Inspection on 11/03/08 for Oakfield

This inspection was carried out on 11th March 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Oakfield 22/08/06

Oakfield 03/05/05

Oakfield 13/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Oakfield 30 Oakfield Road Ashtead Surrey KT21 2RD Lead Inspector Kenneth Dunn Unannounced Inspection 09:30 11 March 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakfield DS0000013342.V357738.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. Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakfield Address 30 Oakfield Road Ashtead Surrey KT21 2RD 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) 01372 272540 020 86427729 trilodge@hotmail.com Trilodge Limited Mr C Aristidou Care Home 24 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (24), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (24) Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The service may accommodate five (5) named service users below the age of sixty (60) years within the category Mental Disorder (MD). One named service user may be accommodated under sixty five (65) years of age under section 37/41 of the Mental Health Act of 1983. The named service user referred to in condition 3 - within the category of Mental Disorder (MD) may be accommodated subject to the following arrangements: (I) There are frequent and regular reviews in conjunction with all significant others and professionals involved in the service users plan of care. (ii) All risk assessments relating to the service user must be reviewed regularly as part of the review process. (iii) The home fire safety risk assessment must be reviewed to incorporate the associated risk in respect of the service user. 22nd August 2006 Date of last inspection Brief Description of the Service: Oakfield is a care home that provides nursing care for 24 people with mental disorder. It is located in a residential area close to the village of Ashtead in Surrey. The home can accommodate twenty four service users both male and female. The accommodation is on three floors, which can be accessed via a lift and comprises of two communal lounges, bathrooms and shower rooms, a kitchen, a laundry, a designated smoking area, an office and a staff room. There is a well maintained back garden with mature trees and a large raised patio area. Private parking is available. Current fees range from £650. To £700.00 Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced ‘Key Inspection’. For the purpose of the report the individuals using the service prefer to be addressed as residents. The inspector arrived at the service at 09.30 and was in the home for four hours. It was a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that the Commission for Social Care Inspection has received about the service since the last inspection. The home had supplied the Commission for Social Care Inspection with a documented Annual Quality Assurance Assessement (AQAA) some detail of which has been included within the report. During the course of the day the inspector met with the residents. A number of residents living at the home have communication difficulties, so observing their facial expressions, using sign and body language, listening and observing the residents and staff interactions assessed their responses. Additional information was also sought in the form of surveys form the residents and a random selection of their families and next of kin. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, medication procedures, staff files, a variety of training records, health and safety records, and several of the homes policies and procedures. The commission noted that requirements made during the previous inspection on the 22nd of August 2006 had been complied with. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of clients who have diverse religious, racial or cultural needs. Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 were assessed during this visit. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The homes admission and assessment procedures ensure that the needs of the people who use the service are appropriately identified and met. EVIDENCE: The home has a robust system in place to ensure that in the event of a vacancy at the home any person being considered for the place will have a full needs assessment and an evaluation of their needs prior to being offered the place. The manager stated that there has been one new admission to the home since the previous inspection by the Commission for Social Care Inspection 22/08/06. A random review of the residents files including the most recent admission provided evidence that assessment are conducted, they were in depth and provided full details of the person and their needs. Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 9 No intermediate care is offered by the home. Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 10 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): Standards 7, 8, 9 and 10 were assessed during this visit. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The people who use the service are assured that their health care and personal support requirements are going to be offered and met by the home. Care is offered in a way that protects the individual’s privacy and promotes their dignity. Medication procedures and practices are robust. EVIDENCE: The care plans had been developed from the pre assessment documentation and included the resident’s care and support needs. The care plans sampled were well written to allow the reader to gain a good overview of the residents medical, social and personal care needs including the complexities of their mental health needs and behavioural issues. Due to the complex mental health needs of the residents the manager stated that care plans are devised with the resident and where appropriate their families involvement is also sought. There is evidence of the care plans being reviewed regularly and changes made to reflect any changes in the resident’s needs or condition. Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 11 The manager stated residents have access to healthcare professionals to meet their needs. The sampled care plans provided evidence that the residents are registered with a local General Practitioner (GP) and the home has extensive input from a psychotherapist to meet the mental health needs of the residents. The home had a set of policies and procedures on safe storage and handling of medications. The manager stated that only the staff who are qualified nurses administered medications to the residents. Medication record sheets were dated and signed by staff and a list of staff specimen signatures was available for information. The controlled drugs register was sampled it was up to date and correct. It is recommended that the manager reviews the way in which the medication record sheets are stored, and to introduce dividers with photographs each individual where their section begins. The policy employed by the home is to only have staff dealing with all residents’ medications irrespective of the ability of the individual. The manager stated that due to the mental health needs of the people who live at the home, “it is essential that the staff undertake this task to ensure that the residents are safeguarded from mishandling their medications”. It is recommended that the manager conducts risk assessments and develops an agreement with the residents to agree with this practice to ensure that there is sufficient documentation to support this practices. The home had a service level agreement with a local chemist and a contract with an approved company for the disposal of medications. The manager stated in the Annual Quality Assurance Assessment that the home has a policy on privacy and dignity. Observations confirmed staff addressed residents by their preferred names and knocking on doors before entering resident’s bedrooms. One survey returned by a family member of a resident stated “All the nurses without exception are very kind, and never seem to tire of giving the residents encouragement reassurance and most of all they are treated with the greatest of respect”. Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 12 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): Standards 12, 13, 14 and 15 were assessed during this visit. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The people who use the service are able to access a range of lifestyle experiences that meets their expectations and preferences. Visitors are welcomed and encouraged to visit the home whenever they can. Systems are in place to ensure that the residents have opportunities to exercise choice over their lives. Meals at the home offer variety and choice. EVIDENCE: The manager stated in Annual Quality Assurance Assessment that the home had a policy on social contact and activities. The people who use the service are encouraged and supported to exercise choice in relation to leisure, social activities and cultural interests. A sample of individuals files and daily notes evidence that the residents actively participate in activities both within the home and in the wider community. The homes activities co-ordinator has devised an activity programme that encourages interaction between the residents and stimulates them to develop alternative choices. A review of the activities programme reflected reality orientation, music therapy, dance classes, social gatherings and manicure sessions. During the site visit the some of the residents were actively engaged Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 13 in a visual spelling game. One resident commented that the coordinator was “really good and that everybody is helpful’’. The manager stated that the home values equality and diversity and encourage residents to participate in community life. During the site visit some of the residents were seen to be supported by staff to make arrangements to visit Epsom and another was going visiting with friends. A sample of files highlighted the contact the residents have with family and friends both at the home and in the community. The home had a very flexible visitor’s policy to promote links and to reintroduce contact with resident’s relatives and friends. One resident requested that an external padlock be fitted to the bedroom door to ensure that when she was not in the room “her stuff would be safe” however there is no clear guideline on how this arrangement operates and when the request was made. It recommended that the manager conducts a risk assessment and discusses the situation with the residents to develop and agreement with the individual to clearly state that this is her wish. Menus were sampled and seen to be varied, well balanced and choice. One resident stated that “I enjoy the food, it is good home cooking’’. Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 14 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): Standards 16 and 18 were assessed during this visit. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The people who use this service are protected by the homes complaints and safeguarding adults procedures. EVIDENCE: The home has an established complaints procedure. The managers stated that when a complaint is received the home will fully investigate the issue and the records kept by the home evidenced this, unless the complaint deems being escalated to an external authority for safeguarding issues. No complainant has contacted the Commission for Social Care Inspection with information concerning the home or a complaint made about the service since the last inspection. Information received from the random survey would suggest that the majority of residents were confident that the manager or staff would deal with any concerns or complaints they may have. However out of the fourteen survives received from residents four did state that they were not aware of the complaints policy. Records sampled indicated that staff have attended safeguarding vulnerable adults training. Records sampled indicated that Criminal Record Bureaux checks (CRB) and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. The home has a copy of the Surrey County Council Multi-agency Procedures for Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 15 Safeguarding Vulnerable Adults. One safeguarding referral had been have been made since the previous inspection and had been satisfactorily concluded. Oakfield DS0000013342.V357738.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): Standards 19 and 26 were assessed during this visit. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The home provides accommodation that is safe, personalised, homely, hygienic and odour free. EVIDENCE: The location and layout of the home remains suitable for its stated purpose. The home is maintained to a satisfactory standard and is pleasantly decorated and providing a homely environment for residents. The service was undertaking a large extension to the side and rear of the current building, which has caused some inconvenience to the residents. The manager stated that the planned completion for the extension would be June 2008 and it is hoped that the residents will benefit greatly from the additional rooms. In addition the service has also scheduled a new kitchen to be installed and this is again planned to be in place by June 2008. Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 17 Residents spoken with said that they liked their bedrooms, some of which were viewed during the tour of the premises they were clean and personalised. The communal areas of the home were bright, spacious and comfortable offering a homely environment. The home has an infection control policy in place and staff are trained in infection control procedures and were observed adhering to infection control measures for example wearing protective clothing, washing their hands to prevent the spread of infection in the home. There is a daily cleaning schedule in place and the home was clean and odour free throughout. One survey returned from a relative commented that “the standard of cleanliness and hygiene was always good” and “They provide a good homely environment for the residents”. Oakfield DS0000013342.V357738.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): Standards 27, 28, 29 and 30 were assessed during this visit. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The staffing levels of the home were considered adequate to meet the current needs of residents. The residents are protected by the homes recruitment policies and procedures. EVIDENCE: The home had a relaxed atmosphere and staff were observed to undertake their tasks in a professional manner. The inspector observed staff interactions with residents all of which were supportive and friendly and they were afforded the utmost dignity when being assisted. The returned surveys from the residents and their family members expressed comments about the staff and the support they offer. “the staff were always supportive and kind”, “they looks after my brother very well”, “The staff are excellent and are kind and friendly to residents and visitors”. The staffing levels of the home were evidenced and considered adequate to meet the current needs of the residents. The Annual Quality Assurance Assessment states that the service has currently 100 of the staff trained to National Vocational Qualification (NVQ) in Level 2 or above. Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 19 Three staff recruitment files were viewed and it was evidenced that these files contain all items required under the Care Homes Regulations 2001 (as amended 2006). However in all three files gaps were identified in the employment and educational histories of the applicant. The application form was found to be restrictive and did not afford the person completing it enough room to complete a full disclosure of there employment and educational histories. It is recommended that the responsible individual complete an audit of staff files to ensure that any gaps is highlighted, explanations gained and placed on file. In addition it is also recommended that the application form be reviewed to ensure that potential applicant can effectively record all relevant information. In line with a requirement from the previous inspection report (22/08/2006) the service has developed staff training records and it was evident that staff have received mandatory training in safeguarding adults, fire, food handling, food hygiene manual handling, health and safety, first aid and managing medication. Oakfield DS0000013342.V357738.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): Standards 31, 33, 35 and 38 were assessed during this visit. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The management of the home is robust to ensure the safety and wellbeing of residents. Residents are consulted regarding the running of the home and their health and financial interests are safeguarded. EVIDENCE: The registered manager of the home has many years of experience caring for older people and is supporting people with mental health diagnoses. The managers demonstrated a good knowledge of the care home and the support needs of the residents and staff. There were clear lines of management accountability during the day of the inspection and staff demonstrated an understanding of the roles and responsibilities of people employed. All persons spoken with during the Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 21 inspection spoke highly of the abilities and knowlegde of the registered manager and staff morale appeared good. It was evident that the registered manager has a good rapport and knowledge of each of the residents and was seen to listen to the resident’s views and opinions. Residents confirmed that the manager was friendly, approachable and always took concerns or comments about the home seriously. The manager stated the home had a policy on residents money and that each individual had personal accounts at a local post office or bank to safeguard their financial interests and regular auditing of the accounts was undertaken in order to safeguard residents from financial abuse. The inspector sampled finance records and noted it was up to date, correct, signed by two members of staff or by the resident themselves. Records indicated that health and safety checks are maintained, fire safety equipment and records were documented and equipment serviced. The sluice and laundry areas were noted to be clean and tidy. The home had a full environmental inspection completed on the 31st of January 2008, recommending that the service replace the kitchen, which is scheduled for completion June 2008. Oakfield DS0000013342.V357738.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 X 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 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 Oakfield DS0000013342.V357738.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 OP9 Good Practice Recommendations It is recommended that the manager reviews the way in which the medication record sheets are stored, and to introduce dividers with photographs each individual where their section begins. It is recommended that the manager conducts risk assessments and develops an agreement with the residents to agree to allow the service control their medication. It recommended that the manager completes a risk assessment and develops and agreement regarding the external padlock on a bedroom door. It is recommended that the responsible individual complete an audit of staff files to ensure that any gaps in education and employment are highlighted, explanations DS0000013342.V357738.R01.S.doc Version 5.2 Page 24 2. OP9 3. OP14 4. OP29 Oakfield gained and placed on file. 5. OP29 It is recommended that the application form be reviewed and expanded to ensure that potential applicant can effectively record all relevant information on the form. Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oakfield DS0000013342.V357738.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!