy on death and dying at the home. Staff interviewed demonstrated knowledge of the importance of keeping information about residents confidential. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are enabled to maintain links with their families; they are also provided nutritious meals however the home fails to provide meaningful activities for the residents 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. One resident spoken with stated that their daughter visits every weekend Staff said that the home had no restrictions and families’ visit whenever they like. One relative comment card states that they “visit their relative everyday staff are very good they understand my relative’s need and we are always well received by staff that are very hospitable” On the day of inspection residents were noted relaxing in the lounge and enjoying the company of each other, some residents were noted sitting in their Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 14 bedrooms, other residents were also observed being supported by staff to access different areas of the home without restriction. The manager stated in the pre-inspection questionnaire that the residents are provided with a range of activities to include painting, cake making, bingo, musical session, scrabble and card games and provides opportunities for the residents to visit places of interest. For example, the Horse World, the seaside and garden centres. The home employs two activities organisers whose responsibilities are to provide appropriate activities based on individual capabilities. Whilst touring the building the activities organiser based on the ground floor was met in one of the lounges with a group of six residents. The inspector was informed that they had just finished a sing-along session. 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 one resident met in the room stated “I sit in my room doing nothing all day”. On another occasion the inspector met and sat with some residents in one of the lounges on the ground floor sitting on their own with no activities to stimulate them. One of the residents told the inspector that this is how they spent their time sometimes. The response from the activities person about providing individualised activities especially for challenging residents on the ground floor was unfavourable (for example ‘the resident is always shouting’) and led the inspector to believe that more needs to be done to promote active participation in order to relieve boredom. One relatives’ comment card states “it would be nice if the carers could spend some time talking to the residents. I believe this is important as they spend hours alone”. The other inspector met with the activities organiser who works upstairs mostly. She works part time and says during her time at the home she tries to see as many residents as possible. Records seen confirmed that some residents experience different activities with the organiser. Some refuse to join in these organised sessions and this makes offering them meaningful activities difficult Access to information about people’s lives before they came into the care home may enhance the programme offered, particularly for those residents Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 15 who cannot communicate verbally. It was unclear if care staff try to offer this when the organiser is not working.” One entry (23/04/07) noticed on one resident’s progress note states “had a difficult time finding sleep so rang all night long asking for sleeping tablet/or just rang for nothing at all. By am got up and sat out. Had resorted to shouting and pulling the jack off (bell) or just ringing constantly. Tea offered and had been made comfortable but continues to buzz”. 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. This will be checked at the next inspection. 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. The tables were laid with tablecloths and fresh cold drinks were offered to all residents. Some tables had bowls of fresh fruit. 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. By the time the meal arrived some residents had been in the dining room for an hour. This information was passed to the Manager. The chef stated that there is a risk assessment for the kitchen kept in the folder for kitchen staff to access when necessary. The fridge and freezer temperatures were up to date and the foods in the fridge were labelled. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are enabled to complain and are confident that the home will protect them from harm and abuse. EVIDENCE: A review of the complaints book showed that three complaints were recorded since the last inspection about a previous staff member visiting a resident, using the residents lounge as a smoking lounge and unavailability of some food items over the Christmas period. The registered manager stated that these have been satisfactorily resolved. The homes complaints procedure was noted displayed at the entrance of the home. The home has policy and procedure on Protection of Vulnerable Adults from Abuse. There was evidence that staff have attended training on this to ensure that the residents are adequately protected A comment card received from a relative after the inspection showed concern about the relative’s manual handling procedure that may be the cause of bruises noted on the person’s arms and hands. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 17 The individual stated on the comment card that the manager was made aware of this concern. The manager was contacted and requested to provide an explanation and evidence to the Commission of how the home dealt with the concern. A satisfactory explanation was received from the home before this report was concluded. One staff member spoken with confirmed that they have attended the above training are aware of how to recognise and report incidences of abuse if they occurred. The home has policy on Whistle blowing to enable staff to report any bad practices without reprisal. The staff member stated, it doesn’t matter if is a friend or colleague I will report it”. A new member of staff’s file contained Criminal Record Bureau checks and two satisfactory references before commencing employment to ensure that service users are protected. The home checks the personal identification numbers of all qualified nurses with the Nursing and Midwifery Council (NMC) before employment and periodically. Residents are offered the opportunity to vote at elections using the postal voting system. Two residents met in the lounge had the voting cards on the table and one resident told the inspector that she would ask for assistance to post it when completed. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Generally the residents enjoy a comfortable and pleasant home; however, the home fails to provide them with safe, well-maintained environment and a clean kitchen. EVIDENCE: There have been no changes in the services provided at the home since the last inspection. The location and layout of the home remain suitable for it’s stated purpose. Residents were found to be relaxed in the lounges and some in their bedrooms. The home was found clean, tidy, warm and free from offensive odour. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 19 At the last inspection, a requirement was made in relation to changing the flooring in a resident’s bedroom to ensure that the resident enjoys the comfort of the individual’s room it was pleasing to note that this has been replaced. It was also pleasing to note that one of the toilets on the ground floor that was being used for storage of wheel chairs and manual handling equipment had been cleared to ensure that adequate toilet facilities are provided to meet residents needs. However the people who use the service on the top floor have been living in an environment, which is of a lesser quality than those people who live downstairs. There are plans to redecorate and refurbish this floor but it was disappointing that this had taken so long to be organised. It was noted that there were no signs to aid orientation on that floor on bathroom and toilet doors, this would benefit those people who might be able to find those rooms independently if they could recognise the room. A requirement notice has been made for the flooring to be refurbished sooner to provide a more comfortable environment for the residents on that floor. A further requirement was issued for the home to provide signs on the bathroom and toilet doors to aid orientation of more independent residents. The kitchen was not clean. Built up grease was noted in the work top drawers, under the kitchen sinks and the bases of the worktop. The kitchen floor was also noted to be very untidy. The chef on duty stated that there was a cleaning schedule, however, staff were not following the schedule. An immediate requirement notice was issued for the kitchen to be deep cleaned and to be kept clean in order to protect the residents at all times 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 manager stated that all staff including the house keeping staff have attended COSHH training and infection control to enable them to carry out their duties effectively and to protect the residents. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with sufficient numbers of staff to meet their needs. However the home fails to provide adequate training on upholding residents’ dignity and respect. EVIDENCE: The rota reviewed on the day confirmed that there were adequate numbers of staff on duty to meet the needs of the residents. Staff were noted knocking at the doors and waiting before entering the room to assist residents with personal care. House keeping staff were also noted working together as a team. One staff member spoken with stated that “ we work together as a team and we are committed to looking after the residents very well”. Evidence from the staff training records showed that staff have attended training on basic food hygiene, manual handling and Protection of Vulnerable Adults from Abuse. One staff spoken with confirmed that they have undertaken National Vocational Qualification (NVQ) at level 3. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 21 Registered nurses have also attended training updates to include care of a dementia suffer and care planning to enable them to provide appropriate care for the residents. Records of two recently appointed staff evidenced that appropriate recruitment procedures were followed as well as appropriate induction to enable the staff to familiarise themselves with needs of the residents and the home’s general routine before assisting them with personal care. Residents were very complimentary of staff and the home. One resident stated “ staff do everything for me, they are very good”. Another resident states “staff are very kind. They are doing there best for us.” One comment card from a relative states “not only the care staff give the agreed level of support they give it with kindness, patience and cheerfulness. Nothing is too much trouble”. Whilst the residents and the relatives were complimentary towards staff, one of the inspectors observed that the attitude of some staff towards one resident For example during the inspection visit some staff were seen moving residents without telling them what they were going to do first, this practice is demeaning and should be checked by the senior staff in future. A requirement has been made for staff to receive training update on the importance of upholding and maintaining residents’ dignity and respect. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is satisfactory Residents are protected through appropriate policies and procedures and staff supervision. EVIDENCE: Mrs Janet Miller is the current registered manager of Oaktree House. Mrs Miller has recently completed the Registered Managers Award to enable her to support the staff in providing good standards of care for the residents and to enable staff to identify any areas of concern that could affect their work with the residents. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 23 Staff spoken with stated that the manager is approachable and will listen to concerns raised. One resident stated that the manager is “approachable and comes round to see us”. One comment card received from a relative stated “my mother is well cared for and very happy at Oaktree House. She likes it here”. Documentation in relation to health and safety procedures were in date, the fire logbook evidenced that the last fire drill was on 18/01/07.The manager stated that the Periodic Inspection of the electrical installation safety certificate would be issued when the current work on the electrics is completed A new call bell had been installed with added features to include a link to the front door and four handsets carried by nursing and care staff that could be used in emergency. The inspectors reviewed the Regulation 37 Notification sent to the Commission about the lift breakdown at the home. On the day on this inspection the lift was still out of use, however the home drew up an action plan on what they would do to ensure health and safety of the residents whilst the lift was out of use. The inspectors noted that a stair lift has been temporarily installed to aid residents who are not able to manage the stairs. The lift was deactivated and blocked with warning signs that the lift was out of use. Other health and safety measures about the lift beak down were satisfactory. One resident’s relative confirmed that they were regularly informed in writing of new development about the lift. The inspectors were informed that the installation phase of the lift repair would commence on the 8 May 2007. Records evidenced that staff received regular supervision to ensure that they are supported in their responsibility of providing personalised care to the residents. In relation to Quality Assurance the manager stated that care plans are reviewed monthly and other departments produce monthly audits to the manager. The above information is collated and analysed to identify areas of improvement. The manager also stated that the home has an open door policy and residents, relatives, friends and other visitors approach the management at any time to talk about any issues, confidential or otherwise. Residents’ records and other confidential information were locked away. Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 1 X X X X 3 X 1 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 3 3 3 Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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. Standard OP7 OP7 Regulation 15(1) 12 (1) Requirement Ensure that care plans are in place for identified residents Develop person centred care plans that meet the residents needs Provide specific training on dignity and respect of residents for all staff. Furthermore provide manual handling update for all care staff. Ensure that medication is administered as prescribed and all hand written medication on the Medication Administration Record Sheet is signed and dated. Deep clean the kitchen and maintain cleanliness at all times Refurbish and redecorate upstairs flooring. Develop activities based on individual preferences and in consultation with the resident and/or their relatives Ensure that there are signs in the bathroom and toilet to DS0000020252.V334700.R01.S.doc Timescale for action 27/04/07 07/06/07 3. OP30 18 (1) (c) (1) 27/06/07 4 OP9 13 27/04/07 5 6 7 OP26 OP19 OP12 23(d) 23(b) 16(n) 27/04/07 27/07/07 27/06/07 8 OP19 23(n) 27/06/07 Oak Tree House Version 5.2 Page 26 9 OP10 12 (4)(a) orientate residents who could recognise them independently. Ensure that residents are treated in a dignified respectful and sensitive manner. 27/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oak Tree House DS0000020252.V334700.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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