Inspection on 30/05/05 for Oakfield

This inspection was carried out on 30th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 11/11/05

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 Announced 30 & 31 May 2005 09:30 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Oakfield Address Weston Park Bath Bath & N E Somerset BA1 4AS 01225 335645 01225 336498 Acegold Ltd ( a wholly owned subsidiary of Four Seasons Health CAre Ltd) Mrs Naomi Elizabeth Drewe Care Home for Older People 28 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of OP Old age 28 registration, with number of places Oakfield Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 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 8-Mar-2005 Announced 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 Bath’s 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over fourteen hours and was carried out following an announced inspection in March 2005 and in response to a complaint by a deceased service users relative about poor quality of care. The inspection also followed up requirements made at the last inspection. As a part of this inspection two immediate requirements were made. In relation to medication left in a resident’s room and ensuring that pudding is covered between transportation from kitchen to the residents. Four other requirements were made in regard to other issues. It was disappointing to note that some of the requirements made at the last inspection had not been met. A cross section of the comments made by service users spoken with during the inspection will be reflected in the body of the report What the service does well: What has improved since the last inspection? The home is making progress in relation to reviewing the care plans for residents. Oakfield Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oakfield Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Oakfield Version 1.10 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 standard(s) 12345 Admissions to the home are well planned providing service users with information to enable them to make an informed choice about moving to the home, however, it does not provide residents with Terms and Conditions of their stay at the home. EVIDENCE: The home has a Statement of Purpose and a Residents’ Guide which describes the services provided at the home. Inspection of two recently admitted residents’ files showed no evidence of Statement of Terms or Conditions of their stay at the home. The Manager produced a letter which is sent to the prospective residents representative before admission. This letter contained information about the fee to be paid and how to claim benefits from the Benefit Agency. The former refers to the self funded residents and the latter refers to the Local Authority funded residents. The letter does not confirm if the home is able to meet their individual needs. Oakfield Version 1.10 Page 9 Six service users care files viewed contained pre-admission documentation. There is individual assessment of nursing and care needs and how these needs are to be met. These included physical, psychological and social needs. One service user spoken with stated that she was encouraged to visit the home before moving in. Oakfield Version 1.10 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 standard(s) 7891011 Whilst the home offers care and support to residents at the end of their life it fails to protect residents in the lack of care plans of health needs and appropriate medications administration. EVIDENCE: Six care plans were reviewed. There was evidence of pre-admission assessment of the service users. The needs identified had individualised care plans on how their needs were being met. However, a recent emergency admission at the home had no activities of daily living assessment and few details were noted on the file. There was evidence of manual handling assessment, pressure sore risk assessment and general risk assessment. There were entries in the daily report that the resident suffered from low mood and urinary incontinence, however, there was no care plan on how the home was meeting these needs. Another service user who suffers from behaviour that challenges and is regularly reviewed by the consultant psychiatrist and community psychiatric nurse had no care plan on how staff were dealing with his/her challenging behaviour and wandering into other residents rooms. Oakfield Version 1.10 Page 11 There were three entries on his/her daily report of ‘shouting all morning’, ‘upset a resident’ by shouting and going into his/her room on 8/4/05. The Manager is required to ensure that care plans are in place for specific residents individual needs and how the identified needs were to be met by staff. The Manager stated that the resident was recently visited by his/her GP and medication is regularly under review. Medication administration was checked and was satisfactory. The stock of medicines held in the home were in date and relevant to the prescriptions. Photographs of residents were noted on the medication administrations sheets for easy identification and prevention of drug errors to the residents. However, one dispensed tablet was noted on a service user’s bedside table. The resident stated that it was not his/her own and that she/he found it there. The Nurse on day shift in