CARE HOMES FOR OLDER PEOPLE
Oakdene Ringwood Road Three Legged Cross Wimborne Dorset BH21 6RB Lead Inspector
Amanda Porter Unannounced Inspection 11:15 13 March 2006
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 DS0000020448.V286341.R01.S.doc Version 5.1 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. DS0000020448.V286341.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Oakdene Address Ringwood Road Three Legged Cross Wimborne Dorset BH21 6RB 01202 813722 01202 828346 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) Dorset Health Care Limited Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places DS0000020448.V286341.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To accommodate one person over the age of 65, as known to the CSCI, with mental health needs. 21st September 2005 Date of last inspection Brief Description of the Service: Oakdene is a purpose built care home registered with the Commission for Social Care Inspection to accommodate a maximum of 45 older people requiring nursing and personal care. The home is situated in a small village close to local amenities including a shop, post office and garden centre. Accommodation is provided in 44 rooms one of which is a shared room, 41 of the rooms have en-suite facilities. These are situated on the ground and first floor and two passenger lifts provide access between the floors. There is communal lounge and dining room space on the ground floor and a smaller lounge is situated on the first floor. The ground floor houses the homes kitchen and office areas. A laundry is sited on the first floor. There is easy access to the attractive and well maintained garden, which surrounds the home. DS0000020448.V286341.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the morning and afternoon of the 13th March 2006 and took two inspectors four hours each. The new manager, Mrs Linda Harmer, was on hand throughout to aid the inspection process. The inspectors were impressed with her knowledge of the home considering she had only been in post one week. The purpose of the inspection was to review the requirements and recommendations made in the last report and to assess outstanding key standards. Four residents, one visitor and four members of staff were spoken with and asked their views on the services provided at Oakdene. Comments included: “Staff are marvellous.” “It’s very nice living here.” “Staff are first class.” Some documentation was reviewed including care documentation, maintenance records, policies and procedures. What the service does well:
Residents said that the lifestyle experienced in the home matches their expectations and preferences. Residents are encouraged to maintain their links with family and friends and visitors to the home are made most welcome. The complaints and quality assurance procedures reassure residents that their views are important to the home and that any complaints they raise will be properly investigated. The house and gardens are well maintained which provides residents with a very comfortable place to live. Residents are encouraged to personalise their rooms with small items of furniture, pictures and a variety of mementos. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. A thorough recruitment process is followed when employing staff, which ensured that residents were protected from risk. Financial procedures within the home also ensure that residents’ interests are protected. The health and safety of the residents and staff were protected by the policies and procedures that the staff followed at Oakdene. DS0000020448.V286341.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000020448.V286341.R01.S.doc Version 5.1 Page 7 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 DS0000020448.V286341.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during this inspection. Standard 6 is not applicable as the home does not provide intermediate care. EVIDENCE: DS0000020448.V286341.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 & 9. The care planning system in place is not sufficiently thorough to adequately provide staff with the information they need to satisfactorily meet resident’s needs. The systems for the administration and storage of some medications are not sufficiently robust and potentially place residents at risk. EVIDENCE: The care documentation for five residents was reviewed. Each file contained care plans and these were of varying quality. Although it was apparent that residents were receiving adequate care, evidence of this was not clearly given in the care documentation. Instructions in some of the care plans gave general instruction rather than specific information pertinent to a particular resident. There was no evidence that residents or their relatives had been included in the care planning process. The medication administration records were reviewed and one entry showed that the registered nurse administering medication had signed to say a medication had been given but it was still stored in the blister pack and had not been administered.
