Inspection on 04/04/05 for Oak Tree Manor

This inspection was carried out on 4th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Manor 04/02/09

Oak Tree Manor 10/07/07

Oak Tree Manor 05/04/06

Oak Tree Manor 07/11/05

Oak Tree Manor 25/11/04

Oak Tree Manor 02/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Oak Tree Manor Residential Home 2 Chene Drive, off Waverly Road St Albans AL3 5PH Lead Inspector Pat House Unannounced 04 April 2005 10:00 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 Manor Residential Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Oak Tree Manor Address 2 Chene Drive off Waverley Road St Albans Hertfordshire AL3 5PJ 01727 832393 01727 866653 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) Oak Care Limited Sue Stacey Care Home 80 Category(ies) of DE(E) Dementia over 65 - 80 registration, with number PD(E) Physical Disability over 65 - 80 of places OP Old Age - 80 Oak Tree Manor Residential Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 25 November 2004 Brief Description of the Service: Oak Tree Manor is a care home providing non-nursing services for up to eighty older people who may also have a physical disability, or dementia. The home is owned by Oak Care Ltd., is purpose built and is situated in a residential area in central St. Albans, near the City Hospital. The home has three floors and is served by a passenger lift. All the bedrooms are on the ground and first floor and all are for single occupancy and have en-suite facilities. Each of these residential floors has its own dining room, kitchenette, hairdressing room and lounges. The main kitchen and laundry are on the ground floor and the top floor provides living accommodation for staff. The home is sited at the end of a long drive and there is a large car park in front of the building. There are gardens to the rear of the building. The nearby city of St. Albans has good transport links and provides extensive shopping and leisure facilities. Oak Tree Manor Residential Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place over one day. Two inspectors were present and the bulk of the time in the home was spent talking to service users and staff. Recruitment files were also thoroughly examined and the care plans of service users spoken to were examined in detail. Some visitors were spoken to and care procedures and the environment in general were observed throughout the visit. There had been a complaint made directly to the CSCI, about the home, and this was investigated as part of the inspection. As a result of findings from the inspection, the complaint has not been upheld, but some suggestions have been made to the Manager, which should clarify some issues, and these are described below. What the service does well: What has improved since the last inspection? The staff have worked hard to improve the system for administering medication and in general the procedures were well documented and with no unexplained errors. Since the last inspection, a new Deputy Manager has been appointed and was present at the end of the inspection. A system whereby not all staff attended “hand-over” sessions between shifts, but were given information by others, has ceased. Staff spoken to said they now all attend hand-over sessions and felt they were better informed and able to work more effectively. Oak Tree Manor Residential Home Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oak Tree Manor Residential Home Version 1.10 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 Manor Residential Home Version 1.10 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) 3. All potential service users have detailed assessments completed by senior staff in the home, to ensure their individual needs can be met. (Standard 6 does not apply to this home). EVIDENCE: Service user records were examined during the inspection and all contained detailed assessments, completed when service users applied to enter the home. Some had summaries of individual needs from referring agencies, and in all cases checked, the home could clearly provide appropriate care for those individuals. Oak Tree Manor Residential Home Version 1.10 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, 8, 9, 10 and 11. Service user needs are detailed in individual care plans, enabling staff to be aware of the care required. Health care needs are being met, ensuring that service users live as comfortably as possible. Sound procedures for administering medication also add to the well-being of service users. Service users are happy that their dignity is being maintained in the home and the sensitive care provided by staff, at times of illness and death, enables individuals to remain in the home for as long as possible. EVIDENCE: Care plans were fully examined during the inspection, and contained detailed information and risk assessments. Reviews had been completed and there were details of health professionals’ visits and on-going health monitoring. At the time of the inspection, one service user had a pressure sore. This individual had been discharged from hospital with the sore, and details were seen of district nurse involvement for its treatment. Two service users had been referred to the local Falls Clinic and there were records of recent physiotherapy input to the home. The entries in the care plans accurately reflected the information given by service users who were spoken to. Oak Tree Manor Residential Home Version 1.10 Page 10 Service users also confirmed that visits from health professionals took place in private and that staff treated them with respect, and always knocked before entering their bedrooms. There had been a recent death in the home and staff said that family members had been fully involved with the care provided. One care worker spoken to said that the service user had been cared for in her room and had received all possible care and attention. Staff said that they had received training in “Care of the Dying” and that they were aware that details of service user and family wishes about illness and death were written on to care plans. Medication administration was checked on each floor of the home and staff confirmed that only seniors are involved in the procedures. The systems for administration were found to be sound, and there had been a recent report produced after a pharmacy inspection, which reflected