Inspection on 27/03/08 for Oakcroft Nursing Home

This inspection was carried out on 27th March 2008.

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

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

Oakcroft Nursing Home 07/01/09

Oakcroft Nursing Home 15/05/07

Oakcroft Nursing Home 15/01/07

Oakcroft Nursing Home 19/05/06

Oakcroft Nursing Home 03/03/06

Oakcroft Nursing Home 05/09/05

Oakcroft Nursing Home 31/03/05

Oakcroft Nursing Home 09/11/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Oakcroft Nursing Home Oakcroft 41-43 Culverley Road Catford London SE6 2LD Lead Inspector Unannounced Inspection 09:15 27 March 2008 th 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 Oakcroft Nursing Home DS0000007037.V360936.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. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakcroft Nursing Home Address Oakcroft 41-43 Culverley Road Catford London SE6 2LD 020 8461 5442 020 8698 0636 oakcroftnursing@btinternet.com 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) Mr John Moore Vacant Care Home with Nursing 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Physical disability (28) of places Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Physical disability - Code PD The maximum number of service users who can be accommodated is: 28 15th May 2007 Date of last inspection Brief Description of the Service: Oakcroft Nursing Home provides care for up to 28 older people and caters for respite stays as well as long-term care. In the past 12 months the registered manager ended her employment and the new manager who is experienced in the field of providing nursing care has taken up the post of manager. There has also been a substantial change in the care and nursing staff, with more than have to staff team having been employed since the last inspection. The home is a detached house with three storeys close to Catford train station and local shops and services. The area is also well served by buses to central and south London. There is accessible off road car parking space for up to 6 cars at the front of the building. On the day of inspection there were 8 vacancies according to the home’s current registration. However as the double rooms were being used as singles at the time, this translates to no vacancies. Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide, which are given to all service users. The recent CSCI report is kept in the lobby area of the home open for viewing. A reference is also included in the homes newsletter. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 5 At 27/3/08 the weekly fees are £495 per week for private and publicly funded residents. An additional £10 is charged for some residents with higher support needs. These fees cover all of the homes charges including food. Residents have to pay extra for other personal expenses such as hairdressing, transport, and personal shopping. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality Rating for this service is 1 Star. This means that the people who use this service experience adequate quality outcomes. Since the last key inspection two enforcement notices were issued to the registered provider. There followed an enforcement inspection visit on the third and fourth of December 2007, and it was found then that the home had complied with all of the requirements within the notice. The inspection was unannounced and was completed over one day from 9.15am to 8.45pm. The inspection ended on the 31/3/08 following receipt of further information from the home. The registered provider and the home’s manager facilitated it. Four care staff spoke with the inspector and their comments are included in this report. Four staff employment files were examined to check that they had been properly recruited, trained and supervised. Five residents gave their views on the home and four residents files were examined. Comments and information are included in the report. Three relatives who were visiting also gave their views. A visiting health care professional who visits the home weekly and knows the residents well gave her views on her experience of the home. Comments from the Lewisham adult protection team were also considered. There were eight residents’ vacancies but many of these beds are in double rooms, which are now used as single rooms. The inspection involved a tour of the premises and examination of a range of management documentation. What the service does well: The manager is experienced and provides good direction for staff in how to do their jobs. Both she and the owner are available to speak with residents when they need their help. All of the residents spoken to said the manager and owner are “always available for meetings and discussions” and that they are “quick to put things right”. People live in a comfortable, well maintained and mainly safe home, which is clean and hygienic. Staff are friendly and welcoming to visitors at all times, Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 7 including pre-admission visits. Residents enjoy a good choice of food. They are supported by an adequate amount of staff with a good level of NVQ training. All of the residents and relatives who spoke to me said there are generally positive about the home and that many improvements have been made. What has improved since the last inspection? The manager of the home, who is very experienced, has remained in post and has done much work to improve the environment including painting, decorating and replacement of furniture in many parts of the home. There are new members of staff who have started working in the home who show a good attitude of involving residents and participating in activities with them. The residents and their families said that staff are very nice and helpful and make them feel welcome. Training for staff is