Inspection on 06/12/07 for Oakapple Care Home

This inspection was carried out on 6th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Oakapple Care Home 30/09/08

Oakapple Care Home 23/05/07

Oakapple Care Home 25/10/05

Oakapple Care Home 13/05/05

Oakapple Care Home 16/12/04

Oakapple Care Home 25/05/04

Oakapple Care Home 03/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Oakapple Care Home Debdale Hall Bungalow Debdale Lane Mansfield Woodhouse Mansfield Nottinghamshire NG19 7EZ Lead Inspector Mary O’Loughlin Unannounced Inspection 6th December 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakapple Care Home DS0000008724.V352097.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. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakapple Care Home Address Debdale Hall Bungalow Debdale Lane Mansfield Woodhouse Mansfield Nottinghamshire NG19 7EZ 01623 622 588 01623 631 959 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) Mrs Wendy Mary NG Yin Kwong Mrs Wendy Mary NG Yin Kwong Care Home 10 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (10), Old age, not falling within any other of places category (10) Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users shall be within category DE(E) (10), DE (10) or OP(10) Date of last inspection 23rd May 2007 Brief Description of the Service: 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 available for 6 cars. The manager said on 23/05/07 that the fees for the service range from £334 £344 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. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents 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. One inspector conducted the unannounced visit. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The care manager and registered provider, members of staff and visitors to the home were spoken with as part of this visit. Documents were read as part of this visit and medication management was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken which included a sample of resident’s bedrooms, to make sure that the environment is safe and homely. A review of all the information we have received about the home since the last inspection was considered in planning this visit and this helped decide what areas were looked at. A range of additional information was used to determine the outcome of this visit, including information provided by the registered provider within an Annual Quality Assurance Assessment (AQAA). What the service does well: Visitors are welcome to come to the home at anytime. This enables residents to keep in contact with family and friends. The home is suitably decorated and furnished and kept in a good state of repair as a result residents live in a safe and well-maintained environment. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 6 Most staff have either completed or are working towards National Vocational Qualification level 2 so residents are cared for by staff that have a qualification in their work. What has improved since the last inspection? What they could do better: Improvements in the recording and safekeeping of medicines must be made to ensure the health and safety of the residents. All staff files need to be audited to ensure that all appropriate records are in place that reflect a safe and robust recruitment system is being followed. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 7 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. Oakapple Care Home DS0000008724.V352097.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 Oakapple Care Home DS0000008724.V352097.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): 1-6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home only take place following an assessment of the prospective residents needs. Intermediate care is not provided. EVIDENCE: Following the last Key inspection on 23/05/07 Requirements were made for the improvement of the process of admissions, ensuring that prospective residents to the home had their needs assessed before admission. The provider’s response to the improvement plan stated that pre-admission assessments would be put in place by August 2007. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 10 At this inspection I examined the admission records of the last three admissions to the home, all admitted after the date of the improvement plan. I evidenced that in all three cases a pre-admission assessment had been undertaken in accordance with National Minimum Standards I spoke to the relatives of one of those case tracked who confirmed that the assessment had been undertaken with them involved. The resident had received a Mental Capacity assessment from a social worker and the records contained evidence that the resident had lacked capacity to understand the process of care planning and had therefore not been able to be actively involved. Oakapple Care Home DS0000008724.V352097.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): 7-8-9-10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. Improvements are needed in the management of medicines to ensure the health and safety of the residents. EVIDENCE: At the last inspection of 23/05/07 there were identified shortfalls in the care planning for residents. The care manager has since improved the recording and care planning systems and provided staff with training to ensure that the needs of the residents are identified and met. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 12 Three care plans were examined, each plan had a clear description of the holistic needs of the residents. The plans were clearly written and easy to follow. Mobility plans showed a significant improvement since the last inspection, they were more detailed and explained the method of moving and handling that staff were to undertake. One resident that required hoisting and suitable bed raisers had been provided to allow for the hoist to get under the person’s bed appropriately. Each plan had a review record monthly and had evidence of a six monthly review including those acting in the interests of the resident. One resident had significant weight loss that was identified early by staff ensuring they were weighed monthly, a care plan then advised weekly weighing and a food chart was commenced. The relatives of this resident told me they had been informed by the manager of the weight problem and the manager had asked the doctor to visit on three separate occasions. The relatives of a resident said that staff demonstrated skill and understanding of their father’s condition. They said they could read his care plans whenever they wish. They felt confident in the care he was receiving, staff had endeavoured to manage his restlessness without overly sedating him, they had been fully consulted about this, and found staff spent time talking to him and spending time with him. The home had received an inspection by the Primary Care Trusts (PCT) Pharmacist on 22/11/07. The record of this inspection was examined and showed that there were shortfalls identified. The medicine records of those resident’s case tracked showed that all three had received their medicines as prescribed. There was evidence that staff had hand written medicines without appropriate signatures, this was also picked up on the PCT inspection. The PCT identified suitable medicine policies were in place, however I advised the manager to access the Royal Pharmaceutical Society guidance from Commission for Social Care Inspection website. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 13 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): 12-13-14-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices about their life style, and are supported to maintain individual choice. Recreational activities meet the needs and expectations of the residents. Resident’s benefit from the provision of an appealing balanced diet. EVIDENCE: Improvements were identified in the provision of suitable activities and meal provision since the last inspection. The records of two residents were examined. The first record showed that the person had received a mental capacity assessment from external professionals, this indicated that he did not have capacity, the care plan demonstrated that staff had acted in his best interests and provided a level of activity that suited his individual needs, they had Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 14 collected information from his relatives and used this to inform how they supported him in activities of everyday life. The second resident although cognitively impaired was still able to choose how he spent his day, the care plan identified how staff were to ask him what he wished to do and respected his right to privacy and non participation as he so wished. Records of each individual’s activities were also seen along with a staff allocation book that identified who was responsible for each activity each day. Although there is no dedicated activities employee there were 6 staff on the premises at the time of this inspection and on my arrival residents were having hairdressing and staff were seen to spend time with the residents. Residents and staff were unhurried and needs were being met. The lunchtime meal was observed being served out and residents received individual attention from staff to ensure they were offered choice. There were sufficient portions available to everyone. Staff were observed encouraging and supporting people to eat their meals with respect and dignity. Religious needs are recorded in the care plans but all those case tracked were non-practising. The manager said that residents would be supported to attend church if they wished to do so. The care manager said that she intended to appoint a cook but financial restraints earlier in the year due to poor occupancy levels had prevented them from doing this, but they are now trying to recruit. The staff spoken with said they enjoyed working in the kitchen, did not feel rushed and had received food hygiene training. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 15 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): 16-18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a small home and the revised care reviews and key worker system encourage good communication with residents and relatives, creating cooperative relationships that prevent situations where complaints develop. Where people may have serious concerns and fear of victimisation there is an appropriate complaint procedure and Safeguarding Adults procedure that are accessible and advises of alternative agencies that they can refer to. EVIDENCE: It was established at the last inspection that an appropriate complaints procedure was available to residents and advocates within the main entrance. This is still in place. The residents case tracked had limited or no capacity to actively make a formal complaint. There are good systems that are in place now to ensure that concerns are addressed through valuable interventions such as the 6 monthly multidisciplinary reviews and monthly care planning that involves wherever possible the resident and their advocates. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 16 The relatives I spoke to describe an open culture in the home where information was very accessible and staff very approachable. They described how staff go out of their way to talk over care and concerns and work with them to ensure positive outcomes for the residents. They said that they knew about the complaints procedure but felt they had never got to the point of needing to formally complain as concerns were dealt with quickly. They said they can ring up anytime and staff will also take the phone to the resident if they wish to speak to them directly. The Commission was alerted to three complaints since the last inspection. These complaints were referred to Social Services for investigation and the outcomes have not been received to date. Robust systems for protecting residents from abuse were assessed as in place at the last inspection 23/05/07and were not re-assessed at this inspection. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 17 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): 19-26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-maintained environment. EVIDENCE: These standards were assessed on 23rd May 2007 and were found to meet the National Minimum Standards. There have been no concerns received since the last inspection in relation to these standards. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 18 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): 27-28-29-30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the residents who use the service. The manager follows appropriate recruitment procedures that safeguard residents but needs to audit all staff files to ensure that they are complete. EVIDENCE: The last inspection found that care staff on duty had only recently been employed and lacked the skills and experience required. The manager has since worked hard obtaining access to training for all staff employed and a staff-training matrix was seen that identified appropriate training in mandatory areas and Dementia care. Three staff files evidenced that all had received training in Dementia care. Relatives said that staff working with the residents know what they are meant to do, and felt that they were meeting the residents needs. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 19 There were shortfalls in the checking of Criminal records and obtaining references at the last inspection. On this occasion the three staff files examined were complete apart from one that did not contain 2 references. The manager said she had received these but was unable to locate them, however she said that she would ask for them again immediately. The manager said she does not employ any young workers under (18yrs). At the last inspection there were no available records of the duties that staff worked and there were concerns that the numbers and skill mix of staff could not meet the needs of the residents. On this occasion I examined the duty records which indicated that the care manager or manager alternate being on duty each night. There is now a senior member of care staff on duty during the day. There were three care staff, the care manager and the registered manager on duty. Residents and relatives said they were happy and felt well cared for. Standard 28 was met at the last inspection. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 20 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): 31-33-35-38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff and residents feel supported by the management of the home. Improved infection control systems ensure the health and safety of the residents. EVIDENCE: Standards 31-33-35 were all assessed, and met National Minimum Standards at the inspection of 23/05/07. There were shortfalls in Standard 38 as it was noted that staff did not wear protective clothing when undertaking care work and kitchen work. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 21 The care manager has provided training in infection control and staff spoken with said they wear appropriate protective clothing when undertaking clinical duties. I discussed with staff the availability of protective clothing and they confirmed it was provided. The staff were observed wearing appropriate protective clothing when giving out meals and when providing care. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 22 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X X 3 Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 23 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 OP9 Regulation 13 Requirement You should make suitable arrangements for the recording, handling and safekeeping of medicines 1. Sign all hand written Medicine records. 2. Ensure there are no gaps on Medicine record sheets. 3. Date the opening of liquids 4. Monitor the temperature of the storage area. All staff files require auditing to ensure that all appropriate recruitment documentation is in place. This is a repeated requirement and must be addressed within the timescale. Failure to comply with the provision of the regulation stated is an offence. Timescale for action 01/01/08 2. OP29 19 01/02/08 Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 24 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 Refer to Standard OP8 OP8 Good Practice Recommendations You should contact the G.P. or District Nurse team for guidance and referral of residents to the falls team specialists. You should ensure that risk assessments such as nutritional risks are re-assessed monthly or as conditions change, this should inform the actual care plan of the resident. You should access advice from the Community Dieticians for those residents identified as a significant nutritional risk. Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Nottingham Area Office Tottle Road Riverside Business Park Nottingham NG2 1RT 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 Oakapple Care Home DS0000008724.V352097.R01.S.doc Version 5.2 Page 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. 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