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Inspection on 30/09/08 for Oakapple Care Home

Also see our care home review for Oakapple Care Home for more information

This inspection was carried out on 30th September 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home benefits from consistent management and a well trained staff team. They are keeping fully up to date and there is strong evidence that the ethos of the home is open and transparent. The views of both people who use the service and staff are listened to, and valued. The staff team are trained in their role and have achieved nationally recognised training standards in the care of older people, ensuring that the care delivery is safe. There are plentiful staff available at all times to support the needs, activities and aspirations of people in an individualised and person centered way. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs.

What has improved since the last inspection?

The management of medicines is safer, staff now ensure that hand written medicines are signed and witnessed, there are suitable audits of the administration of medicines and compliance with the home`s policies. Staff recruitment is more robust ensuring that all staff files contain the required checks that consider their suitability to work with vulnerable people.

What the care home could do better:

They need to obtain a suitable controlled medicine cabinet that complies with the new revised controlled medicines safe custody regulations to ensure there is no misuse of these potent medicines. They must improve how they assess people within the environment regarding the risk to their safety with hot water and exposed radiators so that wherever possible people are safe from hazards to their safety.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oakapple Care Home Debdale Hall Bungalow Debdale Lane Mansfield Woodhouse Mansfield Nottinghamshire NG19 7EZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mary OLoughlin     Date: 3 0 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Oakapple Care Home Debdale Lane Debdale Hall Bungalow Mansfield Woodhouse Mansfield Nottinghamshire NG19 7EZ 01623622588 01623631959 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Wendy Mary NG Yin Kwong Type of registration: Number of places registered: Mrs Wendy Mary NG Yin Kwong care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Service users shall be within category DE(E) (10), DE (10) or OP(10) Date of last inspection Brief description of the care home Oakapple is a care home providing personal care and accommodation for 10 older people. The home provides long-term care and will accept emergency admissions. The home is owned by Mrs Wendy Mary NG Yin Kwong, which is run as a family business. The home is located in the grounds of Debdale Hall between Mansfield and Mansfield Woodhouse about a mile from shops, pubs, the post office and other amenities. The home was opened in 1987 and consists of an extended bungalow.6 of the homes bedrooms are single, and 3 of the bedrooms have en-suite facilities. The home has large gardens that are well maintained and easily accessible. There is car parking Care Homes for Older People Page 4 of 26 Over 65 10 10 10 0 Brief description of the care home available for 6 cars. The manager said that the fees for the service range from £338 £348 per week depending on dependency needs. There are additional charges for hairdressing and chiropody. Further information about the home is in the Statement of Purpose and Service User Guide. Any further information wanted can be obtained from the manager or care manager. A copy of the latest inspection report is available in the entrance hall. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. A review of all the information we have received about the home was considered in planning this visit including the Annual Quality Assurance Assessment (AQAA), and this helped decide what areas were looked at. The main method of inspection used was called ‘case tracking’ which involved selecting Care Homes for Older People Page 6 of 26 the care plans of 2 people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Members of staff, people who use the service and their relatives were spoken with as part of this visit. A partial tour was undertaken, which included looking at people bedrooms and communal areas of the home. The last key inspection was done on 06/12/2007. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The way people are admitted is person centered and ensures that the individual needs and wishes of the person are identified and care agreed to before they come to stay. Intermediate care is not provided at the home. Evidence: From previous information and through looking at the records of a recently admitted person we identified that the manager spends a significant time assessing peoples needs before they agree on admission. We saw that staff make every effort to obtain information from other agencies that may be involved with the person so they have an in depth picture of the persons needs. Care Homes for Older People Page 10 of 26 Evidence: Once people are assessed they receive a letter confirming that the home is able to meet their needs and a care plan is drawn up with everyone involved from the outset of the admission to make sure people know what to expect and have agreed to the support being provided. Because the service provides care for people with Dementia the information obtained about people includes a pen portrait of the persons life, wishes and expectations, choice and consent, to allow staff to work in the best interests and wishes of the person throughout the process of their illness. The staff files identify that they are trained in how to care for people with Dementia using person centered approaches to care which identifies and respects all the individual needs of the person. Information about the services that the home provides is available in large print. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and personal care delivered in accordance with their wishes and receive their medicines safely. Evidence: From information we have received through the AQAA it tells us that the staff have received training about working in peoples best interests when they lack capacity to make their own decisions. We saw an example of how staff responded to a person when they made requests to leave the home and return home.The staff ensured they listened to the person and took her seriously. They made a request for the social worker to review the person to ensure that they were working in her best interests. There have been no serious accidents or changes in peoples health and wellbeing reported to the commission since the last inspection. Care Homes for Older People Page 12 of 26 Evidence: We looked at how people were protected when they had an increased risk of falling due to their poor mobility. We saw examples of how staff work to maintain peoples mobility and encouraging their independence in daily living.One person who was at risk of falling had a care plan that described how staff were to improve her safety and showed how they work with external falls risk nurses to keep people safe. There were some shortfalls in the frequency of assessing people for any risk of them developing pressure sores, staff did not always review these assessments each month and may not reflect their current risk level as a result. Improvements in the management of medicines were identified, these included that staff always sign and witness hand written medicines to ensure there are no errors. The manager conducts audits of medicine administration to make sure staff are following the homes policies and people receive their medicines on time. The controlled medicines were not stored in accordance with the revised Safe Custody laws to ensure there is no misuse. People told us that staff treat them well and relatives told us that they are always consulted about care plans and kept informed of any changes in peoples condition. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in meaningful activities according to their individual interests, needs and abilities. Evidence: This is a small home that reflects a family like environment with 2 separate lounges that people can spend their day in. Each person has a record within their care files that records their previous hobbies and interests and preferences with diet. We saw how staff have developed activity books that remind people of what events they have been involved in including photographs of these events and people close to them. The dining room has a bar area where people can have drinks in the evening. People were watching television during this visit and they told me that they enjoyed their days and were able to have visitors when they choose. Care Homes for Older People Page 14 of 26 Evidence: People have their nutritional needs assessed and we saw how staff review people each month by recording their weight and keeping food records for people at risk. The staff are trained in safe food hygiene practices and the meal delivery was seen to be well organized and congenial. People requiring soft diets and assistance to eat received staff time and support to do so. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are listened to and taken seriously and are protected from abuse through appropriate policies and procedures. Evidence: The service continues to listen to people and improve ways to ensure that they are clear about how to complain or make suggestions for improvements. Each person has a complaint procedure posted in their rooms and a complaint box is visible in the main reception. The commission have not received any complaints about the home since the last inspection. The manager said that she holds records of any complaints but these were not viewed at this inspection. Staff ensure that people access their advocates and care records identified how one person was to be helped to telephone her advocate when she wished. People told us that they felt safe and relatives told us that they are always able to talk over changes with the staff. Care Homes for Older People Page 16 of 26 Evidence: The AQAA tells us that the manager ensures staff have training in how to protect people from abuse and we saw that staff training files contain evidence that they receive this training. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and people are protected from the spread of infection. Evidence: The home was clean and warm throughout. The entrance is alarmed to alert staff to anyone that may wander from the building who may be unsafe. Minor repairs seen are recorded and dealt with as part of the ongoing maintenance programme in place. The AQAA told us that the manager recognises the importance of good infection control practices to protect people from harm. We saw how they have completed a full audit of the infection control practices at the home in line with the Department of Health guidance. We saw that some staff have received training in infection control and every new member of staff is informed of the homes policies to protect people from infection. Care Homes for Older People Page 18 of 26 Evidence: Care plans identified how people are referred to professionals in infection control when any health problems require this support. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are trained in the needs of people living at the home to ensure that they are in safe hands at all times. Evidence: The AQAA tells us that the manager recognises the importance of a trained staff team who they retain, to ensure that the people in the home receive a good standard of care at all times. The records of staff training show us that the manager has considered the needs of people in the home and ensured staff are trained in those areas to provide safe outcomes in care delivery. There is a clear focus on providing a person centered approach for people in the home and we saw through case tracking that staff are aware of and work to expected practices when people lack capacity to make their own decisions. The staff records show that they are recruited through robust procedures that make sure they are suitable to be working with vulnerable people and also shows compliance with the previous requirement set at the last inspection. Care Homes for Older People Page 20 of 26 Evidence: People said they were happy with the care they were receiving and relatives said that staff consulted them on all plans of care. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of people who live there. Evidence: The manager sent us the completed AQAA document in time and the information was satisfactory within all sections giving a fairly clear picture of the improvements they are making and planning. The compliance with requirements set at the last inspection and the improvements that have been made show that the manager is aware of her obligations and current developments both nationally and within the Commission and plans the service accordingly. From what people tell us and from care records we see that people at the home are benefiting from a trained staff team that support their individual needs. Care Homes for Older People Page 22 of 26 Evidence: The care plans tell us that people are consulted on their satisfaction with the services offered. We saw that the Environmental Health Inspection during July 2008 found very good hygiene practices within the home. Staff are trained in areas of health and safety such as how to move people safely and how to protect people from harm through good risk assessments. There were shortfalls in ensuring the environment had suitable assessment of risk, the hot water management was unclear and the manager did not know if the hot water was regulated to a safe temperature. Some radiators were not covered and could present a burn risk to vulnerable people. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Ensure that controlled 07/01/2009 medicines are stored as required under the Misuse of Drugs Act (Safe Custody). To ensure there is no misuse. 2 38 13 Ensure that people are assessed for risk to their safety from the management of hot water and uncovered radiators. To ensure that as far as possible all parts of the home are free from hazards to their safety. 07/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 8 9 Assess people for their risk of developing pressure sores each month and as their conditions change. Retain the certificate of compliance when you obtain the new controlled medicine storage cupboard. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!