now better, and includes much more in-depth training in important areas such as the management of dementia, and there is significantly more involvement from external health care professionals on a regular basis. Care assessments and care plans for residents have now improved, and include enough information about peoples care needs to provide them with the support that they need. Residents are now involved in their care planning and they said that the manager and staff at also include residents families every month in reviewing the care plans. The care plans for residents now include activities such as bingo, music, doing puzzles and exercise. The residents and the visiting professional confirmed that these activities are happening regularly. Residents’ finances are now better protected and the home has done a lot of work to gather information from residents and their families about the best way to look after their money. The supervision of staff has also improved, and although there is still some work to do to ensure staff receive formal supervision six times a year, the staff records examined showed that all of the staff had received at least two supervisions in a five-month period, and that annual staff appraisals have now begun to happen. The residents and families are now being consulted in a meaningful way by the home by the use of questionnaires and quarterly meetings with residents and their families. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 9 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 Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 10 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): 3 and 6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. All residents have adequate written assessments of their care needs in place, but improvements are needed in areas regarding social and leisure needs and clearer information about the care of dementia. Intermediate care is not provided. EVIDENCE: There have been significant improvements made to the home’s care assessment process and in the assessments carried out. All residents now have care assessments in place and these are being used to plan care and support for residents. The home has started admitting residents with a diagnosis of dementia and admitted two residents with this support need in March 2008. The home is not registered for dementia and the inspector asked that they do not admit any new residents with a diagnosis of dementia, without first formally agreeing Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 11 with the social services, or with the commissioning agent, whether the residents support needs are such that they would present the home with significant problems in providing a service, such as risk of injury or of leaving the home without support. A visiting healthcare professional that works closely with the home in provision of care for the elderly said that none of the current residents have complex needs and felt that the home is able to provide for their needs. The manager agreed that in future they would always discuss and agree the implications of individual residents behaviours when carrying out an assessment. Where dementia is a consideration during the referral process, the home must ensure that a formal agreement is reached with the commissioning agent stating that the resident does not have complex support needs resulting from dementia and that this is formally recorded in care assessments. (Refer to Requirement OP3) The home’s assessment system now includes a section which clearly assesses the abilities and wishes of residents in relation to the management of their finances and benefits. The home does not manage the benefits or bank accounts for any residents. Residents either do this themselves or have family or a solicitor do this for them. This has now been clarified by the majority of residents or their representatives in the completion of a letter sent to them by the home. Copies of this letter are held on the residents’ files. The registered provider has had 11 out of 18 letters completed and returned to him. The home has complied with a previous requirement to include social, emotional and cognitive care needs of residents suffering from dementia in their care assessments and care plans. They have complete assessments for all of the resident’s files examined and all of these have a care assessment provided by social services included. There is evidence that these are used to develop care plans. The majority of residents are placed by social services but a small number of residents are privately funded, and would normally depend on the home’s own care assessment system for gathering all the relevant information to enable a decision to be made whether to admit such residents to the home. One of the files examined was that of a privately funded resident, and this appeared to be well organised. There is mention of the dementia support and effect of UTI’s regarding health and memory. At the last inspection in December 2007, the home’s own assessment system lacked information regarding mental health, dementia and social/leisure/cultural and religious needs. There was a separate system for looking at the social/leisure/cultural and religious needs immediately after admission, but this assessment should be done to some extent prior to admission, to determine whether the home can meet these needs before the resident moves in. There was a requirement made for the home to include more information about all of these areas in the home’s own care assessments. This has now been done, but the requirement is only partially met. The assessment form has been redesigned to include these areas of support need. However, the information recorded on these assessments showed only very Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 12 sketchy information about