CARE HOMES FOR OLDER PEOPLE
Oakdene Ringwood Road Three Legged Cross Wimborne Dorset BH21 6RB Lead Inspector
Amanda Porter Key Unannounced Inspection 26th October 2006 10:30 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.V317439.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. DS0000020448.V317439.R01.S.doc Version 5.2 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 Mrs Linda Marie Harmer Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places DS0000020448.V317439.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. One named person (as known to CSCI) in the category of MD(E) may be accommodated to receive care. One named person (as known to CSCI) under the age of 65 years may be accommodated to receive care. 13th March 2006 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. Weekly fee rates range from £475 to £730. DS0000020448.V317439.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 23rd October 2006 and took approximately five hours. The purpose of the inspection was to review the requirements and recommendations made in the last report and to assess all the key standards. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • A pre-inspection questionnaire completed by the registered manager. • 11 Comment cards completed by residents and relatives/visitors. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. Five residents, one relative and six members of staff were spoken with and asked their views on the service provided at Oakdene. Comments received included: “I receive excellent care from both day and night staff.” “I have enjoyed my stay here.” “I love my work here.” “I have no complaints at all.” All the staff and residents were welcoming and helpful. What the service does well:
Oakdene continues to provide a very comfortable and kind atmosphere in which to live. Residents are well care for by well-trained and experienced staff and residents say that staff are very kind and considerate and that privacy and dignity is respected at all times. The home has produced a very informative Service User Guide, which is made available to each new prospective resident and family and gives a clear idea of what to expect whilst living at Oakdene. The home carries out thorough assessments prior to residents moving in and this includes finding out about social interests, hobbies as well as health and personal needs. Assurances are given that individual needs can be met. DS0000020448.V317439.R01.S.doc Version 5.2 Page 6 Residents’ health needs are well met by the home and community health professionals. The activities arranged within the home meet the expectations of the residents living there. Residents are encouraged to maintain their links with friends and family and all visitors are made welcome. Residents are helped to exercise choice and control over their lives as far as possible. Meals are wholesome and nutritious and planned around the likes and dislikes of residents. 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 comfortable place to live. Residents are encouraged to personalise their rooms with small items of furniture, pictures and a variety of mementos. The home protects the residents from abuse by ensuring robust policies and procedures are in place, which staff find easy to follow. 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 ensures that residents are protected from risk. Oakdene has an ongoing training programme for staff, which means that residents will be cared for by skilled staff. Financial procedures within the home also ensure that residents’ interests are protected. The health and safety of the residents and staff are protected by the policies and procedures that the staff follow at Oakdene. What has improved since the last inspection?
Since the last inspection Mrs Harmer has been registered with the Commission for Social Care Inspection as manager of Oakdene. She and her staff have updated many of the ways of working in the home in order to give a higher level of service to residents. Many of the home’s policies and procedures have been reviewed and amended and this includes those relating to medication. Medication is now well handled at the home to promote the health and well being of residents. DS0000020448.V317439.R01.S.doc Version 5.2 Page 7 The care documentation for residents has improved and residents and their families are included in drawing up and reviewing their plans of care. The home has invested heavily in the training for staff and now approximately 50 of care staff hold the NVQ level 2 or above in care, which can reassure residents they are in safe hands. All grades of staff are offered and encouraged to take up training opportunities. 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. DS0000020448.V317439.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 DS0000020448.V317439.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 & 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose and Service User Guide provide detailed information about the care and services provided at Oakdene so that an informed decision about admission can be made. New residents move into the home having had their needs assessed and been assured that these needs will be met. EVIDENCE: Since the last inspection the service user guide has been updated and it gives a very clear picture of what to expect when living at Oakdene. It was readily available to anyone visiting the home. Residents and their families were encouraged to visit the home prior to admission. Nine residents responded to the question “Did you receive enough information about this home before you moved in so you could decide if it was the right place for you?” and seven answered “yes” and two answered “no”.
