Inspection on 28/11/08 for Oakdene

This inspection was carried out on 28th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oakdene 15/11/06

Oakdene 22/08/05

Oakdene 08/04/05

Oakdene 15/02/05

Oakdene 23/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oakdene 197 London Road Waterlooville Hampshire PO7 7RN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christine Walsh     Date: 2 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Oakdene 197 London Road Waterlooville Hampshire PO7 7RN 02392640055 02392640055 gillsteve.bryden@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs G Bryden Name of registered manager (if applicable) Mrs G Bryden Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is:19 The registered person may provide the following category/ies of service only: Care home only - PC 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 - OP Dementia - DE Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home The home is a large Edwardian building set on the main road between Waterlooville and Cowplain. It is registered to provide a service to up to nineteen older people, some of who may have dementia or mental health problems. The home has eleven single Care Homes for Older People Page 4 of 36 care home 19 Over 65 0 0 19 19 19 0 Brief description of the care home rooms and four shared rooms. Four of the rooms have en-suite facilities. There are two lounges, a large dining room and a new conservatory overlooking the gardens. The gardens are very well maintained and designed so that residents can access them safely. Current weekly fees range from #405 to #500 per week with additional costs being made for hairdressing, newspapers, chiropody and toiletries. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This site visit formed part of the key inspection process and was carried out over one day by Mrs C Walsh, regulatory inspector, the head of care and administrator assisted the inspector with the inspection visit as the registered manager was on holiday. The manager completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to the visit to the service. Care Homes for Older People Page 6 of 36 The AQAA informed us that the service does the following to ensure the race, gender, identity, sexual orientation, age, religion and beliefs are promoted and incorporated into what they do. This includes encouraging residents to follow their own beliefs and encourage everyone, staff, residents, relatives and visitors to accept all of us for who they are and to celebrate our differences. The home tells us it have altered menus and activities to cater for their ever changing population as well as arranging church visits and communion. The information obtained to inform this report was based on viewing the records of the people who use and work for the service, of which four service user records were looked at in depth. The day-to-day management of the home was observed, and discussions with residents, staff and visitors took place. The people who use this service are referred to as residents. What the care home does well: Oakdene does well to ensure it provides prospective residents and their representatives with information about the home, it assesses if it can meet their needs and supports them to become familiar with their new surroundings and others living in the home. This is done by supporting visits to the home prior to moving in. The majority of residents at Oakdene have varying degrees of dementia, however it does provide for people who are elderly, frail and people suffering with mental illness. Despite this mix of clientel the home shows us that it can meet the diverse needs of the residents, taking into account their strengths, needs, compatibility and the skills of the staff. The home does well to respect the wishes and decisions of residents, involving family members in this process where necessary. It encourages the residents to develop and maintain their independence, access their local community and maintain contact with family and friends. The home encourages residents to take part in varied in house and community based activities. The staff do well to ensure the physical and psychological needs of the residents are being met, providing the residents with support to access health care professionals such as GPs, dentists, district nurses and other specialist health care professionals if required. The home listens to the residents needs, wishes and concerns and acts promptly to deal with any concerns or complaints the residents or their representatives may have. Staff are trained to protect the residents and to inform someone immediately if they are concerned that they are at risk of harm. Comments received from residents, relatives and staff. Relative. I think this home is fantastic, it has supported my relative to settle in and they now look a lot better, happier and healthier since moving in. Resident. The staff here are wonderful, kind and patient. Resident. I really like it here the staff treat me with respect. Staff. We have a nice home and nice staff, if we have a problem we can go to the manager, she is very approachable. Oakdene offers a homely, safe and welcoming environment, which is tastefully decorated and furnished. Residents bedrooms are personalised and decorated to the residents liking. The manager and her staff are skilled and competent to meet the needs of the residents, the staff go through an interview and induction process followed by mandatory training such as moving and handling and fire safety and specific training such as abuse awareness and dementia care. The staff go about their day-to-day responsibilities in a calm and relaxed manner and show kindness and respect to the