residents social care needs. For example a number of assessments said that the resident: “ likes to watch TV, read and to socialise” but did not expand further on what this means for the individual resident. The care plans went a bit further in explaining what these comments meant, and discussion with staff, residents and a visiting professional said that far more is happening with individual residents than is included in the assessment paperwork. I also observed this to be the case. While it is clear that the home is now assessing the social and leisure needs of residents and recording these, and that there is good involvement by residents, families and some visiting professionals in gathering information and improving social and leisure activities, it must also ensure that these detail are included in individual residents assessments. (Refer to Requirement OP3) Intermediate care is not provided. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health and social care needs are set out in an individual care plan, but these do not yet fully meet dementia care needs, though there has been much improvement. Residents’ health care needs are being fully met. They are offered the opportunity to be responsible for their own medication, and are protected by the home’s policy and procedures for managing medicines. Residents are treated with respect and their right to privacy is upheld. EVIDENCE: The Care plans have not yet been changed as was required following the enforcement inspection in December 2007, but this was still within timescale and the manager agreed that further changes needed to be made to make the plans more specific for each resident. There was a requirement made at the last inspection for the home to ensure that there are clear procedures in place for the management of personal finances. This requirement is now met and of the home has sought agreement from relatives, in consultation with residents, about how they will have this money available to them. Formal written Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 14 agreements are in place for each of these residents. (See also Standard 35 and Standard 3) The home has also spoken to relatives concerned and agreed that if they need to use the homes own funds to get items for residents that this will be refunded with receipts provided. There was a requirement made at the last inspection to include more specific details regarding what is meant by dementia for each resident in their individual care plan. This was to be supported by written direction for staff in how to provide the support. Good work has been done to improve care plans for new residents who have moved in to the home since January 2007, and adequate work has been done to include dementia in care plans for the residents who lived in the home prior to January 2008, but more detail about how the dementia affects these residents and how best to support them, including guidance for staff, is needed. This requirement is still within the timescale of the 30th of April 2008, and therefore this requirement still remains. (Refer to Continuing RequirementOP7 partially met) There was a requirement made at the last inspection of 3/12/07 for the home to ensure that care plans for residents with dementia are updated to include relevant activities specific to their dementia care needs. This requirement has been partially met and is still within the timescale. A visiting professional’s comments about the improved practice, and my own observations, together with the fact that there is now a record for each resident showing the activities they have participated in, allows me to feel that the delivery of service regarding care planning has improved significantly. Good work has been done to improve the recording and planning of activities for all residents, and theres now a record of daily activities that each resident takes part in. Care plans are in place for all residents and are being reviewed and dont present risk to residents. The current system and practice is for residents to be offered general activities and for records of resident’s participation to be recorded. However the care plans for residents with dementia need to be written in a way that is more specific to each resident regarding their preferred activities and briefly describe how and when to offer these activities and how staff should provide support. Staff training in this area should also be considered. (Refer to continuing Requirement OP7) There was a requirement made at the last inspection for the home to ensure that daily records for each resident be consistently completed regarding details of care and support of dementia and mental health and are applied to the care planning review process. There has been some improvements made in staff recording and some reference is now being made to these issues in the files I examined. However more detail is needed in these daily records to adequately support care reviews. This requirement was still within timescale and is a continuing requirement. (Refer to Continuing Requirement OP7) Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 15 Two visitors said that they are involved in their relatives care planning now, and they were busy completing a monthly information form given to them by the home for the purposes of reviewing the care plan for their relatives. Both of them commented that activities have improved for their relatives, and that there are now meetings between the home’s management and the residents and relatives which they find very helpful. It is recommended that the home consider recording the time and place that activities take place, and also record when activities are offered and refused by residents who suffer from dementia. This information should be used to monitor what is happening, and to offer alternative times, activities, or