DS0000020448.V317439.R01.S.doc Version 5.2 Page 10 Five pre-admission assessments were reviewed and showed that prior to people moving to the home their needs had been fully assessed by the registered manager or her deputy. Mrs Harner gave written assurance that needs could be met. DS0000020448.V317439.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 good. This judgement has been made using available evidence including a visit to this service. Generally there is a clear care planning system in place to make sure that staff have the information they need to meet residents’ needs. The health needs of the residents are well met with evidence of good support from staff and community health professionals. The medication at this home is well managed promoting the good health and well being of residents. Residents are treated with respect and their right to privacy upheld. DS0000020448.V317439.R01.S.doc Version 5.2 Page 12 EVIDENCE: The care documentation for five residents was reviewed. Files contained a variety of assessments including: • Moving and handling • Risk of falls • Environmental risks • The risk of pressure sores. Information from the assessments was used to formulate plans of care. Since the last inspection there has been a considerable amount of work done to improve the standard of care planning and generally they were seen to be easy to read, to the point and very informative. Most of them clearly set out individual care needs and how they are to be met. However there were still some that gave general rather than specific instructions as to how needs were to be met. Residents and/or their chosen representatives were invited to be involved in drawing up care plans, which were reviewed regularly. It was clear from discussions with staff and residents that they have access to the health services they need. There was evidence to show that residents get support from General Practitioners, the district nurse, chiropodists, opticians and dentists. The home has a well-written and informative medicines policy and procedure including reference to self-administration and associated risk assessment and arrangements for ordering, administration and disposal. Medicines were stored securely. Records were kept of the receipt, administration and disposal of medicines. Examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. Comments received from residents and their relatives/visitors confirmed that staff treated them with respect and were supportive and kind. Nine residents responded to the question “Do you receive the care and support you need?” and four said “Always”; three said “Usually” and two said “Sometimes”. In response to the question “Do the staff listen and act on what you say?” seven said “Yes”: one said “No” and one said “Sometimes.” DS0000020448.V317439.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. There is an adequate range of social opportunities available in the home, which reflects residents’ interests and preferences. There is a strong sense of homeliness and inclusion of family and friends in life at Oakdene. Residents are helped to exercise choice and control in their daily lives within their capabilities and desire to do so. The dietary needs of residents are well catered for with a balanced and varied selection of food available that meets their tastes and choices. 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. Some chose to spend time on their own but knew they could join in with any organised activities if they so wished. DS0000020448.V317439.R01.S.doc Version 5.2 Page 14 The home employs an activities coordinator and she provides each resident with a monthly programme of events and these are based on the residents’ choices. Activities include: • • • • • • • • • Trips out to places of interest. PAT dogs. Arts and crafts. Musical entertainment. Mobile library, talking books. Videos. Exercises to music. Beauty therapies. Church services. On the day of inspection a church service took place and was very well attended. Residents spoken with during the inspection said they enjoyed the activities and that the activities coordinator worked very hard to provide a variety of interesting things to do. She also made time to spend with residents on a one to one basis. One resident said “There are always activities available to me. I don’t always participate in all of them, but the ones that I have, I’ve enjoyed.” Residents confirmed that their visitors were always made welcome at the home and they could have visits in private. Residents spoken with said that they enjoyed the food provided. The menu offered choice. Menus were frequently discussed at residents meetings and changes were made accordingly. Residents could decide where they took their meals and some chose the dining room; some a lounge and some in their own rooms. DS0000020448.V317439.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. A system is in place to deal with any complaints that might be made by residents. The home’s adult protection policy demonstrates an understanding of abuse and of how to protect residents from it. EVIDENCE: In the last twelve months the home had received two complaints, which were fully investigated. One was partially substantiated and one was not. Residents confirmed that generally any concerns they raised were listened to and acted upon, although two comments received indicated that there had been times when there was a delay in getting a response. The home had a robust policy and procedure to respond to suspicion or evidence of abuse or neglect. Through discussion staff demonstrated knowledge of the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. Training records showed that staff had received training on this subject. DS0000020448.V317439.R01.S.doc Version 5.2 Page 16 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. The standard of the environment within Oakdene is good providing residents with an attractive, homely and safe place to live. The home is kept clean and smells pleasant thereby making daily life for all in the home more pleasurable. 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. All areas of the home were clean and there were no unpleasant odours. Nine residents responded to the question “ Is the home fresh and clean?” and they all said “Always”.
