Inspecting for better lives Thematic inspection report
Care homes for older people
Name: Address: Oak Tree Manor 2 Chene Drive Off Waverley Road St Albans Hertfordshire AL3 5QP The quality rating for this care home is: The rating was made on: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a thematic inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jeffrey Orange Date: 0 4 0 2 2 0 0 9 Information about the care home
Name of care home: Address: Oak Tree Manor 2 Chene Drive Off Waverley Road St Albans Hertfordshire AL3 5QP 01727832393 01727866653 oak.care@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Oak Care Limited care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability 0 0 0 Over 65 80 80 80 Conditions of registration: Date of last inspection Brief description of the care home Oak Tree Manor provides non-nursing care services and accommodation for up to eighty older people who may also have a physical disability, or dementia. Detailed information about the services offered including the latest report by the Commission for Social Care Inspection is available in the home. Weekly fees for services range from £490 to £520 per week. Additional charges are made for newspapers, toiletries, chiropody and hairdressing services. (This information was correct at February 2009) The purpose built home is owned by Oak Care Ltd. and is situated in a residential area close to the city centre of St. Albans with its good transport links and extensive shopping and leisure facilities. The home has three floors served by a passenger lift. Care Homes for Older People
Page 2 of 10 The bedrooms are on the ground and first floor and are all single occupancy with ensuite facilities. Each of the residential floors has a 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. There is ample parking and the home has attractively laid out gardens to the rear of the building, with the recent addition of a covered pavilion area where residents can sit outside protected from the sun. Care Homes for Older People Page 3 of 10 What we found:
The last Key Inspection of Oak Tree Manor was carried out in July 2007 when it was rated as a service that achieved good care outcomes for the people living there. In July 2008 we carried out an annual service review, which does not involve a visit to the service but is a summary of any new information given to or collected by us, since the last key inspection. That Annual Service Review found that the rating as a service that achieved good care outcomes for the people living there remained valid and appropriate. The next key inspection is due to be carried out before the end of April 2009. This random inspection was carried out in response to information received by the Commission for Social Care Inspection (CSCI), raising concerns that people living in the home were being got up unreasonably early in the morning in order to suit care staff and the routines of the home rather than because they chose to do so. This unannounced random inspection was carried out by one inspector. Where this report refers to We it recognises that the inspection was carried out on behalf of the CSCI. The inspection visit started at 5.25 a.m. in order to give an opportunity to observe the very early morning routine of the home, so that we could assess if the concerns raised with us were supported by what we saw on the day of our visit. We would like first of all to thank all the care staff on duty for the courteous and efficient way they assisted us throughout this visit. It is recognised that an unannounced inspection this early in the morning can be particularly stressful for staff and we were pleased that the correct procedures were followed in order to record and authenticate this visit. We were able to observe care being provided to those people who were already up and dressed or who were being assisted to get washed and dressed during the inspection. We spoke to the senior care staff on duty, together with members of their teams, in order to clarify the routines and procedures of the night staff up to handover to day time carers at approximately 7.30 a.m. We looked at care plans for people that we identified as having been got up or helped to wash and dress early in the morning and compared them with other records setting out care duties for night care workers. Throughout this visit we attempted to either talk directly to people who live in the home who were already up or to gauge their state of well-being from non-verbal indicators and behaviour. We spoke to the registered manager when she arrived shortly before the inspection ended and explained to her the reason for the random inspection visit and what we had found. We are grateful for her understanding of the need for this visit and for her positive response during our discussion about its findings. Care Homes for Older People Page 4 of 10 We found that whilst it is certainly true that some people are routinely prepared for the day from as early as 4.30 a.m., (as we were informed by care staff), there is no evidence that unreasonable pressure is put on anyone to get up before they feel ready. We saw that the majority of people living in the home were still in bed and were either asleep or waiting until they felt ready to get up or be assisted to get up, washed and dressed. Throughout the visit, care staff were responding to call bells and were heard to ask people if they were ready at that point to get up, we also heard some people living in the home asking to be helped to get up and get dressed. We found that some people have been identified as early risers in night care staff duty lists, with instruction that they should be assisted to wash and dress by night care staff, that is effectively before 7.30 a.m. when the day care staff take over. We found that whilst every care plan includes a record of residents choices, completed when they moved into the home, this did not, in every case, reflect the current practice in respect of the time they would like to get up. For example, in several cases whilst they had indicated a preference to get up at 8 a.m. they were routinely getting up considerably earlier than that. We found that porridge and sandwiches were prepared well in advance of people getting up, and it was not possible to tell if this impaired the quality of the food or not as the time between preparation and consumption varied from person to person and the exact time of preparation was