places to do the activities, as appropriate. (Refer to Recommendation OP7) Current care plans for residents are handwritten, and sometimes are difficult to read. It would be helpful for residents and relatives to be able to read their own care plans should they wish to, and currently this may be sometimes difficult. While it is not required the care plans be typed, they must always be legible. There is an admin. support issue and the current and admin. person works two days a week, making it difficult to envisage all care plans being typed. It is recommended that training be provided for RGNs responsible for writing care plans, in order to address the issues of plans being done in a consistent and legible manner. (Refer to Recommendation OP30) Risk assessments were observed on care plans. There is a record of these assessments being reviewed monthly, and there is guidance for staff in how to manage risk when it is identified. This is a significant improvement in the management of risk for residents in the home since the last key inspection. As at the last inspection there is a range of health care professionals involved in the provision of specialised support for the home. All residents are registered with a GP, dentist, chiropodist and optician, with some receiving support from the district nurse and psychiatry. Records showed weekly visits from GPs. Nursing care is provided at the home and all nursing staff are in charge of medication management and nursing care issues, while leading the shift. There is always at least one nurse available and the home’s manager is a qualified and experienced nurse. There have been few hospital admissions since the last inspection and tissue viability issues are being better managed. The files examined showed that the residents had skincare included in their care plan and that there was improvement in the level of recorded bedsores. The home’s medication policy has been updated to include the sections required by the commission’s pharmacy inspector. Residents’ medication needs have also been reviewed. Medication is supplied to the home by Lloyd chemists and the majority of residents who use medication use a blister pack system, which is easier to administer. All staff receive management of medication Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 16 training by the home and residents abilities to self-medicate is assessed as part of the home’s assessment process. There were three requirements made regarding medication management in the home at the last key inspection. These requirements are now met. I examined five residents’ files including medication administration recording and found that these were satisfactory. All residents need support in personal care and examination of four randomly chosen residents files showed that there is a personal care plan on file for each resident. Residents commented positively about how they are supported in personal care by staff and said that there has been much improvement in the care provided. Care plans showed risk assessments for people who needed moving and handling support. Care staff and a nurse said that communication between them was good and care staff are now writing clearer notes about the care provided to help nursing staff to review care plans. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s approach to activities has improved but there is more work needed to improve individual activities for residents. Residents maintain contact with families, friends and others from the community, and are supported to exercise choice and control in their lives. Residents are provided with a choice of varied and nutritious meals EVIDENCE: There is not specific mention in care plans as to how the dementia effects each resident personally and there are no written guidance for staff in how the residents should be best approached to engage them successfully in activities. Care plans dont specify the activities, games and exercises beneficial to individual residents, but rather say things like: “ ball game or puzzles” which is generalised. The activities specific to each resident need to be agreed to a greater extent, such as what puzzles to use and what type of exercise is preferred and in what area of the home to carry it out. The best time of day to offer activities for each resident needs to be made more specific for staff based on knowledge of each individual resident’s dementia behaviours. In summary care plans need to be more detailed in describing how dementia effects Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 18 individual residents and have better written guidance for staff in how provide the necessary support in activities for these residents. (Refer to Continuing Requirement OP7) Two of the files examined showed that either activities listed in the care plan were no longer relevant or activities did not include specific information about exercise or puzzles beneficial to the resident. The assistant manager explained that there are activities offered to these residents but are not appearing in care plans. The home must ensure that care plans for residents are updated to include current relevant activities specific to each resident, which are beneficial to the care of dementia. This needs improvement and improvement will only come when better daily records show what activities are offered, when, and whether they were taken up or refused. Care assessments and care plans are in place and are being reviewed monthly as is the case. (Refer to Continuing Requirement OP7) It was apparent that staff are now engaging residents in more activities such as games and exercise in the home. There is more verbal communication between care staff and nursing staff, and this has lead to developments in activities for residents which are not yet reflected in the homes care plans