residents and their visitors. Care Homes for Older People Page 8 of 36 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures the people who wish to move into the home are assessed prior to admission to make sure they can meet their needs. The home does not provide intermediate care. Evidence: The AQAA (Annual Quality Assurance Assessment) tells us that the home does well to carry detailed pre admission assessments, listen to the requests of perspective residents in order to accommodate their diverse needs. It also tells us Oakdene provides a welcoming atmosphere for all who enter the home. This was tested by viewing the assessment documents of four residents, speaking with a small number of residents, visiting family members and the head of care. Care Homes for Older People Page 11 of 36 Evidence: The head of care told us that the manager will meet and obtain information from the perspective resident, family members, and social services and health care professionals if applicable. A family member who was spoken with at the time of the visit said that they had heard good things about the home, that it was local to them and they knew when they first visited that it would be the right place for their relative to live. They informed us that they had met with the manager who asked lots questions about the needs of their relative. This included what their relative could do for themselves and what they need help with. The relative of the visiting family told us. Its OK here, they look after me well. Another resident told us. I was lucky to find this place having been in many hospitals over the years. Assessment documents were viewed for four residents two of which had recently moved in, the assessment information is comprehensive and asks for information about the persons health, strengths and needs and other information relating the residents wellbeing, social interests, likes and dislikes and cultural and religious beliefs. There was evidence in personal care plans that information obtained through the assessment process is reflected in the day to day care of the residents. One example of this is the use of specific sensory tools to assist residents with dementia and visual impairment to eat their meals independently. The home is not registered to provide intermediate care, but it does offer respite care where residents are welcome to stay for short breaks, be it to support main carers or to support the resident to get back to good health following an illness. Care Homes for Older People Page 12 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the home each have a personal plan, which tells the reader how the person wishes to have their health and personal care needs met. However improvements could be made in the accessibility of each care plan. The people who use the home have access to health care professionals to ensure their health care needs are met. The homes current medication administration procedures do not ensure the people who use the service receive their medications safely and as prescribed. The people who use the home tell us they feel they are treated with respect and their right to privacy upheld, but some written records tell us that people may not be fully respected. Care Homes for Older People Page 13 of 36 Evidence: The AQAA told us that the home does well to have comprehensive care plans, risk assessments and good links with health care professionals in place. The AQAA goes on to tell us that the service has an inclusive approach, involving the residents and their relatives as and when they wish. The AQAA tells us that the home recognises where it can make improvements and how they are going to do this in the next twelve months. It recognises it needs to ensure good communication and more concise record keeping. It is going to improve this by updating and reviewing all aspects of standards in health and personal care and continue to encourage residents and relatives to have their say. The above was tested by viewing the personal plans, daily notes and medication records of four residents. Speaking with residents, relatives, staff and the head of care, and observing day-to-day practice in the home. Each resident has a personal plan of their own which provides information on their daily personal, physical and mental health care needs, social support and areas of where the residents maybe at risk. Care plans provide detail on how the resident requires assistance allowing for consistency of care. Some of the residents have a life history in their personal file providing staff with background knowledge about the person, their occupation, their family, their likes and dislikes and their social hobbies and interests. Staff spoken with at the time of the visit said they were aware of the individual needs of the residents from information obtained on them prior to admission, care plans and daily handovers. A handover was observed and gave detail about each residents health and wellbeing. Residents plans are held in a central place with in the home and can be accessed by staff. All care plans, which provide guidance for staff are held within a plastic envelop within the personal file, this only allows the top one to be viewed unless they are all removed from the envelop. The home should consider separating the care plans so they can be easily read. Care plans are linked to risk assessments and provide detail of the risk and action required by staff to minimise the risk. The information was written in plain English and easy to follow. Residents and relatives who were spoken with at the time of the visit were very complimentary of the care and support the staff and manager provide. Care Homes for Older People Page 14 of 36 