this. Some small changes to recording had been implemented, with staff now making it clear how many tablets were administered for taken as needed (prn) medication. However, it was discovered that some medication was being disposed of by flushing down the lavatory and a requirement has been made that all non-administered medication must be returned to the pharmacy. Oak Tree Manor Residential Home Version 1.10 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15. The home provides good levels of activities and entertainments and service users are happy with the services provided. Families and friends are welcomed in the home at all times, enabling links outside the home to be maintained. Meal provision is of a good standard and service users enjoy the food and the mealtime experience. EVIDENCE: On the morning of the inspection, service users on the dementia unit were joining in activities in the lounge, which included a game of skittles. There were separate activities taking place on the ground floor. Notice boards around the home had laminated lists of the week’s activities and a separate notice displayed entertainments planned for the coming months. Service users on both floors praised the level of activities and the activities co-ordinators, and said they were always made aware of events. There are two co-ordinators in the home, one for each floor, who work from Monday to Friday. One family member said that the co-ordinators were “fantastic” and provided real stimulation to the residents of the home. One co-ordinator said that penpictures were being produced of the histories and preferences of each service user. Visitors to the home who spoke to the inspectors said that they could visit at any time and were always made welcome by staff. Service users said that they enjoyed the food provided and made their choice of meal the day before. Oak Tree Manor Residential Home Version 1.10 Page 12 Menus were displayed around the home on notice boards and these confirmed that service users could choose an alternative if they did not want the day’s menu. The chef had recently changed the menus from winter to spring, so that seasonal ingredients could be used. The mid-day meal was observed and was as advertised on the menu, was well balanced, hot and looked very appetising. Pureed meals were served form separate containers and each ingredient was provided separately. Service users confirmed that they had plenty of drinks provided and could ask for additional snacks if required. Oak Tree Manor Residential Home Version 1.10 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Generally service users are confident that their concerns are listened to and taken seriously by staff. Policies and procedures in the home help protect service users from all types of abuse. EVIDENCE: The home has a written Complaints policy which staff and service users were aware of and which is included in the home’s Service User’s Guide. Two service users spoken to said they would not feel comfortable telling staff if they had a complaint, but they did not wish this issue to be looked at further. However, all other service users said that their concerns were taken seriously, and one said the Manager had sent a memo to all staff as a result of listening to her concerns. Staff were aware of the home’s policies on Adult Protection and Whistleblowing and said they had received training in the implementation of these policies. Procedures for handling service users’ money were not examined on this occasion. There has been one recent complaint about the home, received by the CSCI. The Manager had not been aware of this, and this inspection was used to investigate the allegations. Evidence from the inspection was used to assess the complaint, which was subsequently not upheld. Oak Tree Manor Residential Home Version 1.10 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. The home is kept clean and well maintained and service users live in a safe and comfortable environment. There are sufficient facilities and equipment to meet the needs of service users. Service users have many of their own possessions in their bedrooms, which helps to ensure a homely environment is maintained. EVIDENCE: On the day of the inspection, which was unannounced, the home was generally clean and looked well maintained, both inside and out. The gardens looked attractive and service users said they were looking forward to sitting outside in the warmer weather. There are dining rooms on both floors and communal lounges where service users had activities organised and other lounges where service users could sit quietly. Furniture was generally of good quality and service users felt the lighting was adequate for all their requirements. Service users and staff said there were adequate numbers of bathrooms and lavatories throughout the home and the provision meets the requirements of the Standard. Oak Tree Manor Residential Home Version 1.10 Page 15 There are assisted baths and grab rails in appropriate places and wheelchair access to all parts of the home and gardens. Call alarms were appropriately placed in bedrooms and service users confirmed that they could always summon help when alone in their rooms. Bedrooms were well furnished and most service users had personalised their rooms with their own possessions and pieces of furniture. There are no shared bedrooms in the home. Hot water was checked and was being delivered at safe temperatures and radiators in the home have low-temperature surfaces and windows are restricted where appropriate. The laundry was clean and had separate hand washing facilities for staff and the washing machines had high temperature settings for soiled articles. Staff were asked if there were sufficient supplies of disposable gloves in the home, as concerns about this were included in the complaint received by the CSCI. Generally, staff felt that gloves were available when required, and that problems with access were historical and had been resolved. The Manager has produced a written protocol for the use of disposable gloves, and it was suggested that these guidelines are checked by the Infection Control Team, to reassure all concerned that procedures are adequate. Oak Tree Manor Residential Home Version 1.10 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. There are usually sufficient numbers of trained staff on duty in