CARE HOMES FOR OLDER PEOPLE
Oak Tree Manor 2 Chene Drive Off Waverley Road St Albans Hertfordshire AL3 5PJ Lead Inspector
Patricia Rogan Unannounced Inspection 7th November 2005 10:00 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 Manor DS0000019486.V260332.R01.S.doc Version 5.0 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 Manor DS0000019486.V260332.R01.S.doc Version 5.0 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 oak.care@virgin.net 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) Oak Care Limited Sue Stacey Care Home 80 Category(ies) of Dementia - over 65 years of age (80), Old age, registration, with number not falling within any other category (80), of places Physical disability over 65 years of age (80) Oak Tree Manor DS0000019486.V260332.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th April 2005 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 DS0000019486.V260332.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place during one day and was the second inspection of the year. Two inspectors carried out this inspection. Residents, members of staff, relatives and visiting health professionals were spoken to in privacy and asked for their opinions of the service provided by Oak Tree Manor. Their positive responses were supported by the favourable remarks written in the comment cards. The comment cards were issued to service users and their relatives a few weeks prior to the inspection and were returned with the self assessment documents which had been completed by the home. During the inspection, a tour of the home included resident’s rooms, communal areas, bathrooms, kitchen and storage rooms. Time was spent in the dining areas while dinner was served to the residents. Where it was appropriate to do so, care staff were observed assisting residents and administering medication. Key standards which were inspected during the previous inspection of 4th April 2005 were not inspected in detail and reference should be made to that inspection report for details. What the service does well: What has improved since the last inspection?
Management has ensured increasing involvement of relatives and one day a month three senior members of staff are available for relatives to discuss any issues arising. Relatives are informed when these dates are.
Oak Tree Manor DS0000019486.V260332.R01.S.doc Version 5.0 Page 6 The Statutory Requirement from the previous inspection requiring the correct recording and safe return of medication to pharmacy for disposal has been addressed. The manager has worked hard to reduce the staff turn over. A considerable number of care staff from abroad previously worked in the home for only six months before returning to their home country. The manager now offers one or two year contracts. This allows more in depth training and a more settled Team. Many residents said they prefer staff working in the home for a longer period. They said they liked the care staff and felt sad when the carers left after six months, finding it took time to get used to the new staff. 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 Manor DS0000019486.V260332.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Oak Tree Manor DS0000019486.V260332.R01.S.doc Version 5.0 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 the following standard(s): 2, 4, 5. (Standard 6 does not apply to this home) All service users are given an easy to read written contract which provides information about the home. During the assessment, service users and their representatives are told about the home and the services that will be provided. Prospective service users and their representatives are invited to visit the home and meet with staff and residents prior to moving into the home. EVIDENCE: Residents had the contracts in their rooms and said that staff had ensured they understood it before signing. Relatives of those residents with dementia said they were given a copy of the contract to sign on behalf of the resident. Residents said they felt supported to air their views during their assessment. Residents and relatives said the welcoming atmosphere when they visited the home prior to admission made them feel reassured.
Oak Tree Manor DS0000019486.V260332.R01.S.doc Version 5.0 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 the following standard(s): 9. (Standards 7, 8, 10, 11 were fully assessed during the inspection of 4th April 2005. Please refer to the report of that inspection for details.) Medication records were examined and part of the medication round was observed. No discrepancies were found in the medication records and the system for disposal of unused medication has been improved. EVIDENCE: Care plans were examined and the majority were well set out and regularly reviewed. There were one or two minor inaccuracies where a resident’s care needs had changed but not amended on the risk assessment. Residents and residents said they were involved in reviews and they felt pleased to be consulted. Staff support those residents who choose to take their own medication. A risk assessment must be completed for each resident who self medicates to ensure the safe taking of that medication. Senior staff are responsible for giving medication and they did this in a careful, unhurried way which was helpful for residents, particularly those with memory impairment.
Oak Tree Manor DS0000019486.V260332.R01.S.doc Version 5.0 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 the following standard(s): 14. (Standards 12, 13, 15 were fully assessed during the inspection of 4th April 2005. Please refer to the report of that inspection.) Many residents and family members were asked whether they felt they still had some choice about they way they wanted to be cared for within the home. For the purpose of this report, some evidence in the comments cards have also been used. EVIDENCE: During the inspection, some residents chose to remain in their rooms all the time. They said they felt that staff respected their wish to live a more private lifestyle. ‘I think of my room as a small flat with lovely ladies coming in to help me when I need it.’ Other residents enjoy activities such as card games and they have been encouraged to make use of the communal areas where there are tables they can sit at. The manager encourages residents and family members to air their views. One relative said his mother had been in another home previously and that Oak Tree Manor staff had ‘taken into account his mother’s level of dementia and had taken time to get to know her likes and dislikes.’ Care plans reflected ways to support the individuality of residents.
