Inspection on 11/11/05 for Oakfield

This inspection was carried out on 11th November 2005.

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 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 08/10/07

Oakfield 30/05/07

Oakfield 11/05/06

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 Unannounced Inspection 11 November 2005 09:15 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.V261827.R01.S.doc Version 5.0 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.V261827.R01.S.doc Version 5.0 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.V261827.R01.S.doc Version 5.0 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 30th May 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. Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 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, three immediate requirements were made in relation to preparing a care plan, review of risk assessment and ensuring that an identified residents’ room are kept clean at all times. A tour of the building was undertaken and a number of records were viewed. Six residents, three staff members and two relatives were spoken with during the inspection. What the service does well: What has improved since the last inspection? What they could do better: At the last inspection a requirement was made in relation to providing the residents with a programme of stimulating activities. It was disappointing to note that the Home has failed to meet the requirement. The Manager must Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 Page 6 address this concern to enable that the residents to feel a part of the Home and the Community in general. The requirement remains in place. A resident would be better cared for if care plans are drawn up for specific needs. A resident would enjoy a better hygienic and odour free environment if the room is kept clean at all times. To prevent serious injury to a resident it would be better to renew the risk assessment following each fall. Residents would be better protected from fire hazards if the fire doors were not wedged Residents would be better protected if staff receive training on Protection of Vulnerable Adults and call bells are put within easy reach of all residents. 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.V261827.R01.S.doc Version 5.0 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.V261827.R01.S.doc Version 5.0 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): 1,2,3,4,5 The Home provides information to prospective residents and their representatives and ensures that the admissions process provides safeguards to meet the assessed needs of residents. EVIDENCE: The Home’s Statement of Purpose and Service User’s Guide contain required information required by the regulations. The Service User’s Guide is given to prospective residents to enable them to make an informed choice about moving into the Home. Reviewing the care files of two recently admitted residents showed that the residents were assessed before admission to ensure that their needs would be met. Two relatives met on the day confirmed that their relatives were assessed by the Manager before they were admitted. Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 Page 9 The Manager is aware that residents must receive confirmation in writing that the Home is able to meet the residents’ needs. Terms and Conditions in relation to the resident’s stay at the Home is usually given to the relative of the resident to sign and return to the Home. Residents who are able to read and sign their Terms and Conditions are enabled to do so. Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Whilst the Home offers care and support to residents including at the end of their life, it has not provided care plans on how to meet the health care needs of some identified residents. EVIDENCE: At this inspection three care files were reviewed. Evidence showed that two recently admitted residents had pre-admission assessments. Most of the identified needs on admission had individualised care plans, which described how these needs are to be met, and the care plans were regularly reviewed. Evidence from the daily report confirmed detailed entries of how the home w However, one of the recently admitted residents with communication problems had no care plan on how staff were to communicate effectively with him/her to enable them to meet his/her needs adequately. There was an entry on 16th November 2005, which stated “not able to understand what he/she wanted”. Furthermore, it was noted that the resident had a fall on 1st November 2005; Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 Page 11 however, there was no review of the risk assessment following the fall. It was also noted that the resident “wandered down stairs” on 2nd November 2005 at 21:50 and previously 29th October 2005. The home must ensure that risk assessments are reviewed regularly and care plans provided to ensure that the identified resident is protected from potential serious injuries. In addition, it was noted that another resident admitted earlier in the year who had falls on 27th September 2005, 28th September 2005 and 29th September 2005 had not had a risk assessment review. However there were detailed entries by the night staff of actions taken to ensure his/her safety. An immediate requirement was made in relation to the above concerns. Residents interviewed confirmed that staff provide them with privacy whilst assisting them with personal care. One resident stated that “staff respect me”. Another resident’s relatives stated that they were satisfied with the care given to their person. Staff were noted knocking at the residents’ doors and waiting for an answer before going in to answer the call bell or providing the resident with personal care. One resident who was seen at the last inspection and was visited at this inspection, looked very well cared for. The resident stated that he/she feels well and is now very settled. There was evidence of visits from the Doctor and other health professionals on the care files reviewed. Staff interviewed demonstrated knowledge in relation to death and dying of residents and also the importance of keeping information about residents confidential. The Home has a Death and Dying and Confidentiality Policy. Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The Home enables the resident to maintain contact with families, friends and the Local Community; it also ensures that choice is provided to residents in respect of meals and meal times. However, there is insufficient time spent on social and therapeutic activities provided to meet the residents needs. EVIDENCE: Residents and relatives interviewed on the day confirmed that the Home actively support the resident to maintain contact with families, friends and relatives. Two relatives met on the day stated that there is no restrictions at the Home and that they visit their relative regularly. One resident stated that she has friends that visit daily. Another resident stated that his son visits daily. Residents spoken with stated that they have a choice of when to get up and retire. One resident stated “I have a choice to stay in bed if I feel like it, staff don’t mind”. Whilst walking around the Home, it was noted that most of the residents sat in their rooms with little or no stimulation. Some residents were noted in the Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 Page 13 lounges listening to soft music all through the inspection. At a discussion with the manager in relation to residents’ daily activities, she stated that there is a church service alternate Wednesdays, music and exercise alternate Thursdays and that an occupational therapist visits the Home monthly to see the residents individually. The Manager must ensure that a programme of meaningful activities is in place routinely to meet the residents’ needs. The menu on the day of inspection contained two options and was noted to be nutritious. Residents spoken with stated that they like the meal. Two residents made remarks in relation to food being cold and “lumpy porridge”, this was discussed with the Manager; she would ensure that these concerns are addressed. The kitchen was inspected and the floor requires cleaning, the agency cook met on the day stated that the kitchen is generally cleaned after cooking, however, was unsure of where the cleaning schedule is kept. The Home also employs a kitchen assistant seen assisting with residents’ meals. Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Residents are supported to exercise their legal rights and are confident that the will listen to their complaints, however, the Home fails to protect them through insufficient training on Protection of Vulnerable Adults. EVIDENCE: The Home has a complaints procedure, which is displayed, at the Home to enable residents and relatives to make a complaint if they are not satisfied with the services provided. The complaints procedure contained required information to include details of the Commission for Social Care Inspection. The complaint book viewed had one complaint from a relative regarding damaged clothing washed without an appropriate washing machine programme. Evidence of how it was satisfactorily resolved was seen recorded. Two relatives met on the day stated that they would complain to the Manager however, they were aware of the complaints procedure. Residents spoken with confirmed that they are enabled to complain and would complain to the Manager if they were not satisfied with any area of the service. Policies and procedures in relation to Protection of Vulnerable Adults from Abuse was noted at the Home, however, two overseas nurses who had recently completed their Adaptation training were unaware of the policies and procedures in relation to Protection of Vulnerable Adults and have not attended Abuse training. It was also noted from staff files that some other staff Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 Page 15 members have not attended Abuse training. At a discussion with the Manager, she stated she would ensure that all staff attend Abuse training in the next three months. A requirement was made to ensure that staff receive this training for the protection of residents. Two files of recently recruited staff members contained Criminal Records Bureau (CRB) checks, two references and other required information to ensure that residents are adequately protected. The home also checks the Personal Identification Numbers of all registered nurses with the Nursing and Midwifery Council (NMC) before commencement of employment and periodically. One resident spoken with stated he is aware of his voting rights and would normally use postal votes. Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20, 24,26. The residents enjoy a pleasant, homely environment, however, it fails to provide identified residents with a clean and hygienic room. EVIDENCE: No changes had occurred in relation to the home’s suitability to its stated purpose. Whilst touring round the home, some residents were noted sitting in the communal areas and some in their bedrooms. Residents spoken with stated that they were satisfied with the home. The home was found generally clean, warm and tidy and domestic staff were noted performing their duty, it was noted that one resident’s room was found unclean and another bedroom was noted with unpleasant odour. The manager stated that the broken laundry floor identified at the last inspection would be included in the home’s refurbishment programme scheduled for February 2006. The requirement remains. This will be reviewed at the next inspection. Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 Page 17 Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The recruitment procedure of the home offers protection to the residents at the home. There are adequate numbers of staff that are competent to meet the needs of the residents. EVIDENCE: Review of the staff rota on the day of inspection showed that adequate numbers of staff were on duty to meet the needs of the residents. Residents spoken with stated that staff are good and kind, and would assist them when they wanted help, however, one resident stated that sometimes staff may take time to answer the call bell. The home has a robust recruitment policy. The review of two recently appointed staff members showed that required information was obtained before the staff members commenced employment to ensure that residents were adequately protected. Staff interviewed demonstrated knowledge and understanding of their roles and responsibility in relation to the needs of the residents. Whilst reviewing staff training, it was noted that the home employs a nurse trained outside the United Kingdom and undertaking adaptation programme to enable her to be registered with the Nursing and Midwifery Council. The records showed that the home supported her with a detailed induction Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 Page 19 programme that offers some protection to the residents. During an interview with the nurse and her colleague the nurse stated that the induction programme enabled her to learn about the needs of residents in a different environment and setting. The nurse and her colleague, however, demonstrated lack of knowledge in relation to policies and procedures for the protection of vulnerable adults. Both nurses stated that that they have not attended training on Protection of Vulnerable Adults. A requirement was made for the home to provide these nurses with the above training to ensure that residents are adequately protected. Also see Standard 18. The manager stated that six staff members have completed the National Vocational Qualification (NVQ) at level 2 and 3 and two staff members have almost completed NVQ at level 2 and one staff member is to commence NVQ at level 3 shortly. This would enable the home to work towards achieving the required Minimum ratio of 50 trained members of care staff (NVQ level 2) by 2005. It was agreed that the manager forward evidence of staff supervision and a staff training matrix to The Commission for Social Care inspection to ensure that all staff have received relevant and appropriate training. This information was not received before this report was completed. Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,38. A competent manager runs the home, however the health and safety of residents is only partly protected. EVIDENCE: Mrs Naomi Drewe remains the Registered Manager of Oakfield Nursing Home. Mrs Drewe has recently attended various courses to enable her to be up to date with the current practice and issues regarding managing a home and to support her staff to provide better care for the residents. Training updates attended include Venepuncture, Computer training and Colostomy update. Residents spoken with stated that ‘Naomi’ is a good manager; she is approachable and would listen to their concerns. Documentation in relation to health and safety procedures were noted to be in date, however, whilst touring the building, it was noted that some Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 Page 21 fire doors were wedged open. This is hazardous and puts the residents at risk in the event of fire emergency. It was also noted that some residents’ call bells were not within easy reach of the resident to summon help in an emergency. These concerns were discussed with the manager and immediate requirements were made to ensure that residents are protected from potential harm. The manager stated that the records of residents personal allowance are kept at the home and that receipts are obtained and retained for each item purchased. Evidence showed that this and other confidential information were satisfactorily locked away. Review of the accident book showed a high accident rate at the home however the manager is aware of the rate through the monthly accident audit and stated that measures will be put in place to reduce the rate to protect and prevent residents from injuries. Whilst it was noted that staff are receiving supervision, it was agreed that this needs to happen more regularly to ensure that they are aware of the needs of the residents. The manager stated that the home is making efforts to ensure that adequate time is allocated for regular staff supervision. The methods used by the home to review the quality of its service were reviewed. It was noted that the last home audit by the manager was in March 2005. However the manager stated that the she sees the relatives every fortnight to listen to any concern or feed back and that she is also keeps in touch with two residents solicitors. It was agreed that the home consults with residents as far as is reasonably practicable to ensure that their views are considered and improvement made in the area with unsatisfactory feedback. Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X X X 2 X X STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 2 Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? 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. 3. Standard OP8 OP24 OP38 Regulation 15 16 13 Requirement Provide a care plan for identified resident’s specific needs. Ensure that an identified resident’s room is free from unpleasant odour. Review a residents risk assessment following each fall and ensure that call bells are within easy reach of residents. Ensure that fire doors are not wedged open. Ensure that the laundry floor is repaired. Develop a programme of activities that meets the needs of the residents. Ensure that staff attend training on Protection of Vulnerable Adults. Timescale for action 18/11/05 18/11/05 18/11/05 4. 5. 6. 7. OP38 OP26 OP12 OP30 13 23 16 18 11/12/05 01/04/06 31/01/06 11/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Oakfield Refer to Good Practice Recommendation DS0000020247.V261827.R01.S.doc Version 5.0 Page 24 Standard Oakfield DS0000020247.V261827.R01.S.doc Version 5.0 Page 25 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.V261827.R01.S.doc Version 5.0 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!