not possible to accurately assess. We found that because care staff were engaged in helping other people to get up, there could in some instances be a delay for people who got up earliest receiving a drink or their breakfast. We found that night care records included adequate details of the level of sleep or activity of people living in the home during the night. They did not however routinely indicate at what time the person got up or was helped to get up, washed and dressed. When we spoke to the manager about the importance of people living in the home being able to genuinely exercise choice over the routine of their lives and to be able to vary their routine in line with their particular wishes and choices on a daily basis, she positively endorsed the view that people living in the home should be able to get up each morning at the time of their choosing and not rigidly at a time set out some time previously that either may not now apply or may vary from day to day. She also readily agreed that people living in the home should not feel under any pressure at all to get up at a particular time, simply to fit in with the care routines of either night or day care staff. As stated above, whilst we recognise the concerns expressed to us, and welcome the fact that the person concerned brought them to our attention, we did not find evidence on the day that people were in any way being forced to get up earlier than they would have wished and we were assured by the manager and staff that good practice would be reinforced through staff meetings and training as necessary to ensure that this does not happen in future. What the care home does well:
Care Homes for Older People
Page 5 of 10 When we observed the way that care was being provided to people living in the home, including those who are living with dementia, we found that night care staff were being very gentle, offering reassurance and taking care not to out pace or hurry them. Throughout this visit, we found that staff were respectful and observed the dignity of the people living in the home. When we looked at care plans and daily records, we found that each person had a detailed Residents Choices Form setting out their preferences for the daily routines of their life in the home, including what time they would like to get up and go to bed. This provides the home with a good basic framework, working with the person living in the home and those responsible for them, to ensure that their personal wishes and choices are known and can be taken fully into account when providing care for them. The atmosphere in the home was very calm and peaceful and this means that people who want to remain asleep in bed, are able to do so and are not unreasonably disturbed by any activity associated with those who get up earlier. From what we saw on both floors of the home during this visit, there are sufficient staff on duty to meet the needs of those people who live in the home and to provide reasonable flexibility to enable those who want to get up at different times to do so without being put under any undue pressure to conform to a particular routine. What they could do better:
It is important that the homes records identify and support the choices made by people living in the home over the routine of their lives, including basic things such as the time they get up. People living in the home, including those living with dementia, must be seen to be able to exercise genuine control on a daily basis, with realistic opportunity to change what may be their usual routine if they wish. To achieve this, it is important that the information contained in the Residents Choices section of the care plan is reviewed from time to time, including full consultation with the individual concerned and those responsible for them, to ensure that it remains up to date and reflects the current views and wishes of the person living in the home. It is important that the daily notes recorded by night care staff demonstrate that care is being provided in line with the person living in the homes expressed wishes. They should therefore include, wherever possible, details of the time that the person got up or was assisted to get washed and dressed. Whilst we saw that provision had been made to give people who got up early something to eat, it is important in order to ensure that the food prepared for people living in the home is as fresh and appetising as possible that care is taken to monitor the condition of any food prepared earlier to ensure it is satisfactory at the time it is to be consumed. We were told that drinks are available to people who get up early and we saw one person had a cup of tea provided. People who get up early should routinely be offered a drink and something to eat if they want it and wherever possible this should be Care Homes for Older People Page 6 of 10 recorded in their daily notes. As stated above, we did not find that anyone was being put under undue pressure to get up early, and overall this was a very positive visit. This report is however based upon one visit on one day, it is obviously important that good practice is maintained every day and that people living in the home can be shown to be given genuine opportunities to exercise choice and control in the daily routines of their life on a day to day basis. Care staff should be supported through supervision and training to ensure that this continues to be the case at Oak Tree Manor. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a thematic inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 12 Night care staff should be encouraged to provide details in the daily care notes to demonstrate that people living in the homes wishes are being met, including the time they choose to get up each day. The information for each person living in the home contained in their residents choices should be reviewed regularly with the person concerned and/or those responsible for them in order to ensure that it reflects their current choices and wishes. Staff should be helped through regular supervision and appropriate relevant training to assess their own practice and the care practices of the home to ensure that they continue to routinely offer people who live in the home genuine opportunities to exercise choice and control over their lives. 2 12 3 14 Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - 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. You have been warned!