Oak Tree Manor DS0000019486.V260332.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 16. (Standards 16 and 18 were fully assessed during the inspection of 4th April 2005. Please refer to the report of that inspection for details) Residents are enabled to exercise their legal rights directly and to participate in the civic process if they so choose. EVIDENCE: Residents’ service user agreement and care plans emphasise their right to support from relatives and advocates if they so choose. For those who’s level of memory impairment means they find it difficult to exercise their rights, the psychiatric services and experienced advocates are available to them. Oak Tree Manor DS0000019486.V260332.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 20, 21, 22, 23, 24, 26. (Standards 19 and 25 were fully assessed during the inspection of 4th April 2005. Please refer to the report of that inspection for details.) Residents have access to a choice of communal rooms and dining areas and they can also sit in the grounds in good weather. There is safe access throughout with the exception of the loose banister on one stairway. This has been put out of bounds but needs urgent attention because it is one of the fire exits for the first floor. The residents are provided with specialised equipment according to assessed need. There are sufficient suitable bathroom and toilet facilities, however, there are many toilet roll holders which are missing or broken and these should be replaced as soon as possible. The Manager said these two maintenance issues are already being addressed. Residents rooms are a good size and are light and at a comfortable temperature. Rooms had been personalised with personal possessions. Oak Tree Manor DS0000019486.V260332.R01.S.doc Version 5.0 Page 13 EVIDENCE: Oak Tree Manor is purpose built with an attractive appearance inside and out. A homely feel is created by the comfortable furniture and the flowers and pictures throughout the home. One resident described the home as ‘really lovely to walk into.’ A member of staff said it was a pleasure to work in. Residents’ rooms are well decorated and residents have been encouraged to bring in their own small items of furniture and possessions so that the room is made more personal and individualised. Rooms have locks fitted and residents can have the keys if they wish. There is a lockable cupboard or drawer in each room for residents personal use. There is an ongoing maintenance programme for all specialised and essential equipment within the home and everyone is encouraged to report any item which needs replacement or repair. The home was clean throughout and the domestic staff who were consulted said they had been provided with training in hygiene and infection control. Oak Tree Manor DS0000019486.V260332.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 29. (Standards 27 and 30 were fully assessed during the inspection of 4th April 2005. Please refer to the report of that inspection for details. There are thorough policies and procedures in place to ensure that the persons appointed for jobs in the homes are most suited for this work. After appointment there is a comprehensive induction programme for all new staff to ensure they have the ability to work to the standards of the home. EVIDENCE: All staff have an on going training programme which is tailored to the role they have. There is a focus on person centred care which helps to increase residents confidence that the care they get is able to meet their individual needs and that they are in safe hands. Several residents said they were pleased that staff stayed for longer periods because they felt there ‘was more of a sense of belonging, without having to teach yet another new member of staff what my likes and dislikes are.’ There are a considerable number of residents who have a memory impairment and the effectiveness of this training was evidenced when a carer responded in a calm manner when a resident with dementia became upset and agitated. The carer remained quiet and supportive and was able to reassure the resident. Oak Tree Manor DS0000019486.V260332.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 37. (Standards 32, 36 and 38 were fully assessed during the last inspection 4th April 2005. Please refer to the report of that inspection for details.) The Manager is very experienced in care work and has studied to management level. She is a skilled, experienced manager who demonstrates a commitment to the residents, staff and visitors to the home. There are systems in place to ensure all financial transactions and residents’ financial interests are protected. The home does not act as appointee for any resident and does not directly administer resident’s finances. EVIDENCE: The Manager has policies and procedures in place and ensures that staff are aware of these so that high standards are maintained. Staff in the home have said that the Manager and the senior staff are approachable. This is especially important for the care workers who are from overseas and a few of them said
Oak Tree Manor DS0000019486.V260332.R01.S.doc Version 5.0 Page 16 they were pleased that they had such good support trying to become established in a country unfamiliar to them. Two visitors to the home said that there was a friendly welcome whenever they visited the home and that they ‘felt part of the family’. A health professional said she thought she and her colleagues were supported in their work and the manager and her team had a positive influence on the morale of residents and staff Many residents, their relatives and staff said they thought it was very helpful to have residents meetings where they could air their views. One resident said she never attended meetings but was happy to speak to staff to and said the manager was always willing to listen. A relative said he had viewed several homes before he chose Oak Tree Manor and his decision was influenced by the welcome they received and the openness of the Manager and staff. There are ongoing quality audits throughout the home to assess the effectiveness of the policies and procedures which are in place. This is used to ensure that the changing care needs of the residents are met and the home is run to a high standard. Oak Tree Manor DS0000019486.V260332.R01.S.doc Version 5.0 Page 17 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 3 3 X 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X X 2 2 X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 X 3 X Oak Tree Manor DS0000019486.V260332.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? none 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 OP21 OP19 Regulation 16 (2) (j) 23 (2) (b) Requirement All missing or broken toilet roll holders should be replaced and fitted securely. The loose banister must be repaired to provide safe access to the emergency access. Timescale for action 31/12/05 05/12/05 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 Manor DS0000019486.V260332.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire 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 DS0000019486.V260332.R01.S.doc Version 5.0 Page 20 - 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!
