CARE HOMES FOR OLDER PEOPLE
Oak tree Lodge 12 Jesmond Road Clevedon North Somerset BS21 7RZ Lead Inspector
Catherine Hill Unannounced 27 June 2005 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 Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Oak Tree Lodge Address 12 Jesmond Road Clevedon North Somerset BS21 7RZ 01275 873171 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) Oaktree (Clevedon) Ltd To Be Arranged Personal Care Home Only 34 Category(ies) of Old Age - (34) registration, with number of places Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24 November 2004 Brief Description of the Service: Oak Tree Lodge is set on a hill in a residential area close to local amenities and the town centre. It provides residential care for up to 34 elderly residents in a homely environment. Plenty of in-house activities and entertainment are provided as well as regular local outings for which there is no charge. The home emphasizes the importance of staff and families getting to know each other well so that residents can be offered the best possible service. The home is on four floors and there is a passenger lift to all levels. Thirty of the bedrooms are single, eleven of them have an en suite bathroom and seven have an en suite toilet. Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over the late morning and lunchtime. The inspector spoke with seven of the residents and a visitor, each of whom made very positive comments about the quality of service at the home and about its friendly atmosphere. One of the newer residents said Ive exchanged one family for another. As well as getting service users views of the home, this inspection focused on various issues to do with the management of the home. Since the new owners took over, there has not been a registered manager, despite several people having been appointed to manage the home. The Responsible Individual, Mrs June Keating, is very involved in the day-to-day running of the home and has been ensuring that legal requirements and good practice standards are being met. Observations and residents comments showed that the homes consultative ethos remains very strong. The inspector also looked at a number of records that need to be kept in the home. What the service does well: What has improved since the last inspection?
Record-keeping was the subject of a number of requirements from earlier inspections, but the new owners have worked really hard on developing and maintaining an effective system for keeping essential written information. The schedule of staff training has improved, and records of training are also much more informative. Almost all the staff have now attended a college
Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 6 induction training course, and new staff are automatically being sent on this training. Care plans were only briefly sampled, but those seen showed that the depth of information being kept on residents needs has greatly improved. Their plans are giving much clearer guidance to staff on exactly what is required to meet each persons needs. Residents confidential records are now being kept securely so that only those people who need to know have access to them. The home s Statement of Purpose has been reviewed and brought up-to-date. Records of residents belongings and of any cash handled on their behalf by the home are now being kept. (These were not checked today that will be checked at the next inspection.) The fire officer was consulted about safe ways of holding open fire doors, so that they are still able to shut if the fire alarms sound. Several bedroom doors have now been fitted with safe hold-open devices. What they could do better: 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 Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 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 Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 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 Prospective residents are given enough information to make an informed choice about moving into the home. EVIDENCE: June Keating has been revising the Statement of Purpose and Service Users Guide, ensuring that they cover all the relevant issues and give clear information. A record of the fees paid is now being kept on site. New contracts have been issued in respect of each resident since the new owners took over the home. Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 9 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 & 10 Care plans now provide much more information on how residents needs should be met by staff. EVIDENCE: A new format is now in use for recording residents care plans, and these are being reviewed every month. Residents gave examples of the ways that staff preserve their privacy and dignity when giving them support with personal care. Residents said they are given as much independence as they want, and can retain responsibility for many of their personal care tasks. Staff will do their shopping for them or take them shopping if they prefer. The initial care plan also includes an inventory of the belongings that the person brings with them when they move into the home. The owner confirmed that records are also now being maintained of any valuables and money being held by the home on residents behalf. Small safes have been bought and offered to residents so that they can keep valuables locked up in their rooms if they wish. Residents confidential records are now kept in a locked filing cabinet within a locked office.
Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 The home s routines and services are organised around individual residents preferred lifestyles. Residents have a good degree of choice and control, and are well supported to continue their previous relationships. EVIDENCE: The inspector spent time with seven of the residents, talking to some of them in depth about their experiences of living at the home. It was evident from peoples comments that they have excellent relationships with the staff, and a great deal of confidence in them. One of the newer residents said Ive exchanged one family for another. Residents said that staff are very good at letting them know what is happening, and about involving them in decision making. The inspector saw examples of staff negotiating solutions with residents when a particular problem arose. This was done in a manner that promoted the residents control. When the inspector asked a resident if she could talk to the staff about anything that troubled her, she replied the staff are friends ... I trust any of them with my life. Residents also said June Keating makes a point of staying in touch with them as individuals, coming to talk to them about what is happening in the home and to ask for their thoughts. Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 11 Although the home always did offer a good range of regular activities, the home has not rested on its laurels but has made even greater improvements to this aspect of residents daily lives. Residents described an unusually good range of interesting activities and events. One person said theres always something. A Pub Club has started, and a garden fete is being planned. The weekly newsletter that was started just before the last inspection has gone from strength to strength, and residents are finding it very useful for keeping in touch with what is going on in the home, as well as entertainment in its own right. A poetry club has been started, with different residents contributing a verse each, and the final poem being published in the next newsletter. Menus for the week ahead are also published here. A copy of the newsletter is now also sent to those relatives who have requested it. Residents were generally very positive about the quality of meals and the new menus. Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 12 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) These standards were not assessed at this inspection. EVIDENCE: Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-26 Residents benefit from a pleasant and comfortable environment. EVIDENCE: The home is on four floors, the lowest of which houses the kitchen, laundry and offices as well as a couple of bedrooms. There is a passenger lift. The home is decorated and furnished to a standard that creates a comfortable and homely ambience. The new owners are continuing the programme of redecoration and refurbishment to further improve the environment. More bedrooms have been redecorated and recarpeted since the last inspection. The home has some attractive and unusual original features still in place. There is a very large lounge and two smaller dining rooms on the first floor. There are two communal toilets and two communal bathrooms on each floor. Eleven bedrooms have an en suite bathroom and seven have an en suite toilet. Several bathrooms and toilets were fitted with new suites and redecorated over the past year. Thirty of the bedrooms are single and two are double. Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 14 The new owners are fitting additional window restrictors and radiator covers, and are having hot water and boiler temperatures checked to ensure they comply with Health and Safety legislation. As on all visits, all areas of the home smelled pleasant and were cleaned to a high standard. Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 15 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 & 30 Residents benefit from high levels of well-trained staff. EVIDENCE: Staffing levels exceed the minimum requirements. New files for staff have been set up ready for information to be transferred. These will make information on recruitment, training and supervision much easier to access. All staff have had induction training at a local college, with the exception of one person. A plan of training needs is now in place for each staff member, with a note of the dates that training has been completed. The inspector suggested that a note is also kept of the duration of each course, so that the manager can monitor that each person is getting the required amount of training each year. A training plan has been drawn up for the whole staff team, based on the individual assessed training needs. The staff file sampled showed three training sessions in recent months, with a fourth planned for the near future. A format has been drawn up for recording individual staff supervision sessions. Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 16 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, 36-38 Although a registered manager is still not in place, the home is being wellmanaged and has an open culture. EVIDENCE: An application to register the acting manager has been submitted to the CSCI. A senior member of staff has delegated responsibility for managing care practice within the home, under the supervision of the acting manager. June Keating, the representative of the company that is registered as owner, is also very involved with the running of the home on a day-to-day basis. The fire procedures have been reviewed, and copies in larger print have been placed in each of the residents bedrooms. The Fire Officer came to look at fire doors and fire exits to give advice. Magnetic hold open devices are fitted on some doors already, and the inspector suggested that the home asks the Fire Officer for advice on ways of keeping other fire doors open safely.
Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 17 Mrs Keating is the process of reviewing all policies and procedures, ensuring that they are written with residents interests in mind, and that they are accessible to staff. Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 4 3 x x 3 3 3 Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 19 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Oak tree Lodge D53-D02 S61676 Oak Tree Lodge V222996 20.06.05 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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