charge stated that it may have been dispensed by the night staff and that she would find out from the nurse was on duty the day before. The tablet was safely disposed of. The Manager is required to ensure safe administration of medication to all residents. The home had a medication administration policy. Staff spoken with stated that they are aware of the death and dying policy and procedure and the location of the file. On the day of the inspection, it was noted that one resident refused all food due to mouth ulcers; there was no care plan on how this need was being met. One staff spoken with stated that the “resident does not want to move” and has refused investigations. This was documented in the care file. The resident when visited was on his/her bed with his mouth covered with his/her bed sheet. The resident stated that she/he did not want to eat anything. The care file of another resident who was admitted in April 2005 and sustained an injury on right shin was reviewed. The accident was documented in the accident book. There was a care plan for the injury sustained and interventions to be followed were recorded. The service user was regularly seen by the GP. The subsequent observations of the nursing staff led to the admission of the service user to hospital for a skin graft. There was an ongoing wound assessment and comprehensive daily report on the wound. The service user was due to go to for an Out Patient Appointment (OPA) on the day of the inspection but the ambulance failed to arrive. The healing of the wound is satisfactory. Other care files reviewed for service users with wounds had comprehensive ongoing wound assessments and care plans on how their wounds were treated and the different dressings to be used. There was a risk assessment in place on how to prevent further injuries. There was evidence of regular contact with GPs, District Nurses, chiropodists and dentists. Service users stated that staff treat them with respect. One service user stated, “staff knock on the door before coming into my room”. Oakfield Version 1.10 Page 12 Another service user stated, “staff respect me and help me when I need it”. Residents had private telephones installed in their bedrooms. Oakfield Version 1.10 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12131315 Service users are encouraged to maintain contact with family, friends and Local Community. However, the home fails to provide them with a varied diet and meaningful activities. EVIDENCE: Care files examined contained detailed social assessment forms completed by relatives or residents on admission to enable staff to plan suitable activity for the residents based on the details given. Information on the form includes “likes and dislikes, preferred main meal”. There was no evidence to show how this information was utilised. There was no documented evidence in the files of activities that individual residents have participated in. There was no recorded evidence of planned activities at the home. On the day of the inspection some residents were in the lounge enjoying a sing along with members of a local Church. Residents spoken with stated that they enjoyed the activity. One service user stated that she/he prefers to stay in his/her room and go to the lounge when there is a ‘good thing’ happening. There was a mobile library situated in the main lounge for residents who are able to read. Another service user stated that she/he does not do anything during the day but has a friend who visits every day. Another service user also stated that Oakfield Version 1.10 Page 14 she/he stays in her room, has a few visitors including one special friend who visits her often. The Home Manager is required to arrange a programme of activities for the residents based on individual capabilities. It was agreed that the Manager sends a planned programme of weekly activities to the Commission for Social Care Inspection. Service users spoken with stated that they were able to choose when to get up and when to retire. One service user stated, “I go to bed at 10.30pm, I think the staff are marvellous”. The home had no choice of meal at lunchtime in the present menu except the lunchtime menu on Sunday week 1. On the day of inspection, the menu contained roast chicken, mashed potatoes and cauliflower. Although the residents spoken with said they enjoyed the meal there was no alternative. The food looked nutritious, however, the pudding was noted to be carried uncovered in trays from the kitchen to the bedrooms and lounges. The food was also noted served stacked in trolleys in individual trays. The home needs to consider serving hot meals using the hot trolleys to ensure that residents enjoy their food at a reasonable temperature and ensure dignity in serving the meals. One service user stated “often the food is cold before it is served because it comes on the tray” and “the cup of tea is usually served with the food and it gets cold before I finish my meal”. One resident stated that ‘food is not as you would expect it to be, sometimes the meat is sausage instead of proper meat’. The home is required to provide varied meals for the residents and ensure they are encouraged to make their preferences in the menu. The kitchen assistant spoken with stated that fruits are offered to residents at coffee time. The kitchen was found