Evidence: A resident said. The staff are mostly very pleasant, happy and more like family friends. A relative said in answer to a question in a comment card, the staff always give support and care to their relative as expected and agreed. It has taken a number of years for my xxxx to accept washing and changing regularly by staff. Each resident is registered with a GP and information in residents personal plans tells us that a record is kept of the residents personal health care needs and the support they require to get better. In addition residents have access to other health care professionals such as dentists, opticians, chiropodists and community health care teams such as district nurses and psychiatrists. The home has systems in place for the administration of medication. The home uses a monitored dosage system which is supplied by a local pharmacy. A large number of medications that can not be placed in a blister pack are stored within a secure trolley and topical creams and lotions are stored separately. Medications are received, stored and disposed of using systems as recommended in the Royal Pharmaceutical Guidelines. Observation of the medications being given and viewing medication administration records (MAR) showed us that the procedures adopted by the home are not safe and place the residents at potential risk of receiving the wrong medications and medications not prescribed for them. These included not referring to the MAR and not signing the MAR until all residents had been given their medication. There was evidence of signature gaps on the MAR, so it could not be established on the day of the visit if the medication had been given or not. The homes policy tells staff that they must sign the MAR immediately after dispensing medication. Records also showed that medications received outside of the twenty-eight day repeat prescription system had been hand written on the MAR without all the detail required to ensure the medication is given correctly such as the dose and frequency. Evidence in a residents daily record told us that a resident had received the wrong medication and other residents were being given medications that had been purchased. It was not clear if advise had been sought from the residents GP to ensure Care Homes for Older People Page 15 of 36 Evidence: these medications are compatible with prescribed medications. There is no evidence that the home had reported the medication error to the Commission for Social Care Inspection as required under regulation 37 of the Care Standards Act 2000. It was noted that the residents were smartly dressed, clean and attention had been given to their hair and personal grooming. Although one relative did comment that her xxxx was not always dressed appropriately for the weather conditions. On the day of the visit staff were observed speaking with residents in a respectful manner and addressing any concerns they may have. Staff were observed to address residents by their preferred name and knock on bedroom and bathroom doors before entering. Both residents and relatives tell us that the staff treat them with respect. Staff spoken with were able to demonstrate they have a good understanding of the principles of care, including ensuring residents dignity and privacy is upheld and supported to maintain their independence. Written daily records which were viewed at the time of the visit told us that respect does not extend to these records. These records can be viewed by the resident if they wish. Two of the four personal plans viewed had comments referring to the residents in a manner that may be disrespectful or demeaning. The inappropriateness of the wording was discussed with the head of care and administrator at the time of the visit. Care Homes for Older People Page 16 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures itsupports the people who use the service to participate and engage in activities of their choice, maintain contact with family and friends and provide them with meals that meet their dietary needs and preferences. Evidence: The AQAA tells us the home is very happy place which is enjoyed by who all live, work and visit. It tells us the home is lively and the residents are encouraged to participate in as many activities as possible. The AQAA goes on to tell us that people are not restricted and are encouraged to wander around communal areas and the large garden. The home tells us that it recognises it could do better to extend the range of activities and menus even further. This was tested through observation on the day of the visit, viewing menu plans, the lunchtime meal, and speaking with residents, staff and visitors. The residents personal files provide information on the residents social interests, hobbies and likes and dislikes and of the four personal plans viewed a resident had a personal history that provided staff with information of the residents occupation and Care Homes for Older People Page 17 of 36 Evidence: family history. The information provided an interesting insight to the resident and a member of staff said it had helped to provide topics of conversation. Oakdene provides care and support to residents who have dementia some of whose dementia is very advanced, however it was observed on the day of the visit that staff spend time with the residents engaging in general conversation, having a laugh and joke with the residents and providing stimulation through music and games. The home provides a number of planned activities through out the year which are both seasonal and at the request of the residents such as visiting the theatre, Christmas and Summer garden parties. Board games, reminiscence therapy and watching old musicals and comedy