CARE HOMES FOR OLDER PEOPLE
Oakendale House 17 Rose Terrace Ashton Preston Lancashire PR2 1EB Lead Inspector
Ms Susan Dale Unannounced Inspection 29th August 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakendale House DS0000066053.V298478.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. Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Oakendale House Address 17 Rose Terrace Ashton Preston Lancashire PR2 1EB 01772 720937 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Maninder Kaur Singh Mr Raja Singh Mrs Eileen Wade Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the CSCI The home is registered for a maximum of 15 service users in the category of old age, not falling in any other category (OP) over 65 years of age. 31/01/06 Date of last inspection Brief Description of the Service: Oakendale House is situated in the residential area of Ashton, Preston and is located close to local amenities and a bus route providing easy access to the centre of Preston. The home is registered to provide personal care to fifteen service users of both sexes over the age of sixty-five years. The home is not purpose built and provides accommodation over 3 floors; access to all parts of the home and garden is provided by a lift and ramps. The home does not provide nursing care and care provided is generally for service users who are fairly independent however, in the event of the service user becoming ill and requiring additional help every effort would be made to accommodate them. The aim of the home is for all service users to have specialist individual care whilst still maintaining their dignity and an optimum degree of independence and activity. The home has recently had a change of ownership; the new owners have been registered with the Commission for Social Care Inspection. A new manager has recently been appointed, as the existing registered manager is only part time. At the time of this visit fees at the home were: £364.00 Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The visit was unannounced and the focused mainly on key standards. The inspector was able to speak to service users, staff, and the new manager and examine various records. Comment cards were provided to service users, relatives/friends and health professionals prior to the inspection. 3 comment cards were returned from service users/relatives and 2 were from general practitioners, all the responses were very positive, the results were taken into account as part of the inspection. A tour of the premises took place. What the service does well: What has improved since the last inspection?
There have been no improvements since the last inspection; the service provided remains the same in many respects. Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 6 What they could do better:
A copy of the Statement of Purpose and Service User Guide is currently kept in a file with the policies and procedures of the home; the documentation needs to be readily available to service users, staff and visitors to the home. A recommendation was made that the care plan should be clearly identified and that it should include any aims for the individual concerned as well as their day-to-day requirements. The records seen had not been reviewed since February 2006 and a review should be conducted on a monthly basis. The care plan and any subsequent review should also provide evidence that the service user or their representative has been involved in the process. Any new staff at the home who have not received training in how to recognise abuse must be provided with training as well as the procedure to follow in the event of any abuse occurring. There is a need to ensure that a record is kept of any required maintenance of the home and that all areas of the home are clean. One of the service users commented that she was unhappy about the standard of cleanliness and some staff were a little slow to respond when she had raised these concerns. The details were discussed with the manager who promised to look into the issues raised. Records were examined and the records show that new staff have commenced employment prior to clearance by the Criminal Records Bureau or the Protection of Vulnerable Adults Register (POVA) and before any references had been received. As well as ensuring that appropriate checks are carried out there is a need to record the progress of each staff application and the date requests for references and checks have been made and the date they have been received. As the registered provider is not in day-to-day control of the home there is a need to carry out monthly visits and write a report on the conduct of the home under regulation 26 of the Care Homes Regulations. A copy of this report must be provided to the Commission and to the managers of the home. The new additional manager must be registered with the Commission for Social Care Inspection. A report must also be sent to the Commission if there are any incidents as listed under Regulation 37 of the Care Homes Regulations. The manager was unaware of any formal quality assurance systems in place although questionnaires have been provided to service users in the past. Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 7 There was no evidence that staff have received individual one to one supervision since the change of ownership and there is a need to establish who will be supervising and how frequently. 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. Oakendale House DS0000066053.V298478.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 Oakendale House DS0000066053.V298478.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 The quality in this outcome group was good. This judgement has been made using available evidence including a visit to this service. Information is available about the services provided by the home and prospective service users are able to visit the home and try out the services before a final commitment is made. A full assessment is undertaken prior to commencement at the home. The home does not provide intermediate care. EVIDENCE: A Statement of Purpose and Service User Guide is available that provides information about the services provided. The documentation has been amended to reflect the recent change of ownership but requires additional information to be included as listed in Schedule 1 of the Care Homes Regulations. A copy of the Statement of Purpose and Service User Guide is currently kept in a file with the policies and procedures of the home; the documentation should be readily available to service users, staff and visitors to the home. The staff member spoken with was unfamiliar with the document and not aware of its existence. Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 10 The sign outside the home still indicates the previous ownership; a check needs to be undertaken that all relevant information, service users guide/brochures are updated with the new ownership. The records belonging to service users show that an initial assessment is carried out that covers all areas. A member of the management team visits the prospective service user at home or in hospital to confirm whether they will be able to meet their requirements. The assessment looks at physical and emotional needs, likes and dislikes and any potential risks connected with their care. Oakendale House DS0000066053.V298478.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The quality in this outcome group was adequate. This judgement has been made using available evidence including a visit to this service. Service users are provided with an appropriate care plan that meets physical and health requirements but, requires regular review and show evidence of user involvement. Appropriate medication policies and procedures are in place to ensure the protection of the service users. EVIDENCE: The initial assessment is currently being used as the basis of the care plan although on the records seen, various documents were in place including a summary sheet and a review sheet; it was unclear as to which document is the care plan. A recommendation was made that the care plan should be clearly identified and that it should include any aims for the individual concerned as well as their day-to-day requirements. The records seen had not been reviewed since February 2006 and a review should be conducted on a monthly basis. The care plan and any subsequent review should also provide evidence that the service user or their representative has been involved in the process. There were good records of daily or weekly events for each service user and a communication log of any significant events is kept for the staff to read as they come on duty.
Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 12 A separate record is kept of any communication or visits by health professionals. During the inspection staff were observed to protect the privacy and dignity of service users and those spoken with confirmed that they are treated well by the staff and had no complaints. Appropriate medication policies and procedures are in place for the storage, handling and administration of Medicines as well as Controlled Drugs. According to the acting manager, there has been a change of pharmacist and this has been causing some problems that are being addressed. All staff are trained with regard to the provision of medication. Senior staff at the home oversees the provision of medication and undertake regular checks that the recording of medication provided is correct. Oakendale House DS0000066053.V298478.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality in this outcome group was good. This judgement has been made using available evidence including a visit to this service. The home provides activities that meet the expectations and capabilities of the service users and visitors to the home are made to feel welcome at all times. A varied menu is planned and provided that provides service users with nourishing meals according to their wishes. EVIDENCE: Service users spoken to confirmed that a flexible approach is taken with regard to daily living and activities. Meals can be taken at different times and in service users own rooms if preferred. A number of service users are fairly independent and able go out of the home on their own. Service users’ interests are recorded at the initial assessment and consideration is given to the capabilities of the individual concerned. A local priest visits the home on a weekly basis and a vicar on an occasional basis. A hairdresser visits the home once a week and there is a hair and beauty day 3 times a month. Bingo takes place on a Sunday and Tai Chi twice a month for an hour. A crafts lady is to be re-introduced and a singing duo have visited the home. According to the acting manager, a mini bus is to be purchased and there are plans to visit the illuminations and have a fish and chip supper on the way back.
Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 14 A varied menu is planned and provided that provides service users with nourishing meals according to their wishes. The cook indicated that there are no restrictions on the budget and that an additional cook was due to commence who would cover for her when she was not around. Services users spoken with confirmed that they are able to receive visitors at any reasonable time and in private. Service users are encouraged to handle their own financial affairs for as long as possible. Information about the advocacy service is available as necessary. Oakendale House DS0000066053.V298478.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome group was adequate. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to ensure that service users are protected from abuse. Evidence needs to be provided to show that staff are familiar with the policy and procedure to follow in the event of any abuse. EVIDENCE: The home has a complaints procedure, which contains all necessary information. The home has not received any complaints and neither has the Commission for Social Care Inspection. The inspector recommended that it was good practice to record minor niggles and concerns as some of the service users felt that individual concerns were not being dealt with. The home has a copy of the Department of Health Guidance, `No Secrets’ and all staff have been provided with training on Adult Abuse. The acting manager has also received training on recognising Adult Abuse but was unfamiliar with the procedure to follow in the event of any abuse. The home has a policy and procedure on what to do in the event of abuse and this policy (drawn up by the previous owner of the home) needs to be made familiar to all staff along with ‘whistle blowing’. Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 16 Any new staff at the home that have not received training in how to recognise abuse must be provided with training as well as the procedure to follow in the event of any abuse. Any valuables belonging to service users are kept secure and staff are not allowed to be involved in the assisting or benefiting from service users’ wills. Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The quality in this outcome group was good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable safe environment that meets the needs of the service users. EVIDENCE: The accommodation is not purpose built and any environmental risk is considered at the initial assessment for each service user. Service users who are physically more active are offered accommodation that is suitable for their capabilities. The garden is accessible to all service users via a ramp. The building complies with the requirements of the local fire service and environmental health department. There is a need to ensure that a record is kept of any required maintenance of the home. A member of staff needs to be identified who will ensure that regular checks are carried out inside and outside the home and records the details as well as the date any work is carried out. Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 18 A tour of the home took place and all areas of the home were clean and tidy. There were 2 toilet seats missing at the time of the inspection however this had been reported to the registered owner and they are to be replaced. Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 19 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 The quality in this outcome group was poor. This judgement has been made using available evidence including a visit to this service. Service users are cared for by appropriate staff that have been provided with training that enables them to meet their needs. The recruitment procedures do not protect vulnerable persons and are in need of improvement. EVIDENCE: There are sufficient staff on duty at all times to meet the needs of the current service users. There was written evidence that staff employed have received training that helps them to provide appropriate care. Service users confirmed that they feel well looked after by staff. One service user stated that: “the staff are wonderful”. Records were examined and they showed that new staff have commenced employment prior to clearance by the Criminal Records Bureau or the Protection of Vulnerable Adults Register (POVA). The acting manager was not sure whether a POVA check had been carried out via the Internet and there was no written confirmation as to whether this had been carried out. On one record a note had been made of the date references had been sent for and the date of commencement which was the day after. There were also no references for one of the staff although she had previously been employed on a student placement. The application form has also been heavily photocopied and rather faint in places. Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 20 As well as ensuring that appropriate checks are carried out there is a need to record the progress of each staff application and the date requests for references and checks have been made and the date they have been received as well as the commencement date and induction training. There are 14 care staff and 6 staff have an NVQ qualification, a further 5 staff are to commence NVQ training on the 1st October 2006. Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 21 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): 31, 33, 35, 36 & 38 The quality in this outcome group was adequate. This judgement has been made using available evidence including a visit to this service. The management of the home requires some improvement in order to ensure that staff are led effectively and that the homes policies and procedures are carried out. Appropriate records are kept with regard to the service users. EVIDENCE: The previous registered provider/owner of the home was heavily involved in the management of the home and the current registered manager is only part time. At registration of the new provider/owner, one of the conditions was that an additional manager must be employed to ensure full time management of the home. A new manager has recently been appointed and now requires registration with the Commission. Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 22 Staff confirmed that the new registered provider is approachable and has visited the home on a regular basis. There is a need to establish the responsibilities of each manager and for both managers to ensure they are familiar with the Care Homes Regulations and the legal responsibilities of meeting the standards. As the registered provider is not in day-to-day control of the home there is a need to carry out monthly visits and write a report on the conduct of the home under regulation 26 of the Care Homes Regulations. A copy of this report must be provided to the Commission and to the managers of the home. A report must also be sent to the Commission if there are any incidents as listed under Regulation 37 of the Care Homes Regulations; for example, the death of a service user. The service users have been unsettled by the change of ownership but have been helped through the change by the dedication and continuity of the staff. The manager was unaware of any formal quality assurance systems now in place although questionnaires have been provided to service users in the past. There was no evidence that staff have received individual one to one supervision since the change of ownership and there is a need to establish who will be supervising and how frequently. Staff meetings have been taking place. A record is kept of any financial transactions on behalf of service users. Health and safety policies and procedures are in place and risk assessments are carried out for each individual service user. As in Standard 18 all staff need to familiarise themselves with the reporting procedures connected with any incident of Adult Abuse. Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 23 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 3 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 3 2 Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 24 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. 1 2 Standard OP7 OP29 Regulation 15 19 Requirement The care plans must be reviewed at least once a month Appropriate references and checks must be undertaken before staff are employed at the home including clearance by the Criminal Records Bureau (CRB) and POVA The additional manager must apply to be registered with the Commission for Social Care Inspection (CSCI). A formal system of quality assurance must be adopted to monitor the quality of care provided. The registered provider must conduct a monthly visit to the home and supply the CSCI with a copy of the report. The registered provider must give notice to CSCI of any death, illness, outbreak of disease or any other significant event Timescale for action 30/09/06 08/09/06 3 OP31 9 30/09/06 4 OP33 24 30/09/06 5 OP31 26 30/09/06 6 OP31 37 30/09/06 Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 25 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 OP1 Good Practice Recommendations The Statement of Purpose requires some expansion as listed in schedule 1 of the Care Homes Regulations and should be made available to service users, staff and any visitors to the home. The care plans should show evidence that the service user or their representative have been involved in the process and at any subsequent review. All staff require training in how to recognise Adult Abuse and what to do in the event of any Abuse occurring. A programme of routine maintenance should be recorded. NVQ training of staff should continue. The 2 managers need to identify roles and responsibilities. All staff should be provided with individual supervision at least 6 times a year. 2 3 4 5 6 7 OP7 OP18 OP19 OP28 OP32 OP36 Oakendale House DS0000066053.V298478.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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