to be clean. The temperature of fridge and freezer was regularly recorded. The temperature of the food was also recorded. There was a cleaning schedule for the kitchen and food noted in the fridge was labelled. Oakfield Version 1.10 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 161718 The home enables service users and their relatives to complain, however, it fails to protect the service users through its practices. EVIDENCE: The complaint book was viewed and there was evidence of receipt of a complaint, however, there was no evidence of how the complaint was resolved and if the complainant was satisfied with the outcome of the complaint. The Commission for Social Care Inspection received a formal complaint from a deceased resident’s relative in regard to poor standards of nursing care at Oakfield. This complaint was investigated by the two inspectors and was all upheld. Separate requirements have been made in relation to the complaints and the home and its providers are required to respond with the actions to be taken within a time scale. The home has complaint procedures displayed and has a policy and procedure on prevention of abuse, however, there was no evidence in relation of training of staff on abuse prevention on the staff training list viewed. Two recently employed domestic staff members files were viewed, one had CRB applied for but no clearance had been received before employment, the other staff member had no CRB disclosure and no application was made before commencement of employment. Both have no training in relation to their role to include Control of Substances Hazardous to Health (COSHH) and Infection Control. The home is required to ensure that satisfactory police checks are carried out before commencement of Oakfield Version 1.10 Page 16 employment with vulnerable adults. The home is further required to ensure that staff are trained in order to protect residents. The home checks the personal identification of Registered Nurses with NMC before commencement of employment and periodically to ensure that residents are adequately protected. One service user spoken with stated that she felt safe at the home. Residents are enabled and supported to exercise their legal rights, one stated that he/she voted at the last election. Some service users spoken with stated that they know how and where to complain. Oakfield Version 1.10 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1920212223242526 The home is a generally well maintained and a suitable environment; however, it fails to maintain general hygiene and cleanliness EVIDENCE: The home was found to be well maintained, has good décor and is comfortably maintained. There is a lift access to the upper floor. The communal areas are comfortably furnished. All the bedrooms viewed were well furnished, personalised items and colour co-ordinated, however, two bedrooms had unpleasant odours, two other rooms were noted to have food particles on the floor and the carpet had stains. The framed pictures on the walls were noted to be dusty. Two domestic staff members spoken with on the day felt that more staff were needed on the domestic section to maintain good cleanliness at the home. Both stated that they started from the basement and work up to the first floor and that may account for the rooms still not cleaned at the time of the visit. A requirement was made in relation to cleanliness of the home Oakfield Version 1.10 Page 18 and offensive odour. The Manager stated that she is making efforts to recruit more domestic staff. The Home has sufficient toilet, washing and bathing facilities to assist staff with personal hygiene of service users. The facilities had grab rails and hoists to assist with service users mobility. Handrails were noted throughout the building to include, the stairs and hallways. Staff were noted assisting a service user to walk with a zimmer frame to access the toilet. The home was found to be airy, well lit and residents were noted relaxing in their own environment. A group of residents were noted participating in a sing a long with members from the visiting local Church. Residents spoken with stated that they felt safe at the home, however one resident with mobility problems had different items in her room to include mobility equipment, partially blocking her exit, this potentially puts the resident at risk of falling and sustaining injuries. A requirement was made to remove the potential hazards from the room identified. The laundry facilities included washing machine with sluicing facilities, two driers, aprons and gloves were noted to assist staff with maintaining infection control. The laundry also had hand washing facilities, however, the floor was found to have some broken areas. A requirement was made to ensure the floor is repaired. The home has an infection control policy. COSHH sheets were noted in the laundry to enable staff to deal with any emergency issues in relation to chemicals used at the home. Oakfield Version 1.10 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 272829 The home ensures adequate numbers and skill mix along with competency, however, the home failed to protect residents in relation to recruitment practices. EVIDENCE: On the day of inspection there were two trained nurses from 8am – 2pm; one trained nurse from 2pm – 8pm; one