films is a regular occurrence. At the time of the visit residents were introduced the new musical Mamma Mia. It was observed that the residents appeared to enjoy this activity but preferred the regular favourite of The Sound of musical. Residents and visitors were heard singing heartily throughout the film and playing musical instruments. Another group of residents were observed playing dominos, which they said they regularly enjoyed playing. A relative was also involved in the game and confirmed that whenever she visited there was always an activity taking place. Another group of relatives were complimentary of the home and how it had supported their xxxx who particularly liked their own company to spend more time in communal areas. Their relative is now gradually showing an interest of what is going on around them. The home and staff demonstrated that they have a good understanding of the needs of the people with dementia and the various types of dementia and how this effects their wellbeing, orientation and ability to take part in everyday activities. In the entrance hallway of the home there is a large photo frame full of photographs of the residents in their hay days, these showed pictures of them attending special events, marriage ceremonies and various service roles for example the Land Army. The head of care told us that residents will very often look at the photos, pick themselves out and be encouraged to reminisce. A resident said. I like to do my own thing, I like to read the newspapers and watch TV. I will go out on my own to do my shopping if I wish. Care Homes for Older People Page 18 of 36 Evidence: A relative told us. My xxxx is a free spirit at Oakdene, she is able to be as independent as possible despite her dementia, in that she goes into the garden to walk freely, or can go up to her room to lie down whenever she wishes. The home was busy with visitors. All visitors spoken with said they were always made to feel welcome, that staff are very kind and approachable and the manager or senior staff on duty will provide them with an update on the wellbeing and care of their next of kin. All visitors are asked to sign in and sign out of the home. This is to protect both the residents and relatives wellbeing. At the time of the visit it was noted throughout the day that residents were provided with regular fluids and snacks and a wholesome two-course meal was provided at lunchtime. The member of staff responsible for the cooking informed us that the home uses fresh produce and they are provided with information regarding the residents specific likes and dislikes and dietary needs. The home has two dining rooms, which allows the home to support residents who require support and those who are independent separately. For residents requiring specific support meals are presented in manageable consistencies to assist with the menchanics of eating and swallowing. The home takes into consideration the individual sensory needs of the residents and will refer to dietitians and occupational therapists where and when required. Residents requiring help to maintain a healthy lifestyle and maintain their weight are encouraged and supported to choose healthy options as recommended by health care professionals. All residents who were spoken with said they like the meals and could have something different if they didnt like what was on the menu. A resident said. They help all they can with dislikes and what you would like. Care Homes for Older People Page 19 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that the people who use the service are listened to and concerns raised by them are acted upon. The home takes steps to ensure the people who use the service are safeguarded from the potential risk of abuse, it must however ensure residents are receiving medications that are prescribed for them to prevent the risk of illness through human error. Evidence: The AQAA informed us that the home does well to have a comprehensive and accessible complaints procedure. It tells us it does well to have open dialogue with relevant people who have a stake in the wellbeing of a resident. The home recognises that it could improve their knowledge of the Mental Capacity Act issues, although they have used the act to the advantage of the residents when relatives have not been accepting of certain decisions. This was tested by viewing the complaints procedures and logbook, testing if the home had procedures for safeguarding the residents, speaking with the residents, staff and relatives. The complaints procedure details how the people who use the service can make a complaint and what action must be taken to resolve a complaint. We were told by the Care Homes for Older People Page 20 of 36 Evidence: head of care that the home encourages open dialogue with residents and relatives on a day-to-day basis. The administrator who is responsible for quality said the home welcomes suggestions and complaints as this enables the home to continue to monitor and improve the quality of care they provide. A resident confirmed that she knows how to make a complaint or raise concerns with the manager or a member of staff. Stating that all the staff and the manager are approachable and listen to what she says. A member of staff was clear about the procedure in responding to complaints and a relative indicated in a comment card that they know how to make a complaint and in answer to the question does the home respond appropriately said. Discussion opportunities are always immediate. A relative said. I have a copy of the complaints procedure, Im very happy with the care the home is providing and have no complaints. If I had a concern or complaint I would speak with the