or individual activities records. Two visiting relatives and three residents told me that they are now asked about activities and that the staff and manager are now listening and making changes. They said that they “had been concerned about the home, that food was poor and there were no activities and staff attitude was poor”. They said that: “now things had changed for the better, and there are monthly meetings with the management and the residents and relatives and now things are much better”. A visiting health care professional who attends the home at least every week is involved in the development of care planning for many of the residents. She said that the homes previous management had been poor but now there have been very positive changes and improvements in the staff care practices, and in the management of the home generally. There is now much more involvement of health care professionals in the home and this is resulting in good quality of care for residents. She said that there had been a significant improvement in the activities for residents especially in group activities. She felt that this might not yet be reflected in the homes care plans and records, but was positive about continuing improvements in this area. All residents’ religious preferences are included in their care assessments and there is involvement from church representatives in the home. This was reflected in the four residents files examined. All residents have their own room where they can receive visitors in private. Residents are encouraged to bring personal possessions into the home,including furniture and pictures. Residents rooms are personalised with Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 19 their own pictures and family photos displayed. The home does not have any restriction on visiting times and two relatives who were visiting said that they are welcomed and offered the opportunity to have a meal with their relative. Both commented that the food is very good and said that they see the management on each visit and attend monthly meetings at the home where they are able to express any concerns. They said they feel more confident now in the homes management and staff. Residents and their families are responsible for the management of their benefits and bank accounts. As at the last inspection there are four residents who do not have money for day-to-day spending held by either them or by the home. The responsible individual and manager emphasised that family who hold money for them are very good at providing the necessary items needed by the resident and in providing funds for spending when requested. One of these residents has dementia and the others are able to make their wishes known and have said that they are happy with this arrangement. The home has now explored with these residents, and the family members concerned, as to the needs of the resident in their day-to-day spending and have now got written clarification included in their care plans showing the process for providing this money for these residents when needed. The home operates a four-week rolling menu, and the meals offered appeared to be varied and nutritious. They also included meals for vegetarians and people from other cultural backgrounds. Residents are assisted to complete a form every day to indicate their choices of meals. Residents I spoke to were happy with the meals provided. Comments included “the food is good”, when speaking with three residents. Menus are kept and two main meal menus are offered daily, but the chef said residents could have what they want if it is available. Three residents also confirmed this. The cook is well aware of any cultural needs of the residents and keeps a record of allergies and special diets for residents who need it. The residents and visitors spoken were very complimentary about the cook and about the food provided. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s records and the complaints record show that complaints are taken seriously. The home’s policies, procedures and action in relation to incidents, show that residents are protected from abuse. EVIDENCE: There is a complaints policy for the home and relatives who were asked said they would know how to complain. They also said that they meet at least monthly with the home’s management and see the manager and sometimes the owner on each occasion when they visit. One complaint had been made since the last inspection and had been properly recorded and investigated. Two residents family members spoken to say that they know how to complain if they needed to and that the homes new manager is always available to speak to. The complaints record showed that complaints were clearly summarised with details of investigations recorded in a complaints file. Complaints issues were: A member of staff had been informally discussing private information about resident’s medication with relatives of a resident who was visiting the home. This resulted in a disciplinary investigation and a final written warning. The home’s vulnerable adults policy has been updated in order to cover all necessary areas. There has been one adult protection issue reported since the Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 21 last inspection. This concerned the behaviour of a member of staff who allegedly may have been sleeping while on night duty. This was investigated by the home and was not proven. The staff member was transferred to day duties. There was a requirement made at the last inspection for the home to ensure that bed rails are only used in accordance with the guidelines laid out in the letter from Lewisham Social Services Adult Protection team. At the random inspection of 28/8/08 this was found to have been met and was not checked again at today’s inspection. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable, clean, well-maintained and safe home. However their need for increased communal space is not met. EVIDENCE: The home is in a good location on a side road close to shops and public transport facilities and has a large, accessible and well-kept garden. Maintenance is ongoing and modifications needed to ensure safety have been made. The programme of painting and re-carpeting bedrooms continues but much work has now taken place to improve and update the fabric of the home. None of the bedrooms have en-suite facilities but there are an adequate number of bathrooms with assisted baths, shower facilities and toilets. The lack of adequate communal space, however, remains with only one room for all activities. The provider again re-stated his intention to remedy this, with plans to add on extra space in a conservatory to the back to the house. He said that Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 23 plans and funding are in place for building a conservatory, which are awaiting final approval from the council. When this happens he confirmed that work would begin to improve the communal space. As the owner was able to show that he had done all of the work possible to get approval to have this work done, and residents and relatives confirmed that they had been consulted about this work, this requirement is now changed to a recommendation pending final approval by the council for the work to go ahead. (Refer to Recommendation OP20) On the day of inspection the home was clean and hygienic throughout. I saw eight bedrooms including the respite room with the manager, and it was obvious that a lot of work has been done to renovate the building, and to bring it up to a good standard. The majority of the hallways and residents bedrooms have now been re-carpeted and redecorated, and in spite of continence management being an issue in the home, there were no smells or unwanted odours throughout the building. The manager explained that the cleaner now solely is dedicated to cleaning duties, instead of having to also make beds, as previously was the case. The manager said that this has improved the standard of cleanliness in the home. There is some minor damage to skirting boards and these were caused by the use of wheelchairs, but generally the home is in a good state of repair and decoration. Lifts and hoists are well maintained under contract, and wheelchairs are stored properly when not in use. Improvements have also been made to the staff rest area, and two staff commented that they were very happy with these improvements. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by an adequate amount of staff with a good level of NVQ training. The home has a thorough recruitment procedure, and staff are now trained to do their jobs. EVIDENCE: The rota showed that the home deploys an adequate number of nursing and care staff on duty at all times of the day and night. There are at least one and usually two registered nurses and four care workers on shift during the daytime until 3 p.m., after of which there is one registered nurse and three care workers until 9 p.m. Night times are covered by one registered nurse and one care worker. There is an out of office on call support provided mainly by the homes manager. The number of care staff with NVQ level 2 training exceeds 50 . Examination of four staff files, three of which were new staff, showed that staff induction is now consistently happening in accordance with Skills for Care standards and supervision frequency has improved to an acceptable level. Two of the staff files examined showed that appraisal is now happening, and all of the files showed a good range of appropriate training is also in place for care staff and nursing staff. Training recorded included: adult protection, continence management, fire safety, medication, communication, and food hygiene. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 25 The files of three staff who had been recruited in the last six months were checked and showed that recruitment information is well organised with a good system for recording: application and interview information, CRB checks, references received, health clearance checks, start dates and in induction schedules. There was a good induction records in place for all of these staff, and the manager and staff members were signing off this induction. Staff have had training in dementia and a representative from the Care Home Support Team said that staff practice in the care of dementia had improved significantly, and that there is now very good communication happening between nursing staff and care staff which has impacted positively on the care provided. She said that the improved staff practices might not yet reflected in the paperwork such as in the care plans and activities plans. She also said she is very pleased with the managers input and leadership of staff. She feels that the residents who have a dementia diagnosis (four of them) have not got complex support needs, and are managed well by the home, albeit that the practices have to develop more to reflect the current best practice in the management of dementia. Staff morale and interaction with residents has improved markedly. Staff supervision and appraisal is now underway and is being recorded. Two staff files examined it showed that supervision is now happening almost every two months, except for staff have been off sick or have been undergoing induction. Good notes and are being kept and are staff interviewed were able to confirm that they are having supervision, and find it to be supportive and gives them good direction in how to the job. Staff training has significantly improved and the Care Home Support Team are now very actively involved. I spoke with a representative who visits twice weekly and she said there have been significant improvements made in the training and practices of staff especially in relation to dementia support. Staff have had training in dementia and a visiting health care professional who attends the home weekly and provides advice and training for staff in care of the elderly, said that the staff practices have improved substantially but may not reflected in the homes paperwork. She said she is also very pleased with the manager’s input and leadership of staff. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 26 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is experienced and competent to run the home. Some good quality assurance systems are in place, which ensure that the home is run in the best interests of the residents. Resident’s financial interests are being effectively safeguarded. The home has adequate health and safety policies and systems in place. EVIDENCE: The manager is very competent and experienced and is a qualified nurse with long standing management experience. She is a qualified Level 4 NVQ assessor and a moving and handling trainer, and has been working hard on updating the physical environment. Many improvements have been made to the fabric of the home. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 27 Staff comments were very positive regarding the support they get from the manager, and all staff that spoke with me said they feel the manager has made significant improvements and is approachable and helpful. The atmosphere in the home and the morale of staff has clearly improved for the better. Comments about the owner’s responsiveness and commitment to the care of residents were very positive from relatives, residents, staff and the manager and from a visiting health care professional. The manager is not yet registered with CSCI and has been managing the home for 18 Months. The provider must ensure that an application for registration of a manager is submitted to CSCI for consideration. (Refer to Requirement OP31) The manager is a qualified NVQ4 assessor but does not yet hold an NVQ 4 qualification. She said that she is willing to address this issue. The manager must evidence that she has an NVQ4 equivalent qualification. (Refer to Requirement OP31) The on call system is not robust enough and is largely dependant on the manager providing the on call support. There is no formally agreed on call system, which staff can refer to, although the staff were able to explain how they would contact the manager out of office hours, and reassured me that she is always available. I discussed this with the registered provider and with the manager, and it was agreed that the current system for accessing out of office hours support needs to be put on a formal footing, in writing and made available to staff at the home. The current practices are not unsafe as the staff were able to tell me that they know the managers number and are always able to call her when they need to and do so. However this is not adequate in the medium term and needs to be formalized with support from at least one other on call manager so that both staff and residents are made aware of how to access management out of office hours, and that the risk of an on call manager not being available for immediate response is minimized. The manager agreed with this and said she would look into developing and improving this system with the owner/provider. (Refer to Recommendations OP31) The previously established deputy manager role, which had been introduced since the last key inspection, has now been removed. This was an important support for the manager, providing more management presence in the home in the manager’s absence, and could also have provided help with the on call system. A visiting professional and four staff whom I spoke with agreed with this view and two visitors also said they would like to be able to have a manager available when they visit in the evenings and weekends. It is recommended that this decision be reviewed in light of these comments. The provider agreed to give this real consideration. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 28 (Refer to Recommendations OP31) The owner has now put in place a formal and methodical quality assurance audit system and has begun the process of carrying out a full audit of all of the homes quality assurance systems. This is done by carrying out sections of the audit monthly and producing a report after a 12-month cycle. This is a detailed system and the owner said he feels it is very useful and helps him to focus on individual areas, which need active attention. He said the system has already proven its worth in that consultation with residents and families has been substantially improved. Surveys of residents views are now happening every few months and meetings with residents take place at least quarterly, and typed minutes are now distributed to residents and families showing the issues discussed and the results of the surveys. Comments from five residents and two separate families were very positive about the changes made and how they are now being involved. They said they are invited and attend relatives/residents meetings every couple of months and have completed surveys. One was busy filling out a monthly care plan review form given to him by the home when I spoke with him. While the registered provider attends the home a number of times a week and does complete written reports on the checks that he does, this system needs to be expanded to include checking care plans, risk assessments, medication and finances to ensure that should the management of the home ever deteriorate as it has previously it will be picked up on quickly. (Refer to Requirement OP33) Admin support is only 2 days a week and computer skills among staff are poor, impacting on the documentation in resident’s files. (Handwritten - sometimes difficult to read