CARE HOMES FOR OLDER PEOPLE
Oak Trees Rhode Lane Bridgwater Somerset TA6 6JF Lead Inspector
Jane Poole Announced 19 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Oak Trees Address Rhode Lane, Bridgwater, Somerset, TA6 6JF 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) 01278 451125 Somerset Care Ltd Mrs Julie Ann Watts Personal care home only 67 Category(ies) of Dementia - over 65 registration, with number Old age of places Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To be registered for one named person under the age of 65 years. 2. Rooms 51 and 52 to accommodate service users of low to moderate care needs. Date of last inspection 30 September 2004. 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 and and and home specialises in providing care to older people who have a dementia has two units within the home for this service user group; the Acorn unit the Oak Leaf unit. The Oak Leaf unit is the newest edition to Oak Trees has been opened since the last inspection. 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. Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Jane Poole and Kathy McCluskey carried out this inspection over a 7.5 hour period. The inspectors met with service users living in all areas of the home. Some people were able to fully express their opinions on the care and services offered at the home and a number of these people were spoken to. The inspectors spent time in all units of the home observing care practices and talking with staff. The inspectors were able to speak with one relative visiting the home. All records requested were made available and the inspectors were given unrestricted access to all parts of the home. Twelve service users completed comment cards prior to the inspection and some of the findings of these have been incorporated into this report. All staff and service users were welcoming towards the inspectors and the management team were available throughout the day. What the service does well:
Oak Trees specialises in the care of older people who have a dementia. Almost half the home now accommodates this service user group. The new wing of the home, the Oak leaf unit, has been designed and built using the latest research into the environmental needs of people who have a dementia. Somerset Care has made a great effort to provide a user friendly environment that continues to have a homely atmosphere. All areas of the home are comfortably furnished and all service users have unrestricted access to pleasant garden areas. The home has excellent links with the specialist liaison nurse who offers advice and support on mental health issues. There is ongoing training for staff on aspects of caring for older people. Service users who were able to fully express their opinion felt that they continued to have control over their day-to-day lives. People stated that they are able to choose what time they get up, when they went to bed and how they spent their days.
Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 6 Personal rooms viewed by the inspectors showed that service users are able to bring personal possessions with them, which creates a homely feel. Service users stated that they are able to have visitors at any time and this was confirmed by a visiting relative. A number of new staff has been employed recently to meet the needs of the expanded service. The inspectors saw evidence that there is a robust recruitment procedure in place which minimises the risks to service users. Appropriate steps have been taken to ensure the health and safety of service users and appropriate records are maintained. All service users spoken to stated that they would be comfortable to approach the manager or a member of staff with any worries or concerns. What has improved since the last inspection?
There have been many changes at the home since the last inspection. The number of beds provided has increased from 52 to 67 and a new manager has been registered with the Commission for Social Care Inspection. There is now a member of the management team who has a lead role in the care of people who have a dementia. Everyone who expressed an opinion was very complimentary about the new manager. They felt that although a lot of change was being introduced it was all very service user focussed. The manager was described as having high standards in respect of care but was very open and approachable and keen to listen to ideas and suggestions about the running of the home. Another improvement has been the further development of the social stimulation within the home. There are now two dedicated activity workers. One of the activity workers is based mainly in the units providing care for people who have a dementia. She is currently in the process of compiling information about each service user in order to tailor activities to individual interests. Both activity workers were very enthusiastic about their roles and shared their ideas for enhancing the service they offered. A small shop has been introduced, which allows service users to purchase personal items without leaving the home. Service users felt that this was a very positive development. Staff spoken to felt that the opportunities for staff training had improved. At the last inspection a requirement was made in respect of the recording of medication administration. The Medication Administration Records were viewed at this inspection and found to be well maintained and correctly signed.
Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 7 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 Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4 & 5. All prospective service users are seen and assessed prior to being offered a place at the home. The assessments carried out by the home are basic and do not contain information about likes, dislikes or personal preferences. All service users who move to the home receive a service user guide, which gives clear information about what is provided by the home. EVIDENCE: The fees at the home range from £349.00 to £421.00 per week. A service user guide is given to all when they move into the home. This document clearly sets out what a service user can expect from Oak Trees and what is included in the fee. Personal clothing, toiletries and newspapers are not included in the fee. Since the last inspection the home’s Statement of Purpose has been revised to reflect all changes in the home. This is available to all in the main reception area. Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 10 All prospective service users are seen and assessed by a member of the management team and people have the opportunity to visit the home before making a decision to move in. All service users wishing to move to the Acorn or Oak Leaf unit are seen and assessed by a member of the Community Mental Health Team for older people to ensure that the home will be able to meet their needs. All personal files viewed at this inspection contained pre-admission assessments completed by the home and some had full assessments, which had been completed by other relevant professionals. The assessments carried out by the home did not contain any information in respect of likes, dislikes or preferences. 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. On the day of the inspection these had not been filled in on either the Acorn or the Oak Leaf unit, meaning that people were not able to easily obtain this information. 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 D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10. Service users living at the home have access to healthcare professionals appropriate to their needs. Care plans seen by the inspectors did not always give detailed information about the persons needs and did not include the individual preferences of the service user. EVIDENCE: The inspectors viewed a total of six personal files. Each had a care plan, however, three of the six did not have a full assessment of need so it was difficult to tell where the plan of care had been drawn from. The quality of care plans varied. One seen had full information about the service user and gave detailed information about the assistance required with everyday tasks. One care plan seen by the inspector stated that the person was diabetic but gave no detailed information for staff as to how this was managed. It was noted from the daily records that this persons blood sugar levels were being monitored, there was no mention of this in the care plan and therefore no
Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 12 information about how often this was to be carried out or any indications for staff to be aware of. Two care plans stated that the service user required ‘assistance’ with personal care but again there was no further information about the level of assistance required or the preferences of the service user. Two of the care plans seen belonged to people who were living in the dementia care unit and were not always able to express themselves fully. It was concerning to the inspectors that there was no information in the care plans about people likes or dislikes. There was no information about peoples preferred routines or social histories. Whilst it is acknowledged that some of this information is available in other formats in the home it is not easily accessible to staff and therefore makes it difficult for staff to provide person centred care to individuals. All service users are registered with local GPs and other healthcare professionals appropriate to their individual needs. All service users are assessed in respect of their nutritional needs, the risk of falls and the needs in respect of moving and handling. Some of the information from these assessments had not been incorporated into care plans. For example one person had had 27 falls recorded in a two and a half month period but no care plan had been raised in relation to this. 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 they would be comfortable to discuss healthcare issues with a member of staff or the manager. All felt that they had adequate access to healthcare professionals. All personal care is carried out in the privacy of en suites, personal rooms or bathrooms. The inspectors noted that during the inspection staff interacted with service users in a friendly respectful manner. Staff were seen to knock on bedroom doors before entering and address people in their preferred way. The home uses the Boots Monitored Dosage System for medication. The Medication Administration Records were viewed and found to be well maintained and appropriately signed when administered or refused. Controlled drugs were sampled and stocks held correlated to records kept. A senior member of staff always administers medication. All senior staff have received training in the safe administration of medication. Some points in respect of storage were raised with the manager; the medication storage cupboard on the new unit exceeded the recommended
Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 13 temperature and the temperature of the medication fridge in the main part of the home was not being correctly recorded. Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 14 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, 14 & 15. The opportunities for social stimulation and meaningful activities have improved since the last inspection. Activity workers are currently looking at ways to further develop this and tailor activities to individual interests. Visitors are made welcome at the home at all reasonable times. Some carers demonstrated extremely poor practice when assisting people with meals and require further guidance in this area. EVIDENCE: Service users are able to maintain choice over many areas of their lives. Personal rooms seen by the inspector showed that people are able to bring possessions with them when they move to the home, which gives them an individual homely feel. Visitors are always made welcome and there is information about how to contact outside agencies including independent advocates. Some service users continue to control their financial affairs; some are assisted by relatives and some by the home. The records in respect of personal monies managed by the home were not viewed on this occasion. Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 15 Service users who were able to fully express their views stated that there were no fixed routines in the home. Everyone is able to choose what time they get up, when they go to bed and how they spend their day. On the day of inspection people were seen to spend time joining in with organised activities, reading, chatting to other service users, seeing visitors or occupying themselves in their rooms. The inspectors spent some time in the Acorn and Oak leaf unit observing care practices. Some people were joining in with a cake making activity and others were occupying themselves, people were seen to move freely around the house and gardens. Since the last inspection the home have increased the amount of hours allocated to activity workers and therefore the amount of social stimulation available. There are now two activity workers one based mainly in the Acorn and Oak Leaf unit and one based mainly in the main part of the home. The inspectors were able to speak with both of these members of staff and were impressed by their enthusiasm for their jobs. The worker who is based in the Acorn and Oak Leaf unit is currently compiling information on each service user to determine their interests with a view to tailoring activities to individual abilities and interests. There are group activities organised daily and both workers stated that they also carry out individual sessions with people who prefer not to be part of a group. Service users stated that activities include skittles, quizzes, scrabble, manicures, massage and bingo. There are also some art and craft sessions and the inspector saw some of the work that had been produced by service users. There is a regular church service at the home for those who wish to attend. Some people have newspapers delivered and the library visits on a regular basis. The inspectors saw posters advertising a trip to the local garden centre and a cream tea being held at the home. There are photos around the home of events that have taken place including a party to celebrate 60 years since VE day. Service users stated that they were able to choose which activities they joined in with. The home has recently opened a small shop, which enables some service users to make purchases without leaving the home. Service users spoken to were very pleased with this. Twelve people completed comment cards prior to the inspection seven people answered YES to the question “ Does the home provide suitable activities?” Activity workers stated that they had received training appropriate to their roles and were enthusiastic about this.
Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 16 Service users stated that they were able to have visitors at any time and this was confirmed by a visiting relative who kindly spent time talking with the inspectors. Each area of the home has its own dining area and the inspectors viewed lunch being eaten in each. Food is delivered in hot trolleys from the main kitchen. There is a choice of food at each meal. Service users in the main part of the home choose their meal in advance and are able to help themselves to vegetables from serving dishes on individual tables. People in the Acorn and Oak Leaf unit are offered choices at each meal. Some people require assistance with eating. The inspectors observed two instances where carers helping service users to eat mixed the entire contents of the plate together making the meal very unappealing to look at and giving service users no choice about which parts of the meal they wished to eat or refuse. Eight of the twelve people who completed comment cards prior to the inspection answered ‘SOMETIMES’ to the question “Do you like the food?” this was discussed with the manager and the senior member of staff responsible for the catering. It was stated that the company are looking at new menus based on nutritional research and these will be introduced in the near future. Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 17 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 & 18. Service users stated that they would be comfortable to raise any concerns or worries with the manager. There is evidence that any complaint made is fully investigated and appropriate action taken by the management of the home. EVIDENCE: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. Staff spoken to were aware of the ability to take serious concerns outside the home. (It was noted that the whistle blowing policy was discussed at the last full staff meeting.) The home has received one complaint since the last inspection. This was fully investigated and the manager involved the appropriate outside bodies. The complainant and the Commission for Social Care Inspection were kept informed of the investigation and it’s outcome. Service users spoken to stated that they would be comfortable to raise any concerns or complaints with the manager or a member of staff. As previously stated there is information in the home giving details of how to contact independent advocates. The Acorn and Oak Leaf unit are separated from the home by an electronic keypad, which restricts the freedom of movement of some service users. All the people living in these parts of the home have been assessed by outside
Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 18 professionals as requiring this level of security. The inspectors observed that all service users are able to move freely around their area of the home and all have unrestricted access to outside space. All staff working at the home are checked against the Protection Of Vulnerable Adults register before commencing work and all undergo a Criminal Records Bureau check. Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 19 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 & 26. The home is comfortably furnished and there is an ongoing programme of redecoration and refurbishment. There needs to be a system in place to ensure that the cleanliness of the kitchen is addressed and maintained. 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. The home was purpose built some years ago and the Oak Leaf unit was built and opened earlier this 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
Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 20 independently around the home. There are assisted bathing facilities, raised toilets and appropriately placed grab rails. The new unit 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. As previously mentioned orientation boards in the Acorn and Oak Leaf unit had not been completed on the day of the inspection. All personal rooms in the home are for single occupancy, many in the main part of the house are less than 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. In one bedroom the wardrobe door was missing. There are no facilities for staff to wash and dry their hands in bedrooms where service users are assisted with personal care. 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 areas of the home have direct access to outside space which service users have unrestricted access to. 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. 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. The inspectors discussed with the management team the malodour in one part of the home. Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 21 The inspectors viewed the main kitchen and noted that this would benefit from refurbishment. Although the equipment in the room appeared clean and well maintained other areas required deep cleaning. An immediate requirement was issued to address this issue. (This is the second time that an immediate requirement has been issued in respect of the cleanliness of the kitchen.) Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 22 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, 28, 29 & 30. There is a robust recruitment procedure in place which minimises the risks to service users. The manager has a commitment to ensuring that staff receive the training they require to meet the needs of service users. EVIDENCE: The home employs 52 care staff and 22 ancillary staff. Since the last inspection a number of new staff have been appointed due to the increase in the size of the home. The inspector viewed the recruitment files of four new staff; all contained all items required and gave evidence of a robust recruitment procedure. New staff are currently working alongside more experienced staff who are offering informal guidance and support. Somerset Care offers a full induction package to all new staff. In addition the Specialist Liaison nurse is providing training sessions to all staff in the care of people who have a dementia. The number of staff on duty varies depending on the time of day. Staff spoken to felt that there was adequate staff on duty. There is always a senior member of staff on duty who co-ordinates other staff and supervises the smooth
Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 23 running of the day. There is now a member of the management team based in the Oak Leaf Unit who oversees the care offered here and in the Acorn unit. There is evidence that the manager is monitoring the staffing levels and stated that the night staffing levels are due to be increased next week as a need for this has been identified. Staff spoken to felt that the training opportunities were improving and the new manager clearly is committed to ensuring that all staff receive the training they require to carry out their roles and meet the needs of service users. All staff receive mandatory training and are encouraged to undertake NVQ training. Currently 39 of the care staff have an NVQ in care at level 2 or above. Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36 & 38. The registered manager of the home is competent and gives a clear direction to the home. EVIDENCE: The registered manager of the home has changed since the last inspection. The registered manager is now Julie Watts; the previous registered manager is now taking the lead responsibility for dementia care. Julie has been in post for a number of months and was registered with the Commission for Social Care Inspection in June of this year. She has a wealth of experience of caring for older people in variety of settings. During the inspection Julie was open and co-operative and demonstrated a good knowledge of the service users and staff at the home. A new deputy has also been appointed since the last inspection.
Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 25 Staff spoken to were extremely complimentary about the new management structure and felt that many changes were being introduced that would benefit service users. Staff, service users and relatives stated that the manager was very visible in the home and was approachable and open to suggestions. There are regular staff meetings and minutes of these seen by the inspector show that this is a forum for staff to discuss a variety of issues. All staff receive regular formal supervision and the inspectors viewed a sample of these records, again they showed a variety of subjects discussed. Staff spoken to stated that they found supervision beneficial and it was an opportunity to discuss many issues, including training needs. Appropriate steps have been taken to minimise environmental risks to service users. All hot water outlets in communal areas are thermostatically controlled to reduce the risk of scolding, radiators have been guarded and windows above ground floor level have been risk assessed and restricted, where appropriate, in line with health and safety guidelines. A fire detection system is fitted throughout the home and records show that this is regularly tested. There are up to date certificates in respect of the electrical and gas installations in the home. All equipment is regularly serviced. All accidents are recorded but the inspectors saw no written evidence that these were being audited although records of falls are maintained in individual files. Staff have received training in fire safety, food hygiene, if appropriate, moving and handling and other health and safety issues. All senior staff undertake training in first aid and therefore there is always a qualified first aider on duty. Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 1 STAFFING Standard No Score 27 3 28 3 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 3 3 x x x 3 x 3 Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 7 & 8. Regulation 15 (1) Requirement Care plans must be personalised to ensure that they give clear direction to staff about how to meet the needs of service users in their preferred way. When an assessment highlights an area of risk or need a care plan must be in place in respect of this. Care plans must include information about likes, dislikes and preferred routines. The manager must ensure that medication is stored at an appropriate temperature. The manager must ensure that meals are served in a way that respects the dignity of service users and offers choice. The main kitchen must be deep cleaned. A system must be put in place to ensure the ongoing cleanliness of the kitchen. The manager must address the malodour discussed at the inspection. Timescale for action 15/08/05 2. 3. 4. 7 9 15 12 (2) 16 (2)[m] 13 (2) 12 (4) 30/08/05 15/08/05 30/07/05 5. 26 16 (2) [j] 1/08/05 6. 26 16 (2) [k] 15/08/05 Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 28 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. 2. 3. Refer to Standard 4 15 26 Good Practice Recommendations Orientation boards should be completed daily to ensure that service users are able to easily access information about the day. The manager, in consultaion with service users, should review the menus in the home. Staff handwashing facilities should be provided in personal rooms where assistance with personal care is given. Oak Trees D53_D02 S15988 Oak Trees V229784 190705 Stage 4.doc Version 1.40 Page 29 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier, Taunton Somerset TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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