Gill. (registered manager). The majority of the residents who live at Oakdene have varying degrees of dementia, the head of care and administrator showed us that they have a good understanding of the physical, sensory and cognitive needs of people who have dementia and how this could impinge their ability to make or raise concerns. The AQAA informed us that there have not been any complaints made in the last twelve months, the log book was viewed and found not to have any records of complaints. Compliments received from relatives of deceased residents told us that they had been more than satisfied with the care their relative had received whilst living at Oakdene. The staff are provided with safeguarding of vulnerable adults training, which provides them with the knowledge to identify various types of abuse and how to report these. The staff spoken with at the time of visit confirmed that they had received training and were aware of their roles and responsibilities in maintaining the residents health and wellbeing and reporting incidents of concern. As recorded in the section of this report headed Health and Personal Care the home must ensure residents are receiving medications that are prescribed for them and/or agreed by their GP. There is a risk to residents health and wellbeing if the home does Care Homes for Older People Page 21 of 36 Evidence: not follow safe procedures in administering medication and/or neglects to give medication as prescribed, or give medications that have not been prescribed or authorised by a healthcare professional. Care Homes for Older People Page 22 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures the people who use the service live in a welcoming, comfortable and clean environment. Evidence: The AQAA informed us that Oakdene is a very happy home, which is one of the reasons the home is chosen. It tells us the home is airy and well lit and the rooms are decorated individually. The housekeeping staff take pride in their work and in keeping the home clean and free from odours whilst adhering to health and safety standards. The AQAA also informs us that the home has an ongoing maintenance programme and they continue to try and enhance the home to improve the lives of the residents and staff who live and work in it. This was tested by touring the home, speaking with residents about their personal rooms and the homes environment, speaking with care staff and visitors. An extensive tour of the home provided us with evidence that the home takes pride in its facilities, including the refurbishment of several areas of the home. A number of residents bedrooms have recently been redecorated and furnished using quality furniture and furnishings. Care Homes for Older People Page 23 of 36 Evidence: The home recognises it needs to be compatible for residents with sensory, cognitive and physical disabilities. An example of this was the picture of a large painted flower on the door of a toilet. We were informed that this is in place to assist a resident with dementia to find the toilet. The resident has a particular like for flowers and when asks for the toilet is asked to look for the red flower. The head of care informed us that this has made considerable difference the residents independence. The home has sufficient numbers of toilets and bathing facilities to meet the number and needs of the residents. Where required these facilities are equipped with moving and handling equipment such as hoists and handrails. The home is a two-storey building with a stair lift to the first floor. The home has a large lounge, separate conservatory and dining room, all have been tastefully decorated and furnished. The garden is landscaped, surrounded by a variety of trees and shrubs and levelled patio areas.Residents can access during the warmer months of the year. Large windows allow a good view into the garden. Bedrooms seen were homely, furnished with personal items and in some cases furniture had been brought from their previous home. The rooms were individualised and reflected the persons hobbies interests and personality. The residents with whom were spoken with appeared pleased with their rooms and their cleanliness. A resident said. The staff are very good they clean and help me tidy my room everyday, my sheets on my bed are changed regularly. The home employs staff to clean the home who are responsible for maintaining a good standard of hygiene throughout the home. The home was noted to be clean and free from offensive odours. Cleaning staff spoken with at the time of the visit confirmed they had received training relevant to their roles and responsibilities including health and safety, The Control of Substances Hazardous to Health (COSHH) and infection control. Two care staff spoken with also confirmed that they had received training in infection control and are provided with equipment such as protective clothing to assist in minimising the risk of cross infection. Notices discreetly displayed around the home prompts staff to adhere to good hygiene standards. A relative said. Care Homes for Older People Page 24 of 36 Evidence: There is a good atmosphere and a homely feel. The room my xxxx has is spotless despite all xxx messy activities The laundry facilities were viewed and found to have industrial laundry facilities to deal with and manage the risk of cross infection from soiled linen and clothing. The laundry facility is in need of some refurbishment as steam and condensation have caused blistering paintwork. The home is advised to consider this as part of their ongoing maintenance programme. Care Homes for Older People Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures the people who use the service are supported by