and making it difficult to make changes when needed without having to rewrite whole sections of care plans) I have asked that thought be given to increasing the admin support available so that plans may be made more legible and easier to review. (Refer to Recommendation OP7) The home has now an Annual Development Plan in operation. The current plan is for 2008 Residents money is now well managed and protected and the home is not responsible for any residents bank accounts or benefits. There had been enforcement action taken against the home regarding ensuring that residents had full access to personal finances. The home did good work since then in consultation with relatives to ensure that this happened. Residents and their families are responsible for the management of their benefits and bank accounts. As at the last inspection of December 2007, there were four Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 29 residents who do not have money for day-to-day spending held by either them or by the home. The responsible individual and manager emphasised that family who hold money for them are very good at providing the necessary items needed by the resident and in providing funds for spending when requested. There is now clear written agreements in place for these residents showing how this should be managed. Health and safety is generally given due care and attention by the homes management. There is a health and safety policy and appropriate systems being used for training staff, checking fire equipment, storing dangerous liquids and substances, carrying out risk assessments, and doing regular health and safety checks within the home. The fire officer for the LFEPA, has been involved in inspecting the home and the home meets all fire safety requirements. There was a requirement for the home to carry out risk assessments for all residents assessed as having mobility support needs and this has now been done. Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 30 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 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 Score X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 X X X X X 3 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 2 X 3 X 3 3 X 3 Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 31 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 OP3 Regulation 14.1a Requirement Timescale for action 30/09/08 2 OP3 3 OP7 Where dementia is a consideration during the referral process, the registered person and manager must ensure that a formal agreement is reached with the commissioning agent, stating that the resident does not have complex support needs resulting from dementia, and that this is formally recorded in these residents care assessments. 14(2)(a,b) The registered person and manager must ensure that in future all new residents’ care assessments contain more details about the type of social, leisure and exercise activities they want to take part in including outdoor activities. 15(1) The registered provider and manager must ensure that the care plans for residents with dementia support needs contain more detail describing how the dementia affects them and are supported by written guidance for staff in how to support them in activities. This is a continuing requirement which was made at DS0000007037.V360936.R01.S.doc 31/08/08 30/04/08 Oakcroft Nursing Home Version 5.2 Page 32 4 OP7 15 5 OP7 15 6 OP31 8 and 9 7 OP33 26.4b the last inspection, timescale 30/04/08 still within date. The registered provider and manager must ensure that care plans for residents with dementia are updated to include relevant activities specific to their dementia care needs as discussed in this report. This is a continuing requirement which was made at the last inspection, timescale 30/03/08 still within date. Timescale is revised. The registered provider and manager must ensure that daily records for each resident be consistently completed regarding details of care and support of dementia and mental health and are applied to the care planning review process. This was a requirement from the last inspection, timescale 30/3/08 still within date. Timescale revised. The Registered Person must ensure that an application for registration of the manager is submitted to the Commission for Social Care Inspection. The registered provider must include the inspection of residents care plans, risk assessments, medication and residents finances in the monthly management checking system for the home 31/08/08 31/08/08 31/08/08 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000007037.V360936.R01.S.doc Version 5.2 Page 33 Oakcroft Nursing Home 1 Standard OP7 2 OP30 3 OP20 4 5 6 OP31 OP31 OP31 It is recommended that the registered provider and manager ask staff to record more clearly the success and uptake of activities offered to residents with dementia, as an aid to the review process. The registered provider and manager should provide training for RGNs responsible for writing care plans, in order to address the issues of plans being done in a consistent and legible manner. The registered provider should complete the process of ensuring the provision of adequate communal sitting, recreational and dining space for residents as discussed in this report. The homes manager should evidence that she has the appropriate NVQ qualification in care and management The registered provider should make improvements to the on call management system so that the system is formalised in writing and include more managers The registered provider should consider whether the appointment of a deputy manager would benefit the overall management provision for the home Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Oakcroft Nursing Home DS0000007037.V360936.R01.S.doc Version 5.2 Page 35 - 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!