DS0000020448.V286341.R01.S.doc Version 5.1 Page 10 Most medicines were stored securely in the drug trolley. The home has a lockable medicine fridge and a recording of the fridge temperatures was done on a daily basis. Following risk assessment residents had the opportunity hold and administer their own medication if they so wished. However one assessment seen showed that medicines were not always held securely. The manager confirmed she was in the process of reviewing and updating the home’s policy for the receipt, recording, storage, administration and disposal of medicines. At present the policy does not include the method used for disposal of medicines. DS0000020448.V286341.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 14. The social, cultural and recreational activities provided at Oakdene meet the expectations of residents. The residents are supported in maintaining contact with their friends, family and the narrow community and in making decisions about their lives in the home. EVIDENCE: Residents spoken with said that they were free to make decisions about how they spent their days and they were happy with the lifestyle that living at Oakdene afforded them. An activity coordinator is employed to work between Monday and Friday. She provides each resident with a programme of events on a monthly basis and keeps records of what people have liked. Organised activities are based on the wishes and expectations of the residents and include: • PAT dogs • Bingo • Visits from a local school • Puzzles • Videos • Mobile library DS0000020448.V286341.R01.S.doc Version 5.1 Page 12 Members of the clergy are made welcome at Oakdene and visit regularly. Residents confirmed that their visitors were always made welcome at the home and they could have visits in private. Some residents continued to handle their own financial affairs and others preferred to allow a chosen representative to help in that area. They were able to bring personal possessions in with them to make their rooms more homely. DS0000020448.V286341.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. A written complaints procedure leaves residents in no doubt that steps will be taken to deal with any complaint or concern they may have. EVIDENCE: All the residents spoken with during the inspection said that they would be able to talk to the staff about any concerns that they had. Two complaints had been raised since the last inspection and dealt with appropriately. DS0000020448.V286341.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19. The standard of the environment within Oakdene is good providing residents with an attractive, homely and safe place to live. EVIDENCE: The home is well maintained both inside and out. The gardens are attractive, safe and easily accessible for residents. The building complies with the requirements of the local fire service and environmental health department. There is a programme of routine maintenance, which includes room decoration. DS0000020448.V286341.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Sufficient staff are employed and deployed to ensure that the needs of the residents can be met. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. The short falls in the training may result in some care staff not being fully competent to do their jobs properly. EVIDENCE: Duty rotas showed that there were sufficient numbers of staff on duty. Domestic staff are also employed in sufficient numbers to ensure that standards relating to food, meals and nutrition are fully met, and that the home is maintained in a clean and hygienic state. Five • • • • • • • personnel files were seen. They all contained: Completed application forms Two written references Enhanced CRB and POVA First checks Terms and conditions of employments Documentary evidence of any relevant qualifications Proof of identity A record of the interview DS0000020448.V286341.R01.S.doc Version 5.1 Page 16 The manager confirmed that 36 of healthcare assistants hold the NVQ level 2 Award in care or an equivalent. This falls short of the 50 recommended but a further 3 candidates are working towards the award. Training records show that not all care staff have received either induction and foundation training or common induction training to meet the National Training Organisation workforce training targets. Since taking up her post Mrs Harmer had already identified this shortfall in training and was preparing to implement a robust training programme for all staff. DS0000020448.V286341.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 & 38. The home reviews aspects of its performance through a programme of selfreview and consultations to ensure it is run the residents’ best interests. Residents are assured of sound management of their financial interests. The Health and safety of the service users and staff are protected by the policies and procedures followed at Oakdene. EVIDENCE: In the first week of being post Mrs Harmer had undertaken two audits in the home and had produced actions plans as a result, which were in the process of being implemented. Residents spoken with confirmed they were able to continue to deal with their own finances if they so wish. Some preferred to rely on a relative/friend to
DS0000020448.V286341.R01.S.doc Version 5.1 Page 18 oversee financial affairs. The home holds some “pocket money” for residents at their requests. All financial transactions are recorded accurately. Records showed that all staff had received recent training in fire safety and manual handling. Staff spoken with confirmed this. Substances hazardous to health were seen to be stored securely. Records showed that all equipment had been serviced regularly. The fire safety records seen were complete and up to date. DS0000020448.V286341.R01.S.doc Version 5.1 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 DS0000020448.V286341.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement The plan of care for each resident must be drawn up with the involvement of the resident and/or their chosen representative unless it is impracticable to carry out such consultation. Each care plan must set out in detail the care required to ensure that assessed needs in respect of the residents health and welfare are to be met. All care staff must receive common induction training to NTO specification within the first twelve weeks of appointment. Timescale for action 1. OP7 15(1) 13/06/06 2. OP7 15(1) 13/06/06 3. OP30 18 13/06/06 DS0000020448.V286341.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP9 OP9 OP9 OP28 Good Practice Recommendations The home’s medication policy should be reviewed and include the method used for the disposal of medicines. Any resident wishing to self medicate should be encouraged to store their medicines securely. Medication administration charts should be completed accurately at all times. A minimum ratio of 50 of care staff should be trained to the NVQ level 2 or equivalent. DS0000020448.V286341.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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