adequate numbers of appropriately recruited staff and who receive training that meets the needs of the people they support. The manager must however ensure her staff are appropriately trained to administer medications as stipulated in the Royal Pharmaceutical Guidelines. Evidence: The AQAA tells us the home does well to train and develop its staff, with 75 of its staff trained in a national vocational qualification (NVQ) at levels two and three. It tells us all new staff receive a detailed induction and other staff receive regular updates. The turn over of staff is low and several staff have worked in the home for more than fifteen years. The AQAA goes on to tell us that it recognises that all staff could do better to improve communication, and training will continue in the next twelve months to encourage staff to attend training sessions to increase their knowledge and skills. This was tested by observing practice on the day of the visit, seeking the views of residents and visitors, and viewing staff recruitment and training files. On entering the home it was soon established that the home was busy with staff Care Homes for Older People Page 26 of 36 Evidence: supporting residents with personal care needs, providing refreshments and greeting visitors. The duty rota confirmed that there are sufficient numbers of staff on duty including ancillary staff to meet the current needs of the residents and running of the home. The head of care said she will work hands on and assist with getting the residents up, which allows her to have a good insight to their health and welfare. The AQAA tells us that the home has altered its staff structure to provide two waking night staff and appoint a head of care. The head of care told us she has many years experience working in the care sector and in particular Oakdene. A member of staff said that residents are supported to get up at their leisure and no one is rushed or expected to do anything they dont want to. This was supported by what was observed as a relaxed and organised approach to the day-to-day needs of the residents. Call bells were answered promptly, staff were observed to be happy and involved in cheerful banter with the residents, relatives and other staff. A member of staff said. Oakdene is a happy home and a really nice place to work. We work as a team and will support one another when it is busy and when duties need covering. A resident told us. The staff are lovely, they always come when I call for them and help me with whatever I need. A relative said. The staff always seem to know pretty well where xxxx is when I come to visit, and xxx is extremely mobile! Three staff personal records were viewed including newly appointed staff, recruitment records indicated that appropriate checks are carried out on staff prior to them starting in the home, including two references, criminal record bureau (CRBs) and protection of vulnerable adult (POVA) checks. A member of staff who was met with as part of the tracking process confirmed that they had completed an application, attended an interview and were fully inducted with support whilst getting to know and work with the residents. Evidence of these documents were found on the member of staffs personal records. Care Homes for Older People Page 27 of 36 Evidence: A member of staff spoken with at length spoke of the process of her induction and training which she felt was very good and comprehensive. She went onto tell us how the home has encouraged and supported her to achieve a NVQ. The member of staff showed us that she has a good understanding of her roles and responsiblities and showed good values when she spoke of the importance of ensuring residents health and wellbeing was maintained at all times. The certificates of staff training provided evidence that staff receive mandatory training such as health and safety, food hygiene, fire safety and specific training such as abuse awareness, safe handling of medication and dementia care. Medication training is delivered through distance learning and covers the care and control of medications. The head of care informed us that she had received this training. A member of staff informed us that she was currently receiving training in the Mental Capacity Act, which includes deprivation of liberty. This provides staff with an understanding of the rights of the people they support in the home. The head of care told us that she has received training to train staff in moving and handling and safe practices in fire detection, prevention and evacuation. Certificates of training provided evidence that the home invests in its staff to provide them with the skills they need to carry out their roles and responsibilities. Care Homes for Older People Page 28 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run by a registered manager who ensures the home is run in the best interest of the people who use it and ensures they are safeguarded from potential risk of harm from their environment. The registered manager must ensure the people who use the service are not placed at risk from poor care practices such as the administration of medication. Evidence: The AQAA tells us it does well to run a home that is highly regarded by outside agencies and run by a competent, experienced and well qualified manager/proprietor. The AQAA goes onto tell us that the paper work is thorough and her motto is If it isnt written down it didnt happen and it tells us the home is very relaxed, easy going but quietly efficient with an open and positive atmosphere. The AQAA tells us that the home recognises where improvements can be made and their plans for the future which includes ensuring staff attend more training courses and to have