trained nurse from 8pm – 8am; four care assistants from 8am – 2pm; three care assistants from 2pm – 8pm and two care assistants from 8pm – 8am. Residents spoken with stated that staff attended them when they need assistance. One service user stated that “staff always come if I ring the bell”. The Manager stated that eleven care staff members have completed NVQ2 and two night staff are currently undertaking NVQ2. There is evidence of staff training to include First Aid, Manual Handling, Dementia Awareness and Venepuncture update. The home has a recruitment policy, however it was noted that a recently employed staff member had POVA First clearance but CRB disclosure had not been received. The staff member was not working under supervision. Another staff member had no CRB and no application for CRB had been made. The Home Manager is required to ensure that CRB disclosure must be obtained Oakfield Version 1.10 Page 20 before any staff member commences employment to ensure residents are protected from abuse. The staff members have two satisfactory references. Registered Nurses working at the home had satisfactory checks from the Nursing and Midwifery Council (NMC) for proof of identity. Oakfield Version 1.10 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3132333435363738 The home benefits from good leadership and management; however, its practices do not fully protect the health and safety of residents. EVIDENCE: Naomi Drewe remains the Registered Manager at Oakfield Nursing Home. Mrs Drew is first level registered nurse and has worked at the home for the past eight years. She has attended various training to include Registered Managers Award, Marketing and Budgeting and Parkinsons Disease. Some residents, relatives and staff spoken with made positive comments about the Manager. Oakfield Version 1.10 Page 22 A review of the records for one newly appointed staff working as a domestic has no CRB clearance before commencing employment. A requirement was made for the home to desist employing staff before statutory requirement was obtained. This requirement was made on the last three inspection reports and have not been complied with. The staff member had a POVA First clearance, however, was working unsupervised at the Home. The Home Manager was unable to provide a satisfactory explanation in relations to the new staff member working unsupervised. The Manager stated that the new staff member indicated that he was leaving Oakfield Nursing Home due to a new job offer. There was no evidence of any formal quality assurance systems in operation at Oakfield Nursing Home, however, the Manager produced a comprehensive ‘Care Home Audit’ tool which she intends to use for monitoring all the services provided at the home. The Manager stated that when operational the audit tool would enable the home to identify areas of concern and deal with it promptly and efficiently. The Home is required to develop an audit strategy that takes into account the news of the service user, relatives, visitors and other health professionals. The Home holds two service users’ monies. These were reviewed with the administrator and the Home Manager. The monies were stored in individual wallets and held securely in a safe. The recorded amount of one service user was a few pence more than the amount found in the wallet; also the recorded amount on the other service users sheet was some few pence less than the amount found in the wallet. The administrator stated that the difference in monies may be due to wrong recording. It was agreed that a new system of recording should be put in place to prevent errors in future. All residents records are securely locked to prevent unathorised access. Staff spoken with stated that they have received supervision to review their care practices and any other issues of concern. The Home’s fire log book was well maintained. The Home’s maintenance book was in order. The fire system checks including the fire alarms and call bell systems, smoke detectors and emergency lighting were in date. Staff have attended fire lectures and fire drills at different intervals. Two staff members have not received training on COSHH and Infection Control. These are comprehensive policies and procedures provided by Four Seasons Healthcare to include medication, abuse and complaints. Oakfield Version 1.10 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 1 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 3 3 3 3 2 3 2 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 Standard No 16 17 18 Score 3 3 2 3 3 3 x 2 3 3 2 Oakfield Version 1.10 Page 24 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. 4. 5. Standard 15 9 18 30 19 Regulation 16 13 Schedule 2 18 23 Requirement Ensure that varied meals are provided for the residents. Ensure medication is not left on a residents table unattended Ensure that CRB is obtained before persons are allowed to commence employment. Ensure that staff are trained in relation to their roles Ensure that broken areas on laundry floor are repaired. Timescale for action 31/7/05 30/6/05 31/8/05 31/7/05 31/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Oakfield Version 1.10 Page 25 Commission for Social Care Inspection 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 Version 1.10 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!