DS0000020448.V317439.R01.S.doc Version 5.2 Page 17 The laundry was well managed and adequate supplies of clean linen were seen to be available. DS0000020448.V317439.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 good. This judgement has been made using available evidence including a visit to this service. The deployment and number of available staff is sufficient to meet the needs of the residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are well trained and experienced and residents could be confident they would be well looked after and were in safe hands. EVIDENCE: Staff rosters demonstrated that there are sufficient staff on duty at all times. During the daytime two registered nurses were on duty with seven healthcare assistants in the morning and five in the afternoon. At night there was one registered nurse with three healthcare assistants. In addition these numbers were: • The manager – 40 hours per week. • The deputy manager – 12 hours supernumerary to those she worked as nurse in charge. • Administration/reception – 35 hours per week. • Activities coordinator – 35 hours per week.
DS0000020448.V317439.R01.S.doc Version 5.2 Page 19 There was also sufficient catering and domestic staff on duty to ensure that standards relating to food, meals and nutrition were fully met and that the home was maintained in a clean and hygienic state. The home has an ongoing training programme, which includes NVQ level 2 and 3 in care. At the time of inspection approximately 48 of care staff held at least one of these awards. Five staff recruitment files were reviewed. All the files were well ordered and contained all the information required by law including –: • Completed application forms • Two written references • Enhanced CRB checks • Terms and conditions of employments • Documentary evidence of any relevant qualifications • Proof of identity • A record of the interview. Training records demonstrated that staff were receiving the appropriate training, which included: • Common induction for new staff. • Moving and handling. • Abuse awareness. • Fire training and drills. • PEG feeding. • Continence training. • Parkinson’s disease update. • Role of the stroke co-ordinator. • Care of stroke positioning. • Passive movement therapy. • Nutritional update. The manager confirmed that some staff were about to start a distance learning package in the foundations of palliative care. DS0000020448.V317439.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. The home is run by a committed and competent manager, who creates an open and positive atmosphere, which supports good care practices for residents. The home regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of residents and relatives. 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. DS0000020448.V317439.R01.S.doc Version 5.2 Page 21 EVIDENCE: Since the last inspection Mrs Harmer has been registered with the Commission for Social Care Inspection as manager of Oakdene. She is well supported by her deputy and staff, who work hard to maintain a high standard of care in the home. There is an effective quality assurance and quality monitoring system in place. The home takes steps to review its performance regularly and resident surveys are conducted and results analysed. A recent survey showed that all the residents are happy with the standard of care they are receiving. Staff continue to be encouraged to contribute to identifying any ways in which the service can improve and how this can be achieved. This is done informally on a day-to-day basis and formally at monthly staff meetings. The home’s development plan for the year is available to all interested parties. Residents confirmed that they either deal with their own finances or have appointed a responsible representative to do so. This is frequently another family member. The health and safety team within the home meet monthly and audit all areas in the home regularly and where any action is required this is undertaken promptly. Records showed that staff had received recent training in fire safety and all had manual handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and analysed and appropriate action was taken as necessary. DS0000020448.V317439.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 3 X 3 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 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 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000020448.V317439.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 Timescale for action 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. Refer to Standard OP7 Good Practice Recommendations Every care plan should give clear and specific information to the reader about how the needs of the resident should be met. DS0000020448.V317439.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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
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