an open mind Care Homes for Older People Page 29 of 36 Evidence: to all suggestions whether staff/residents/relatives or visitors. The registered manager tells us in her AQAA that if it is not written down it didnt happen. This was not in the case of the procedures used in the administration of medication. The registered manager must ensure all her staff are following correct procedures when recording when medications have been given, changed or agreed by a GP. This was tested by spending time with the head of care and administrator, observing practice and running of the home, observing interactions between staff, residents and relatives. Viewing health and safety and quality monitoring records such as fire safety records and regulation 26 reports. All staff were observed to go about their roles and responsibilities in a relaxed and confident way, interacting well with residents and responding to their needs and questions. In the absence of the manager the newly appointed head of care and administrator assisted the inspector confidently and efficiently. Staff, residents and visitors were complimentary of the manager and her management team, speaking of their kindness, thoughtfulness and support when the need arises. A member of staff said. If there are any concerns or problems the manager is open and easy to approach for support. The home demonstrates through its quality monitoring systems that it takes seriously its responsibility to ensure the views of residents, staff and relatives are heard. The homes administrator told us the home is visited monthly by a business partner who carries out a regulation 26 visit. The visit involves looking at all areas of care and administration practice and includes seeking the views of residents, staff, relatives and any visiting health care professionals. The home demonstrates that it has effective systems in place to support residents with their personal finances. The administrator provided evidence of the systems used and how monies held on behalf of the residents are kept safe. Records told us that all incoming monies, individual expenditure, receipts and balances married up with monies for individual residents. Fire safety records told us that the home has systems in place to minimise the risk of and protect the residents from fire. Staff receive regular training and regular checks are made on all fire safety equipment. Care Homes for Older People Page 30 of 36 Evidence: The administrator told us that it is her responsibility to carry out a general inspection of the home on a weekly basis. This includes all health and safety equipment such as hoists and procedures used in the home to maintain a safe environment. These included checking small electrical appliances to ensure they are in goods working order and ensuring control of substances hazardous to health (COSHH) are securely locked away. The administrator also informed us she is responsible for ensuring regulation 37s are sent to the Commission Social Care Inspection (CSCI). Regulation 37s are notices that are sent to CSCI when an incident involving a resident occurs, for example a death, admission to hospital or an outbreak of an infectious disease. Through the course of the visit and viewing residents records it was established that CSCI had not been notified of an admission to hospital. The registered manager must ensure regulation 37 is complied with at all times. Care Homes for Older People Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medicines must only be 22/02/2009 given to the person they are prescribed for and they must be given in accordance with the current prescription. You must do this to ensure the people who use the service are only given medications prescribed or bought for them. Advice must be sought from a general practitioner when administering over the counter remedies to ensure they do not contra indicate with other medications. 2 9 13 The home must complete and keep accurate records of all medicines given to people who use the home, which includes the dose and the time the medicine was given. You must to this to ensure that the people who use the service receive their 22/02/2009 Care Homes for Older People Page 33 of 36 medications at the right time, right dose and frequency. 3 9 13 When medicines are prescribed only to be given when needed there must be a clear care plan, giving detailed instructions to staff as to what is meant by as needed. This will ensure medications are administered in a clear and consistent way for the benefit of people who use the service. 4 37 17 The registered manager must ensure that all records maintained in respect of the people who use the service are accurate and completed in full in all areas of their health and welfare. This includes notifying the Commission for Social Care Inspection under regulation 37 of any incidents that effect the health and wellbeing of the people who use the service. You must do this to ensure that care records provide a true reflection of the care required and carried out. You must do this to ensure the people who use the service do not have their health and personal care needs compromised by error or omission. 22/02/2009 22/02/2009 Care Homes for Older People Page 34 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 37 It is recommended the registered manager frequently audit all records pertaining to people who use the service. This is to ensure they are being correctly completed and where necessary the Commission Social Care Inspection are informed, such as in the case of regulation 37 notifications. Care Homes for Older People Page 35 of 36 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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