the home to ensure that service user needs are met. The home operates thorough recruitment systems and provides good levels of staff training, which procedures are the basis for providing support and protection for service users. EVIDENCE: Staff duty rotas for three weeks were provided during the inspection and staff on duty on the day were those listed on the rota. In general, service users and staff spoken to felt that there were enough staff on duty, both in the day and at night. Staff also felt that, in general, they did have enough time to spend with service users and their knowledge about individual residents and the interaction observed on the day certainly supported this view. However, some service users felt that there were occasionally not enough relief staff to cover at times of staff sickness. The home does not use agency staff, preferring to use current staff working additional shifts to cover shortfalls. Some staff live on the top floor of the home and some of these were asked if they were expected to provide extra cover outside their normal shifts, (as was suggested in the complaint received by the CSCI). All of these care workers spoken to denied being expected to work extra hours unless they wanted to and did not feel exploited. Some service users did however say that the home’s policy of employing staff from abroad on short contracts, did mean that there was a considerable turnover of staff every few months. Oak Tree Manor Residential Home Version 1.10 Page 17 These service users said the care workers from abroad were generally excellent and they became very fond of them and were sorry that they were not in the home for longer. Service users confirmed that the domestic staff kept the home very clean and domestic staff spoken to said there were sufficient ancillary staff employed to maintain good standards. Recruitment records of the most recent staff employed were checked and most of these were staff from abroad and were living in the home. The home’s system for recruitment was very thorough in all cases and evidence of all the required checks were seen. The home’s application form is excellent, with space for applicants to complete all their employment history and it states that this history must account for all time since leaving education. The home also asks for and contacts three referees and the form highlights that one must be the current employer. There were interview notes on the records and evidence that all written references were followed up by telephone for added security. CRB checks were in place and the Manager is aware that no staff can be employed until proof of criminal record clearance has been received. The staff files also contained signed contracts with details of pay rates and information about the terms, conditions and rules for staff who were living in the accommodation at the top of the home. All staff spoken to had received induction training when they started at the home and all had completed other basic training, or were booked on courses to complete this. Other recent courses that had been provided included training in Dementia, Incontinence and Care of the Dying. NVQ training for staff is supported in the workplace with an assessor visiting the home every month. Oak Tree Manor Residential Home Version 1.10 Page 18 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) 32, 36 and 38. Service users benefit from staff who are well supervised and from strong leadership by the Manager. Health and safety proceedures in the home also support the well-being of service users. EVIDENCE: Evidence was seen of care staff supervision taking place and staff said that they receive this supervision on a one-to-one basis, every six weeks or two months. Staff also felt supported by the Manager and said that they have staff meetings about every two months. In view of the high levels of foreign care workers in the home, who often stayed for only short periods, it was suggested that more frequent staff meetings might be beneficial. Service users confirmed that they have residents meetings and thought the last one took place just over one month ago. Service users said they found the Manager to be completely approachable and could always discuss any issues with her. The staff application form states that employment at the home is based on the Oak Tree Manor Residential Home Version 1.10 Page 19 practice of an equal opportunities policy. Staff confirmed they had received copies of the Code of Conduct, produced by the GSCC and that they had received regular updated Manual Handling training. One service user confirmed that there were always two care workers involved when using the hoist. All those spoken to said the fire alarms were regularly checked and fire check records were in order. As already stated, issues about disposable gloves and infection control were discussed with staff and the Manager. Care and domestic staff said that gloves were available at all times and service users confirmed that staff wore a new pair of gloves to provide personal care, for each service user, and that these were thrown away after each use. The CSCI regularly receives notification of any incidents or accidents which affect the service users and staff. The entry system for the home requires that a code is used to gain entry and to get out and staff spoken to said they were all vigilant about checking that service users were encouraged to move away from the entrance to promote safety. Staff confirmed that there had been no recent incidents of service users wandering from the home and that they were aware of the home’s policy on unexplained absences. Oak Tree Manor Residential Home Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x x x 3 x 3 Oak Tree Manor Residential Home Version 1.10 Page 21 no 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 9 Regulation 13(2) Requirement The Registered Provider must ensure that all non administered medication is recorded and safely returned to the pharmacy for disposal. Timescale for action 4th April and henceforth. 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 There are none. Oak Tree Manor Residential Home Version 1.10 Page 22 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oak Tree Manor Residential Home Version 1.10 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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