Inspection on 11/05/06 for Oakfield

This inspection was carried out on 11th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Oakfield 08/10/07

Oakfield 30/05/07

Oakfield 11/11/05

Oakfield 30/05/05

Oakfield 08/03/05

Oakfield 07/11/04

Oakfield 18/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Oakfield Weston Park Bath Bath & N E Somerset BA1 4AS Lead Inspector Grace Agu Key Unannounced Inspection 11th May 2006 09:00 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 Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Oakfield Address Weston Park Bath Bath & N E Somerset BA1 4AS 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) 01225 335645 01225 336498 Acegold Limited (a wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Naomi Elizabeth Drewe Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate 28 Patients aged 50 years or over Staffing Notice dated 3/12/2001 applies Manager must be a RN on parts 1 or 12 of the NMC register Date of last inspection 11th November 2005 Brief Description of the Service: Oakfield is a converted older property, which provides nursing care for up to 28 people over 50 years of age. Situated a short distance from Baths city centre and all its amenities, Oakfield is located in the leafy, Victorian suburb of Weston Park. The accommodation is provided on three floors, all served by a lift, and comprises both single and double rooms. Fees range from £465-£585 per week. Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place over eight hours and was undertaken to review the care practices to ensure that it is in line with the legislation and that best practice is being followed at the home. It was also undertaken to review the requirements made at the last inspection to ensure that they have been met. As a part of this inspection, four immediate requirements were made in relation to preparing a care plan, ensuring that the cleaning trolley with liquids is not left unattended, obtaining two satisfactory references for a staff member and that all discrepancies noted in relation to medication administration are remedied. A tour of the building was undertaken and a number of records were viewed. Seven residents, four staff members and two relatives were spoken with during the inspection. What the service does well: What has improved since the last inspection? There is an ongoing refurbishment of various areas of the home. The laundry has been relocated to a bigger room and the home is awaiting delivery and installation of new machines. The new laundry has new flooring, which promotes cleanliness and better infection control. The manager’s office had been moved to create a bigger staff room for individuals working at the home. The radiators have been modernised and covered to give adequate protection to the residents. Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 6 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. Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents needs are assessed on admission and theyare informed of the homes ability to meet their needs. EVIDENCE: Inspection of the care record of one recent admission to the home showed that there was a Care Management assessment from the social services which was given to the home on contact to enable the home to deternime it’s ability to meet the residents needs. The relatives of the individual met on the day confirmed that the manager, before admission to the home, assessed the person in hospital. The manager usually confirms in writing the ability of the home to meet the assessed needs to the resident or their representative. A sample of this letter is held at the Commission for Social Care Inspection. Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home assesses the need of the residents before and on admission however, it fails to provide specific care plans to meet the health needs of the residents. EVIDENCE: Five care files were reviewed at this inspection, including one for the most recent admission. One care file was found not to contain risk assessment in relation to frequent accidental skin tears (skin flap) and no care plan on recently diagnosed infection on a chronic wound (MRSA) in accordance with the homes infection control policy. An immediate requirement was made for these to be put in place It was also noted that another resident with a medical condition and who has a high score of pressure area risk assessment had no appropriate specialist nursing equipment to ensure that the need is adequately met. The manager stated at a discussion that the home will ensure that this is done by the following day. This was followed up with a requirement to ensure complaince. The other care plans were relevant to the assessed needs and were backed up Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 10 with a range of assessments (for example nutruitional and manual handling assessments). The daily report seen on the care files were detailed and contained information of care provided. The care files reviewed showed details of doctors, chiropodist, community psychriatrist nurse visits and follow ups. One resident spoken with stated that “my doctor visits regularly and when I need him to come”. Whilst the home had medicines administration policy and procedure and the stock of medicine held at the home was adequate and satisfactory, it was noted that hand written ammendments of five residents medication on to Medication Administration Record Sheet( MARS) had no indication of who had written them. An immediate requiirement was made for these to be corrected in order to protect the residents. Residents spoken with stated that staff respected them and ensured privacy when assisting them with personal care. Staff were observed knocking on the doors and waiting for an answer before entering residents’ rooms. Staff were also noted interacting with residents in a respecful and informal manner. However, several residents were left unsupervised in the dining room whilst waiting for their meal. One resident was noted very agitated and another resident was noted calming the individual down. A requirement was made to ensure that the residents are supervised at all times. The home has a confientiality policy and staff spoken with were aware of the importance of keeping residents information within the home. Staff spoken with were aware of the Death and Dying policy and would ensure that terminally ill resident is treated with care and sensitivity. Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The residents are enabled to maintain links with their families and friends however the home fails to provide them with meaningful activities and varied meals. EVIDENCE: At the last inspection a requirement was made in relation to providing meaningful activities for the residents. it was diappointing to note that this has not been met. Whilst the home had some activities displayed on the notice board at the entrance, these activities happened fortnightly and monthly. There was no activities on the day of inspection, residents were noted sitting in the lounges and some in their bedrooms with little or no stimulation, four comments cards from residents showed that acivities at the home are not sufficient and are not stimulating. One comment card from a relative stated I wish there was more to stimulate the residents eg: activities, talking together, even outings. Another relative met at the home confirmed that the residents would benefit from activities at the home. At a discussion with the manager, the inspector was informed that the home is providing activities for the residents based on the budget allocated by the provider. This is not Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 12 acceptable. Residents must be provided with regular stimulating activities in line wth the legislation. The requirement remains. The manager is reminded that failure to meet this requirement could lead to enforcement action. During the inspection relatives and friends were noted visiting the home. one relative spoken with stated stated that the staff are wlecoming and that they are satisfied with the care provided for their person. The menu was reviewed and it has one choice of meal at lunch time and a limited alternative. However the residents spoken with said that they enjoyed their meal. Staff spoken with stated that residents are provided with the menu the day before to enable them to make a choice of what to have. The kitchen was found unsatisfactory in relation to cleanliness. Whilst the home had a cleaning schedule, this was not consistently followed, Food particles were noted on the the urn and cookers and the floor was unsatisfactorily cleaned, It was also noted that a piece of equipment in the kitchen had rust and need to be repaired or replaced. These were discussed with the chef and the manager and was followed up with a requirment in other to protect the residents. Samples of food prepared at the home were noted in the fridge along with the fridge and freezer temperature recordings. Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to complain and are confident that they will be protected. EVIDENCE: The homes complaint procedure contained relevant information to enable the residents and or their representatives to complain if they were not satisfied with the services provided at the home and to contact the Commission for Social Care inspection should they need guidance or wanted to take a complaint further. The complaint book was checked and it contained a recorded complaint made by a relative of an individual in relation to unsatisfactory care and services whilst the individual was on respite at the home. The copy of this complaint was forwarded to the commission before this inspection. Response from the organisation and action plan to prevent further complaints, sent to the complainant, was noted in the file. The manager stated that the complainant is yet to respond to enable the home to know if the person was satisfied the outcome of the complaint investigation. Residents spoken with stated that they were aware of to whom they should complain to if they had any complaint and that they felt safe at the home. Two relatives visiting the home stated that they were aware of how and whom to complain to, however they had no complaints. Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 14 Review of staff files and interview with two staff members showed that staff have received training on the Protection of Vulnerable Adults from Abuse and have knowledge of how to report incidents of abuse including the procedure to follow. The home has policy on the Protection of Vulnerable Adults from Abuse, a Whistle Blowing policy and the Councils Guidance on reporting incidents of abuse if they occur. The home also verifies the Personal Identification Numbers of registered nurses with The Nursing and Midwifery Council to ensure that the residents are adequately protected. Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 15 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents enjoy a suilable environment, however the home fails to provide them with a hazard free environment and clean room for a resident. EVIDENCE: The home is well laid out and remains accessible and suitable to the current resident group. The home is currently undergoing refurbishment of various areas of the building to include the hallways, the entrance, the lounges and bedrooms. The manager stated that the refurbishment remains ongoing until all the bedrooms are redecorated as they become vacant. The requirement made at the last inspection in relation to the laundry was reviewed. The laundry had been relocated with new flooring and is awaiting installation of new machines. The manager stated that when the new Laundry ifs fully operational the contractor would run workshops to train staff on the procedure including infection control. The manager stated that the old laundry Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 16 area will be converted to kitchen storage and will have a hatch to the kitchen for food delivery to residents. Review of the requirement made at the last inspection in relation to a residents room found with offensive odour showed that the room had been satisfactorily cleaned, however, whilst touring the building, it was noted that another resident’s room was found with an unpleasant smell. The persons relatives met on the day confirmed that the unpleasant smell was noted in the room before the resident moved in and that this had been previously pointed out to the home. A requirement was made for the flooring to be deep cleaned or replaced to ensure that the resident enjoys a comfortable environment. It was disappointing to note that the cleaning trolley with chemicals was noted unattended in the corridor on the first floor. This is hazardous to the residents and must not be allowed to happen. It was difficult to interview the cleaner due to language differences. However the manger stated that the person had attended Control of Substances Hazardous to Health (COSHH) training. A requirement was made to minimise chemical accidents to residents. Other areas of the building were found generally clean, warm, and well lit. Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides sufficient numbers of nursing and care staff; however, it fails to provide adequate numbers of domestic staff and appropriate manual handling training EVIDENCE: Whilst this home had sufficient numbers of nursing and care staff to meet the residents’ needs on the day of inspection, it was disappointing to note that residents were left unsupervised in the dining room. The residents must be supervised at all times to ensure that they are safe, Furthermore it was noted that only one cleaner was on duty for the size and layout of the home. The manager stated at a discussion that two cleaners are usually on duty three days a week and one cleaner two days a week. A requirement was made for the home to ensure that there are sufficient numbers of domestic staff to maintain high standards of cleanliness at the home. Records of the most recently recruited staff were found satisfactory however it was noted that one staff member employed in 2003 had only one satisfactory reference before commencement of employment. The manager was unable to give a satisfactory explanation as to why this happened. The home must not employ staff in the home until two satisfactory references are obtained. A requirement was made to correct this error to ensure that the residents are protected. Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 18 Other staff records viewed contained satisfactory information to include; application forms, proof of identity, two satisfactory references and appropriate disclosures. There was evidence of staff training in the staff records viewed, however two staff members were observed lifting a resident in the dining area in a manner that could potentially cause serious injury to the resident. This practice must stop in other to protect the resident. A requirement was made for staff to receive immediate training updates on manual handling. Two residents spoken with stated that they were treated well and that staff are caring. Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 19 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, 37, 36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents enjoy a well managed home, however the home fails to protect them from fire hazards through the practice of wedging doors openwedged doors. EVIDENCE: The home is managed by a comptent manager who has been at the home for many years. The manager stated that she had not had formal supervision, however, there is considerable support from the organisation whenever it is needed. Residents, relatives and staff spoken with on the day of inspection stated that the manager is approachable and would listen. Two relatives met Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 20 on the day stated that they were regularly consulted on any issues relating to the care of their person. At a discussion to assess how the home monitors the quality of its services, the inspector was told that the home is in the process of developing a food questionaire to enable the residents and or their relatives to comment on the quality of the food provided at the home. There are regular staff meetings, the last registered Nurses meeting was on 26/01/06. There was also a health and safety meeting held on 01/03/06. Records showed that staff are regularly supervised. At the last inspection a requirement was made in relation to wedging open the bedroom doors. This requirement had not been met as noted whilst touring the bulding. This practice puts the residents at risk in the event of fire outbreak. The manager stated that some residents prefer to have their doors wedged open. The home must seek advice from the Fire Brigade to ensure that all persons are protected from fire hazards. The requrement remains. The fire log book was noted to be up to date. Staff have attended fire awareness training and regulare fire drills. Generic risk assessments of different areas of the home were noted in place. Other health and safety checks as well as the maintainace book were up to date. The manitanance person is booked to attend a training update on being a fire marshall. Accident book showed a high recorded number of accidents to two individuals between March and May 2006. One individual had several falls due to wandering. The individual had a care plan in relation to the frequency of the falls and was seen on 11/4/06 by the doctor to review the medication. It was agreed that there must be a risk assessment following the falls and that this must be regularly reviewed. A requirement was made to ensure that this happens in order to protect the residents. Residents monies and records are stored securely in a locked cabinet. Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 21 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 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 2 Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES 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. 2 3 7 Standard OP9 OP12 OP38 Regulation 13 16 13 Requirement All hand written medication on MARS must be signed and dated. Develop a programme of activities that meets the needs of the residents. Ensure that fire doors are not wedged open and ensure that risk assessment is in place and regularly reviewed following each fall. Furthermore cleaning liquids must not be left unattended in any area of the home. Ensure that an identified resident’s room is free from unpleasant odour. Two satisfactory references must be obtained for identified staff. Identified staff must attend manual handling update. Menu with varied choice of meals must be provided for the residents. Identified kitchen equipment must be repaired or replaced. Provide a care plan for identified resident’s specific needs and ensure that residents are appropriately supervised at all times. Furthermore provide DS0000020247.V292063.R01.S.doc Timescale for action 12/05/06 11/06/06 11/05/06 8 5 6 4 7 1 OP24 OP29 OP30 OP15 OP38 OP8 16 Sch2 13(5),18 (1) 16 23 15&12 11/06/06 17/05/06 17/05/06 11/06/06 17/06/06 15/05/06 Oakfield Version 5.1 Page 23 appropriate nursing equipment for identified resident. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Oakfield DS0000020247.V292063.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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 DS0000020247.V292063.R01.S.doc Version 5.1 Page 25 - 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. 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