Inspection on 16/11/06 for Oak Trees

This inspection was carried out on 16th November 2006.

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 Trees 13/12/05

Oak Trees 19/07/05

Oak Trees 30/09/04

Oak Trees 22/04/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

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 Trees Rhode Lane Bridgwater Somerset TA6 6JF Lead Inspector Kathy McCluskey Key Unannounced Inspection 16th November 2006 09:40 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 Trees DS0000015988.V316354.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 Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak Trees Address Rhode Lane Bridgwater Somerset TA6 6JF 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) 01278 451125 01278 431174 Somerset Care Limited Mrs Julie Ann Watts Care Home 67 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (36) of places Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To be registered for two named persons (in the OP unit) under the age of 65 years. Rooms 51 and 52 to accommodate service users of low to moderate care needs. 13th December 2005 Date of last inspection Brief Description of the Service: Oak Trees is registered with the Commission for Social Care Inspection to provide care to up 67 people over the age of 65. The home specialises in providing care to older people who have a dementia and has two units within the home for this service user group; the Acorn unit and the Oak Leaf unit. The home is located on a housing estate in Bridgwater, accommodation is provided in single rooms on two levels. There is ample communal space in a variety of settings. In the centre of the home is an attractive courtyard garden and there is further secure outside space attached to the Acorn and Oak leaf unit. Oak Trees is owned by Somerset Care and the registered manager is Julie Watts. Current fee range = £295 - £436 per week. Additional charges = hairdressing, trips, newspapers, holidays, chiropody, personal toiletries and where appropriate, continence aids. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key inspection was carried out in line with the Commission for Social Care inspection (CSCI) framework ‘Inspecting for Better Lives 2’ (IBL2). This unannounced key inspection was conducted over one day (7.5hrs) by CSCI Regulation Inspectors Kathy McCluskey and Jane Poole. As part of this inspection, the commission sent out comment cards to healthcare professionals on 3rd October. At the time of this report no completed comment cards have been received and no concerns have been raised by healthcare professionals. Three comment cards were received from G.P’s and responses to questions were positive. The registered manager Julie Watts and the two deputy managers were available throughout the inspection. At the time of the inspection 63 service users were living at the home and 3 were in hospital. The inspector was able to meet with many service users and staff. A tour of the premises was carried out where communal areas and a number of bedrooms were seen. Records were examined relating to service users, staff, medicines and health and safety. The inspector would like to thank service users, staff, and the management team for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 6 What the service does well: Oak Trees has three separate units for service users. The home benefits from a newly built unit, known as Oak Leaf, which has been very well designed for service users who have dementia. Although some bedrooms in the existing home are small, the home has a good range of communal space for service users. All areas of the home have been fitted with various aids and adaptations to ensure that service users independence is maximised. A nurse call system is fitted throughout the home. Several areas of the home have benefited from redecoration/refurbishment and the home has an on-going programme for this. There is a clear management structure and the registered manager gives a clear sense of direction to the home. There is a commitment to ensure that staff receive the appropriate training and support to meet the needs of service users. Service users benefit from appropriate numbers of staff who have been appropriately trained. There is a specialist liaison nurse from the Somerset Partnership NHS and Social Care Trust who provides advice and support with mental health issues. The home ensures that prospective service users are appropriately assessed prior to a placement being offered. All service users have access to appropriate healthcare professionals and the home has established very good links. The home has good quality assurance systems in place which regularly seek the views of service users, staff and stakeholders. Service users and staff confirmed that they felt confident in raising concerns if they had any. Service users are offered a range of activities. Since the last inspection, the home have acquired a wheelchair accessible minibus. The home takes appropriate steps to ensure that service users are protected from the risk of harm or abuse. The home follows the correct procedures to ensure the health and safety of service users, staff and visitors. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Oak Trees DS0000015988.V316354.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 Trees DS0000015988.V316354.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): 1, 3, 4 & 5. Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home takes appropriate steps to ensure that service users are able to make an informed decision about moving to the home. Prospective service users are appropriately assessed to ensure that the home can meet the individual’s needs and aspirations. EVIDENCE: The home has produced a Statement of Purpose and Service Users Guide. Both give detailed information about the home and services offered. These documents are made available to service users, prospective service users and their representatives. The inspectors were not advised of any changes to these documents. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 10 As part of this key inspection, the registered manager completed a preinspection questionnaire which identified the home’s current scale of charges as £295 - £436 per week. Additional charges are met by the service users for hairdressing, trips, newspapers, holidays, chiropody, personal toiletries and where appropriate, continence aids. The inspectors were able to see evidence that prospective service users are appropriately assessed prior to moving to the home. Copies of pre-admission assessments were seen in the care plans examined. These had been carried out by senior staff at the home. Assessments from other relevant healthcare professionals were also in place. Prospective service users and/or their representatives have the opportunity to visit the home before making a decision to move in. The home also offers day care and respite care to enable service users to spend time in the home before making a decision to make it their home. A variety of environmental aids and adaptations are provided to enable people to move independently around the home. There is clear signage in the units for people who have a dementia to assist them to orientate themselves and maintain a degree of independence. Each unit has an orientation board where staff write the day and date and significant events for the day. The home is owned by Somerset Care who have a commitment to providing staff training appropriate to the service users living at the home. All staff at Oak Trees undertake training in dementia awareness and additional training in this area is provided by the specialist liaison nurse from the Somerset Partnership NHS and Social Care Trust. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home has a care planning system in place which requires some improvements to ensure a more person centred approach to care. Service users have access to appropriate healthcare professionals. The home’s procedures for the management and administration of medication requires improvement. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: The home is now using a computerised care planning system. Care records relating to five service users were viewed at this inspection with the assistance of the registered manager and deputy managers. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 12 The inspectors were able to see evidence that service users had been assessed by senior staff prior to moving to the home. Copies of assessments from other professionals had been obtained. Care records contained information on professionals and relative contacts. The computerised care planning system uses a standard template which staff can personalise when developing a care plan for an individual. The majority of care plans seen at this inspection had not been personalised and therefore did not fully reflect or identify the service users assessed needs. The care plan templates allow for the preferences of service users to be recorded though the majority of care plans examined did not identify preferences. Care records examined for service users on the dementia units did not contain sufficient information relating to their dementia care needs. The care records for one service user with ‘challenging behaviour’ contained a standard template which had not been personalised to meet that individual’s needs. The home prints out a ‘hard copy’ of basic care needs for staff, though the registered manager and care staff confirmed that they had easy access to the computerised system. Some paper copies of care records were examined and compared with those on the computer and it was noted that some paper copies required updating. It was not clear to the inspectors how service users and/or their representatives would be involved in the care planning process. The registered manager advised the inspectors that this was something they were considering. The registered manager stated that, if appropriate, service users and/or their representatives could be provided with a ‘hard copy’ of the care plan. This will be discussed again at the next inspection. Staff access the computer system on each shift to enter a progress report for each service user. A selection of entries were shown to the inspectors and it was noted that the majority of entries contained very basic information. This was highlighted and discussed at the time. A risk assessment was seen to be in place for a service user who would be at risk if they left the home unaccompanied. The inspectors recommended that the home also completes a missing person profile for this individual. All issues were discussed with the registered manager and deputy managers as the inspectors viewed the records. All service users are registered with local GPs and other healthcare professionals appropriate to their individual needs. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 13 Three GP’s completed comment cards for the commission and responses to questions were positive. The local district nursing team visit some service users on a regular basis and the Acorn and Oak Leaf unit are supported by a specialist liaison nurse who offers advice and support in respect of mental health issues. Service users spoken to stated that their privacy was respected. The inspectors noted that people were assisted in a kind and respectful way. People are able to choose whether to spend time in communal areas or in their private rooms. All bedrooms in the Oak Leaf suite have en suite facilities which include level access showers. There are also communal assisted bathroom facilities around the home where personal care is carried out in private. The inspectors examined the home’s procedures for the management and administration of medication. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). All medicines were found to be securely stored with no excess stocks. MAR charts contained photographs of service users and clear instructions for the use of individual’s ‘as required’ medicines. The inspectors noted a number of occasions where staff had failed to sign the MAR chart confirming medication had been administered and no reason for non-administration had been given. The number of tablets for one service user did not tally with the number of signatures on the MAR chart. Through regular auditing, the registered manager had herself previously identified the problem of staff not signing MAR charts and was taking steps to address this. Hand transcribed entries on MAR charts were not always confirmed by two staff signatures. Changes to a service user’s prescription had not been appropriately recorded on the MAR chart ie: doses and times had been changed rather than a new entry being made. Staff are not recording the temperatures of the fridges storing medicines on a daily basis. Controlled records and stocks were examined and were found to be correct. These are checked by staff at each change of shift. The last community pharmacy visit to the home was on 03/07/06 and similar issues were raised. Since the inspection, the registered manager has contacted the CSCI to confirm that she is in the process of addressing the issues. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 14 The home takes appropriate steps to ensure that the privacy and dignity of service users is respected. As previously mentioned in this report, all bedrooms in the Oak Leaf unit are equipped with en-suite shower and toilet facilities and there are a number of toilets and bathrooms around the home where service users can be assisted with personal care in private. A number of service users were spoken with at this inspection and all informed the inspectors that staff treated them with respect. None expressed any concerns regarding the assistance they received from staff with personal care needs. Staff were observed interacting with service users in a kind and respectful manner. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users have the opportunity to participate in a range of activities both within the home and outside of the home. The home provides a wholesome and varied menu and a choice of meals is always available. The home needs to review the arrangements for enabling service users on the dementia units to exercise choice at mealtimes. EVIDENCE: Service users able to express a view informed the inspectors that they could choose how and where to spend their day. Service users were observed moving freely around the home. Some service users preferred the privacy of their own bedrooms. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 16 In line with the wishes of service users, visitors are welcome to visit their relative at any reasonable time. Service users choose where to receive their visitors and can use the privacy of their bedroom if they wish. The inspectors viewed a number of bedrooms and it was apparent that service users are encouraged to personalise their private space. The home offers a range of activities and details of forthcoming events are displayed throughout the home. At present with Christmas approaching, the home has various festive events planned which include a Christmas fayre and show, bingo, quizzes, coffee afternoons and a Christmas party. Service users were positive about the range of activities available and informed the inspectors that they could choose whether to take part or not. Service users on the dementia units also benefit from one to one time from staff. This was observed during the inspection. Since the last inspection, the home has acquired a wheelchair accessible minibus. In the summer, five service users enjoyed a holiday in Weymouth. Photographs were proudly displayed in the home. Service users spoken with were positive about the quality and quantity of the meals available at the home. Lunch was seen being served in each of the three units and it was disappointing to note the contrast between the main unit and the two dementia care units with regard to choice. Service users in the main dining area had a selection of drinks to choose from, condiments on the table and vegetables and potatoes were placed on tables in serving dishes. Service users had previously been given the opportunity to choose their main dish. In the Acorn and Oak Leaf units, whilst the quality of the food remained the same, the experience with regard to choice was very different to that on the main unit. The inspectors noted that all service users had been given the same drink. Salt and pepper was only available on one table in each unit and staff were not observed offering this to service users. Staff plated up meals from the hot trolley, which was situated in each dining room and it was not clear to the inspectors how these service users with dementia were given the opportunity to make an informed choice about what they would like to eat. Staff spoken with stated that they did ask service users, but this was not observed during the inspection. The menus seen offered wholesome and varied dishes with choices available. During the evening supper is available ‘on request’. Again, it was not clear how Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 17 service users with dementia would be able to exercise their choice as to whether to have supper. The inspectors findings were discussed with the registered manager and deputy managers at the time of the inspection. The inspectors were informed that the home’s kitchen was due for major refurbishment after Christmas. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has appropriate systems in place to enable service users, staff and other stakeholders to raise concerns. The home takes appropriate steps to reduce the risk of harm or abuse to service users. The home needs to ensure that the contact details of appropriate external agencies are identified on the whistle blowing policy. EVIDENCE: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. The inspectors noted that the whistle blowing policy, contained within the new staff induction handbooks, did not identify the contact details of the commission or any other external contacts. The whistle blowing policy should therefore be updated. Records examined indicated that the home had received one complaint since the last inspection. The inspectors were able to see that the registered manager had taken appropriate action to address this within the agreed timescale. No Complaints have been raised directly with the Commission. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 19 Since the last inspection, staff have received training in abuse awareness from the home’s specialist link nurse. Staff spoken with confirmed that they were aware of how to raise concerns both internally and with appropriate external bodies, including the commission. Service users spoken with did not raise any concerns and informed the inspectors that they would not hesitate in speaking to senior staff if they had any complaints. The home’s robust recruitment procedures reduce the risk of harm or abuse to service users. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 20 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, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and homely environment for service users. Service users benefit from their own bedrooms, which they can personalise. The home provides a range of aids and adaptations to enable service users to maximise their independence. EVIDENCE: There are three separate units within Oak Trees, the main unit provides care to up to 36 older people, Acorn unit is able to accommodate up to 15 people who have a dementia and the newly opened Oak Leaf unit has 16 rooms for people who require care due to a dementia. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 21 The home was purpose built some years ago and the Oak Leaf unit was built and opened last year. Accommodation is provided on two levels with passenger lifts between. Other aids and adaptations have been put in place to assist people to move independently around the home. There are assisted bathing facilities, raised toilets and appropriately placed grab rails. The newest unit, Oak Leaf has been built using the latest research in respect of the environmental needs of people who have a dementia. All areas have excellent signage to assist people to orientate themselves around the home and again promote independence. A call bell system is fitted throughout the home. All personal rooms in the home are for single occupancy, many in the main part of the house are under 10 square meters in size but there is a variety of communal seating areas where service users are able to spend time. The inspectors viewed a sample of the personal rooms and noted that service users had been able to personalise them with their own possessions and small items of furniture. All bedrooms in the Oak Leaf unit are above 12 square meters and have en suite facilities of toilet, wash hand basin and level access showers. Rooms without en suite facilities have wash hand basins as a minimum. All bedrooms are lockable and service users are able to choose whether or not to lock their rooms. Each room has a lockable facility for the storage of valuables, medication or money. The main part of the house has a large dining room, which easily accommodates all service users and can be used for social functions. In addition there are a variety of communal seating areas ranging from a large conservatory to small quiet lounges. In the Acorn unit there is a lounge and small dining room. The Oak Leaf unit has a large lounge/dining room. All ground floor areas of the home have direct access to outside space which service users have unrestricted access to. Since the last inspection, the outside courtyard area of the home has been upgraded and now provides service users with a safe and interesting area to look at or spend time in. All areas of the home are centrally heated and radiators are either cool wall type or have been guarded to minimise risks to service users. Hot water is thermostatically controlled to prevent the risk of scolding. Windows above ground floor level have been restricted in line with health and safety guidelines. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 22 Some areas in the older part of the home have been redecorated since the last inspection and there are plans to up grade further areas. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 23 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from appropriate numbers of staff who have been appropriately trained. The home follows robust staff recruitment procedures, which reduce the risk of harm or abuse to service users. EVIDENCE: There is a clear staffing structure in the home. There is always a senior member of staff on duty who co-ordinates other staff and supervises the smooth running of the day. There is a member of the management team based in the Oak Leaf Unit who oversees the care offered here and in the Acorn unit. Staff spoken with at this inspection did not express any concerns about staffing levels at the home. The management team are committed to ensuring that staff receive appropriate training to meet the needs of the service users. All staff who commence work in the specialist residential unit are given comprehensive information about caring for people who have a dementia and additional training is provided by the specialist liaison nurse who supports the unit. A Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 24 recommendation has been raised at this inspection regarding service users on the dementia unit being able to exercise choice at mealtimes (refer to standard 14) All staff receive in-depth induction training and ongoing statutory training. The home’s policy is to ensure that all staff receive training in moving and handling once a year. Records supplied by the registered manager indicated that of the 59 care staff employed, 32 have achieved a minimum of an NVQ level 2 in care. This equates to 54 which is above the recommendation of the National Minimum Standards. The inspectors examined the homes procedures for the recruitment of staff. Three files were examined and all contained appropriate information as required in Schedule 2 of the Care Homes Regulations 2001. This also included enhanced criminal record bureau checks (CRB) and Protection of Vulnerable Adults checks (POVA). Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 25 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, 34, 35, 37 and 38 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The home benefits from a competent and experienced manager who promotes an open and inclusive style of management. The home takes appropriate steps to ensure the health and safety of service users, staff and visitors. EVIDENCE: The registered manager of the home is Julie Watts. She has a wealth of experience in the care of older people and demonstrates a good understanding of the needs of both staff and service users. Julie has an NVQ level 4 in care Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 26 and management and a Higher National Diploma in managing health and social care. Both service users and staff were positive about the management of the home and stated that they found the registered manager very supportive and approachable. There is a clear management structure in the home. In addition to the registered manager there is a deputy and a specialist manager for the specialist residential unit. Each shift has a care supervisor and team leader who are responsible for the day to day co-ordination of the staff. Meetings are held for staff every three months and for service users twice a year. Six monthly meetings are arranged for relatives, though the registered manager stated that these are not always well attended. The home has a wide range of policies and procedures which are reviewed annually by the company. As part of their quality assurance programme, the home carries out a yearly survey of service users and relatives views on the home. The results of completed surveys for this year were made available to the inspectors and outcomes were mainly ‘good’ or ‘excellent’. The home’s area manager/responsible individual maintains close contact with the home and visits frequently. As part of these visits, monthly reports are completed. The home manages small amounts of monies on behalf of service users where requested. Some service users continue to control their financial affairs, some are assisted by relatives and some by the home. The inspectors sampled the financial records. All seen were extremely well maintained. All transactions had been accompanied by two signatures and receipts were available. At the time of this inspection, the home was taking appropriate steps to ensure the health and safety of service users, staff and visitors to the home. This was ascertained through a tour of premises, discussion with staff and service users and on examination of the following records; FIRE SAFETY – In-house weekly checks are maintained on the home’s fire detection systems. Annual servicing was carried out by an external contractor on 14/11/06. ELECTRICAL SAFETY – Records indicated that an annual check on the home’s portable appliances was conducted on 19/04/06. The home has an up to date electrical hardwiring certificate dated 04/09/06. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 27 EQUIPMENT SERVICING – Records examined confirmed that the home’s mobile hoists were last serviced on the 06/09/06 and 09/10/06. The home’s passenger lift was serviced on 13/09/06. GAS SAFETY – The home has an up to date annual landlords gas safety certificate dated 04/10/06. ACCIDENTS - Accidents are appropriately recorded and analysed monthly by the registered manager. As previously mentioned in this report, to ensure the safety of service users all upstairs windows are restricted, hot water outlets are thermostatically controlled, radiators are low heat surface type and free standing wardrobes are secured to the wall. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 28 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 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 x 3 3 Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 29 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.) Standard OP7 OP8 Regulation 12(1)(a)& (b), 15(1) Requirement The registered person shall ensure that service user care plans are fully reflective of the individual’s assessed needs and contain clear instructions for staff on how needs should be met. Particular attention must be given to psychological needs and any preferences should be identified. The registered person must ensure that staff follow the correct procedures for the recording and safe administration of medicines received into the home; Timescale for action 30/12/06 2.) OP9 13(2) 01/12/06 3.) OP9 13(2) - Staff must sign the medication administration record (MAR) confirming medicine has been administered or make an appropriate entry for nonadministration. The registered person shall make 01/12/06 arrangements for the recording and safe administration of medicines received into the care home; - Any changes to a prescription, authorised by a GP, must be DS0000015988.V316354.R01.S.doc Version 5.2 Page 30 Oak Trees appropriately recorded on the MAR chart. - To reduce the risk of errors, hand transcribed entries must be confirmed by two competent staff signatures. 4.) OP9 13(2) The registered person shall make 01/12/06 arrangements for the safekeeping & safe administration of medicines received into the care home; - Temperatures of the fridges storing medicines must be checked and recorded daily. 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 OP14 Good Practice Recommendations The registered person should ensure that service users on the dementia units are enabled to make an informed choice around meals and drinks offered. Oak Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Trees DS0000015988.V316354.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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